GYN Path - Fung Flashcards
1
Q
most disorders of the vulva are inflammatory and similar to skin path, such as what three things?
A
conact dermatitis
eczematous dermatitis
infectious
2
Q
what are the three M’s used to describe HSV infections histologically?
A
molding
margination
multinucleation
3
Q
Lichen sclerosis is characterized by thinning of the (blank) and sclerosis of the (blank) of the vulva
A
thinning of the epidermis
sclerosis of the dermis
4
Q
Describe the general appearance grossly of lichen sclerosis?
A
leukoplakia with parchment-like vulvar skin
5
Q
t/f: leukoplakia can be neoplastic or non-neoplastic
A
true
6
Q
what is the only way to tell if leukoplakia is neoplastic?
A
biopsy
7
Q
is lichen sclerosis benign/
A
yes, but has a slight chance of going to squamous cell carcinoma
8
Q
in lichen simplex chronicus, you get hyperplasia of what cell type and hyperkeratosis
A
hyperplasia of the squamous cell epithelium
9
Q
describe the gross appearance of lichen simplex chronicus/
A
white patch over thick, leathery skin
10
Q
Lichen simplex chronicus is associated with what behavior?
A
chronic itching and scratching; pruritis
11
Q
Condyloma is most commonly due to what two strains of HPV?
A
6 and 11
12
Q
HPV-associated condylomas have what HPV hallmark histologically?
A
koilocytic changes (raisin-like nucleus)
13
Q
t/f: condylomas often progress to carcinoma
A
false; rarely; low risk strains of HPV
14
Q
vulvar intraepithelial neoplasa (VIN) is ascc’d with what strains of HPV
A
16
18
31
33
15
Q
How does VIN initially present?
A
also as leukoplakia; need biopsy to distinguish from lichen sclerosis
16
Q
t/f: non-HPV etiology of VIN is long standing lichen sclerosis
A
true
17
Q
describe the grading system for VIN
A
I: less than 1/3 of the thickness of the epi
II: less than 2/3 of the epi
III: almost all of the epi
Carcinoma in situ: entire thickness of the epi
18
Q
What causes “orange skinning” of the breast?
A
Paget’s dz of the breast
19
Q
What is the underyling cause of the orange skinning in Paget’s dz of the breast?
A
carcinoma
20
Q
Is there underlying carcinoma in Paget’s of the vulva?
A
nope!
it is carcinoma in situ with no underlying carcinoma
21
Q
From what type of cancer must you distinguish Paget’s of the vulva?
A
melanoma
22
Q
describe the physical findings that suggest melanoma and not Paget’s vulva
A
superficial spreading
not as cohesive of a lesion
produces pigment
23
Q
Describe the following markers for Paget cells:
PAS
Keratin
S100
A
PAS +
Keratin +
S100 -
24
Q
Describe the folloing markers for melanoma:
PAS
Keratin
S100
A
PAS -
Keratin -
S100 +
25
which biomarker stains for mucin?
PAS
26
Histologically, how do the malignant cells in Paget's vulva stand out to you?
They are large with cleared out cytoplasm
27
Clear cell adenocarcinoma is a complication of use of what drug?
DES; use was stopped in the 70's
28
What type of cell lines the vagina?
non keratinized squamous epithelium
29
At what point in the female tract do you get glandular epithelium?
endocervical canal
30
what was the complication of the female fetuses whose mothers were given DES?
Adenosis; persistence of columnar epithelium in the upper vagina
31
Adenosis has an increased risk of developing what type of cancer?
Clear cell adenocarcinoma
32
What part of the cervix does HPV like to infect?
transformation zone where the squamous of the ectocervix meets the columnar of the endocervix
33
Why does the glandular epithelium undergo metaplasia in the transformation zone?
the pH of the vagina is acidic an the glandular epi is not hardy, so it mutates
34
what type of virus is HPV?
dsDNA
35
>80% of carcinomas are caused by what type of HPV?
16
36
Type 18 HPV is known to cause what type of cancer?
adenocarcinoma
37
which HPV gene inhibits p53?
E6
38
which HPV gene inhibits Rb?
E7
39
which two HPV genes are the most important in carcinogenesis?
E6 and E7
40
What gene in HPV controls maintanence and replication of the viral genome?
E1
41
What gene in HPV controls transformation?
E5
42
What gene in HPV controls DNA binding proteins that regulate viral replication?
E2
43
What gene in HPV controls binding and disrupts cytokeratin?
E4
44
What gene in HPV controls the major capsid protein?
L1
45
What gene in HPV controls the minor capsid protein?
L2
46
Describe the difference in DNA rep between high risk and low risk HPV
high risk: DNA integrates into host DNA
| low risk: replication in the cytoplasm
47
What is the hallmark of the changes to cell shape and size that indicate dysplasia?
high nucleus to cytoplasm (N:C) ratio
| hyperchromaticity
48
What percent of low grade squamous intraepithelial lesions (LSIL) regress?
60%
49
Of the cases of LSIL that progress, what do they progress to?
HSIL
50
Of the cases of HSIL (high grade squamous intraepithelial lesion), what percent PERSIST?
60%
51
Of the cases of HSIL that progress, what do they progress to?
carcinoma
52
should we screen younger than 21 for cervical cancer?
no
53
How often should we screen 21-29 year olds for cervical cancer?
cytology alone every 3 years
54
How often should we screen 30-65 year olds for cervical cancer?
HPV and cytology cotesting every 5 years
55
How often do we screen >65 year olds for cervical cancer?
we don't if there is adequate negative prior screening
56
which HPV vaccine is given to males and females? What strains does it cover?
Gardasil
| 6, 11, 16, 18
57
Which HPV vaccine is given to females only? what strains does it cover?
Cervarix
| 16 and 18
58
what hormone does the corpus luteum produce?
progesterone
59
the prolierative phase of the endometrium is driven by...
estrogen
60
the secretory phase of the endometrium is driven by....
progesterone
61
Shedding (bleeding) ocurrs with the loss of what hormone?
progesterone
62
acute endometritis is due to what?
bacterial infection or retained products of conception
63
how does acute endometritis usually present?
fever, abnl uterine bleeding, pelvic pain
64
what types of cells are seen in the infiltrate in chronic endometritis?
plasma cells and lymphocytes
65
what cell MUST be seen in the infiltrate to make the Dx of chronic endometritis?
plasma cells
66
What are some of the causes of chronic endometritis?
1. retained products of conception
2. chronic PID d/t chlamydia
3. IUD
4. TB; WILL SEE GRANULOMAS on histo
67
What is endometriosis?
endometrial glands and stroma outside of the uterine lining
68
What are the theories of the development of endometriosis?
1. lymphatic dissemination
2. venous dissemination
3. retrograde menstruation with implantation at an ectopic site
69
what is the most common site for endometriosis? how does this present?
Ovary; chocolate cyst
70
Endometriosis in the fallopian tube increases the risk for...
ectopic pregnancy
71
Involvement of the uterine myometrium in endometriosis is known as...
adenomyosis
72
What are some causes of abnormal bleeding from the uterus?
anovulatory cycles
polyps
hyperplasia
carcinoma
73
what is an anovulatory cycle?
Estrogen-estrogen cycles without the progesterone phase; so you get uterine bleeding
74
Endometrial hyperplasia results as a consequence to unapposed....
estrogen
75
what drug is a risk factor for developing endometrial polyps?
tamoxifen
76
How does endometrial hyperplasia usually present?
post menopausal uterine bleeding
77
What are the histologic changes seen in simple endometrial hyperplasia?
cystic dilations
| corkscrewing of the glands
78
What is the most important predictor of whether endometrial hyperplasia progresses to carcinoma?
presence of cellular atypia
79
what are the histologic changes seen in complex endometrial hyperplasia?
increased spacing of endometrial glands
cystic dilations
cellular crowding
80
What are the histologic changes seen in complex endometrial hyperplasia WITH cellular atypia?
not stratified
| no stroma between glands
81
what two mutation are implicated in endometrIOID carcinoma?
PTEN and DNA mismatch repair
82
What is the classic patient who has endometrioid carcinoma?
obese female with PCOS
83
what system is used to grade endometrioid carcinoma?
FIGO
84
t/f: serous hyperplasia of the endometrium is a result of hyperplasia
false; unrelated
85
Where in the female tract does serous carcinoma occur?
fallopian tube and ovary
86
what gene mutatoin is implicated in serous carcinoma?
p53
87
what is the fancy name for uterine fibroids?
leiomyoma
88
what tissue makes up leiomyoma?
smooth muscle; its from the myometrium!
89
leiomyoma presents with (single/multiple) lesions
multiple
90
what does leiomyoma look like grossly?
multiple white whorled masses
91
leiomyoma is related to (blank) exposure
estrogen
92
leiomyosarcoma presents as (single/multiple) lesions
single lesions
93
Gross exam of leiomyosarcoma shows what?
necrosis and hemorrhage
94
What are the histologic features of leiomyosarcoma?
necrosis, mitotic activity, and cellular atypia, hyperchromasia
95
t/f: leiomyoma can progress to leiomyosarcoma
FALSE
96
what race has a predisposition to leiomyoma?
blacks
97
where does fertilization occur?
fallopian toob
98
What are three causes of salpingitis
chlamydia
gonorrhea
PID
99
Recurrent episodes of salpingitis can lead to (blank) as a result of scar tissue build
infertility
100
what is the most common cause of salpingitis?
gonorrhea
101
what is the major risk factor for ectopic pregnancy?
scarring of the fallopian tube 2ry to PID or endometriosis
102
what is the most common location for ectopic pregnancy?
lumen of the fallopian tube
103
what are the three tissues from which ovarian tumors may arise?
surface epithelium
germ cells
sex cord stroma
104
what is the most common ovarian tissue that forms tumors?
surface (germinal) epithelium
105
what are the two subtypes of surface epithelial ovarian tumors?
mucinous and serous
106
surface epi ovarian tumors are usually (blank) grossly
cystic
107
what are the three levels of malignancy that mucinous, serous, and endometrioid tumors may all show?
adenoma (benign), borderline, or carcinoma (malignant)
108
Describe the histology of cystadenomas?
SINGLE cyst with simple, flat lining
109
Describe the histology of cystadenocarcinomas?
COMPLEX cysts with thick, shaggy lining
110
Describe the malignant potential and histology of borderline tumors?
features inbetween the benign and malignant but still carry malignant potential
111
are endometrioid tumors usually benign or malignant?
malignant
112
what cells are endometrioid tumors made of/
endometrial like glands; usu arise from endometriosis
113
what type of tumor are composed of urothelium and are benign?
Brenner tumors
114
BRCA1 mutations carry an increased risk for what type of female tract cancer?
serous carcinoma of the ovary and fallopian tube
115
what cell type of ovarian tumors affects women 0-25?
germ cell
116
what is the most common type of ovarian tumor?
serous surface epi tumor
117
mucinous mets to the ovary tend to come from which organ? What is the name of this tumor?
GI tract; Krukenberg tumor
118
serous tumors of the ovary have what characteristic structure on histology?
papillary stuctures
119
(blank) tumors of the ovary show some arborization with papillae, atypia, but no invasion
borderline serous tumors
120
(blank) tumors tend to be friable, discohesive, with high grade nuclei
serous carcinoma
121
t/f: borderline tumors don't invade but still show some level of atypia
true
122
Granulosa cell tumors and fibromas of the ovary tend to present in pts with what characteristic physical finding?
hirsutism
123
Mature teratomas are always (blank) while immature teratomas are always (blank)
mature: benign
immature: malignant
124
What are the four tumors that arise from germ cells?
1. teratoma
2. dysgerminoma
3. endodermal sinus tumor
4. choriocarcinoma
125
teratomas arise from what tissue type produced from germ cells?
fetal tissue
126
dysgerminomas arise from what tissue type produced from germ cells?
oocytes (dysGERMinoma aka germ cells)
127
endodermal sinus tumors arise from what tissue type produced from germ cells?
yolk sac
128
choriocarcinoma arise from what tissue type produced from germ cells?
placental tissue
129
what is the most common germ cell tumor in females?
teratomas
130
Struma ovarii is a teratoma composed of primarily....
thyroid tissue, can cause hyperthyroidism
131
what is the most common malignant germ cell tumor?
dysgerminoma
132
what is the testicular counterpart to dysgerminoma?
seminoma
133
serum LDH may be elevated in which germ cell tumor?
dysgerminoma
134
This tumor is composed of large cells with clear cytoplasm and central nuclei that resemble oocytes
dysgerminoma
135
What is the most common germ cell tumor in kids?
endodermal sinus tumor (think yolk sac so development so kids)
136
what is the glomerulus-like structure seen in endodermal sinus tumors?
Schiller-Duval bodies
137
in what germ cell tumor is serum AFP elevated?
endodermal sinus tumor (yolk sac aka fetus aka AFP!)
138
choriocarcinoma is a malignant tumor composed of what two cell types?
cytotrophoblasts
| syncytiotrophoblasts
139
choriocarcinoma mimics placental tissue but what structure is absent/
villi
140
Because cytotrophoblasts/ syncytiotrophoblasts, choriocarcinoma will begin as a small hemorrhagic tumor with early (blank) spread
hematogenous
141
in what germ cell tumor is b-HCG elevated/
choriocarcinoma (mimics placenta therefore pregnant therefore b-HCG)
142
granulosa-theca cell tumors present with what hormone excess?
estrogen
143
What are the signs of estrogen excess with regard to age?
beofre puberty: precocious puberty
reproductive age: menorrhagia / metrorrhagia
postmenopause: not common
144
t/f: sertoli-leydig tumors can form in the ovary
true
145
what characteristic crystal is found in sertoli-leydig tumors?
Reinke crystals
146
what type of sex cord stromal tumor presents with hirsutism and virilization?
sertoli-leydig; may produce androgens (think about the one that comes from men)
147
mucinous carcinoma of the ovary is usually bilateral, while (blank) is usually bilateral
Krukenberg tumors from the GI tract
148
what is real name for jelly belly?
Pseudomyxoma peritonei
149
Where does the tumor arise from in pseudomyxoma peritonei?
mucinous tumor of appendix; goes to ovary
150
monoamnion twins are (fraternal/identical)
identical
151
what is the most common amnion arrangement for twins?
monochorionic monoamnionic
152
t/f: monochorionic twins are identical
true
153
What is a complete mole?
two sperms joined with one ovum
154
t/f: in incomplete mole there is no genetic material in the ovum
false; complete
155
what is the chromosome number of incomplete moles?
triploid; 69 XXY; two sperms in the ovum
156
Complete moles can be invasive and cause rupture of the (blank) arteries and hemorrhage
endoemtrial
157
Moles can develop choriocarcinoma becuase they contain what two cell types?
CT and ST
