Flashcards in Neoplastic Pathology of the female Reproductive Tract and PATHOMA FEMALE GENITAL SYSTEM Deck (37)
Human Papilloma Virus is what type of virus?
Low risk HPV
6, 11 (episomal DNA)
High Risk HPV
16,18,31, 33 ( genomically integrated viral DNA, Expression of viral oncogenes)
High Risk HPV associated with what two harmful genes?
E6 and E7
E6 gene product does what that is bad?
Binds to and causes degeneration of p53 tumor suppressor
E7 does what that is bad?
binds to and inactivates Rb gene which then allows upregulation of Cyclin E and p16INK4... KNOW...Cyclin E and P16INK4 are proliferation promoters
HPV nearly always affects what area of the cervix?
What even is the transformation zone
It is the area where exocervix joins endocervix. Exocervix consists mostly of squamous epithelium whereas endocervix is columnar cells. The transformation zone exists between these layers and is most commonly affected by HPV
Cervical Intraepithelial Neoplasia
CIN is characterized by?
KOILOCYTIC change, disordered maturation, nuclear atypia, increased mitotic activity...pretty much all of that is pretty routine for neoplasia except maybe the koilocytic change
less than 1/3 of the thickness of the epithlium is involved. Koilocytes near the top
less than 2/3 the thickness of the epithelium
Just barely less than the entire thickness
What is koilocytic change?
- You see large cytoplasm (cytomegaly) the virus particles live here, large nucles (nucleomegaly), perinuclear halo, irregular nuclear membrane (raisin appearance), stippled coarse chromatin, increased mitotic activity as well
What are the most common subtypes of cervical carcinoma
Squamous cell (80%) and adenocarcinoma (15%)...both related to HPV
Best prognostic indicator for survival in cervical cancer?
Stage 1- 85-90% 5 year survival
stage 2- 75%
Stage 3- 35%
stage 4- 10%
CIN risk factors?
Early age at first intercourse
male partner with multiple partners
high parity, family history, other viruses
HPV vaccines use ..... to create HPV specific immunity
Virus Like Particles
Most common tumor of the female genital tract
Leiomyoma present in 75% of women over 40
presence of benign endometrial glands and stroma within the myometrium
secondary amenorrhea due to loss of basalis and scarring
What is the cause of an anovulatory cycle
No progesterone driven secretory phase
Endometrial glands and stroma outside of the endometrial lining
Theories of Endometrioosis...
1) Retrograde menstruation- most popular
2) Menoplastic theory- mullerian duct metaplasia leads to endometriosis
3) Lymphatic dissemination: Endometriosis goes through the lymphatics and migrates to other regions.
endometriosis in the myometrium
Remember that there is increased risk of carcinoma at the site of endometriosis, especially the ovary
Adenocarcinoma of the endometrium
Remember, it is a malignant proliferation of endometrial GLANDS. So you will see tons of glands to less less stroma.
What are the two pathways of endometrial carcinoma?
1) Hyperplasia- due to unobstructed estrogen which causes the endometrim to grow unopposed
2) Sporadic- no evident precursor lesion- average age at presentation is 70
What is the histological appearance of endometrial adenocarcinoma of the hyperplastic pathway called?
endometrioid because it looks like normal endoemtrium
smooth muscle mass arising from myometrium
Leiomyomas are dependent on what for growth
ESTROGEN....enlarge during pregnancy and shrink after menopause
When doing a colposcopy and a pap smear, it is standard practice to do what?
apply dilute acetic acid which turns displastic areas. If its still hard to see you add iodine which will turn the normal endocervical epithelium a brown color and leave the displastic area white
CIN is now called what
SIL (squamous intrepithelial lesion)
Also important to note that high grade SIL covers CIN 2 and 3
Explain the staging of cervical squamous cell carcinoma
Stage 1- confined to the cervix (85% five yr survival)
Stage 2- Local invasion to areas like the vag (75%)
Stage 3- deeper (35%)
Stage 4- distant mets (10%)
What would the histology of a leiomyoma look like?
Markedly elongated, eosinophilic cytoplasm, Cigar shaped nuclei.....THIS IS THE DESCRIPTION OF A SMOOTH MUSCLE CELL
Most common ovarian tumors are of what type
Surface epithelial (65-70%)
- Germ Cell
- Sex cord/Stromal
- Metastases to ovaries