Neoplastic Pathology of the female Reproductive Tract and PATHOMA FEMALE GENITAL SYSTEM Flashcards Preview

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Flashcards in Neoplastic Pathology of the female Reproductive Tract and PATHOMA FEMALE GENITAL SYSTEM Deck (37):
1

Human Papilloma Virus is what type of virus?

DNA

2

Low risk HPV

6, 11 (episomal DNA)

3

High Risk HPV

16,18,31, 33 ( genomically integrated viral DNA, Expression of viral oncogenes)

4

High Risk HPV associated with what two harmful genes?

E6 and E7

5

E6 gene product does what that is bad?

Binds to and causes degeneration of p53 tumor suppressor

6

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

7

HPV nearly always affects what area of the cervix?

Transformation zone

8

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

9

CIN

Cervical Intraepithelial Neoplasia

10

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

11

CIN 1

less than 1/3 of the thickness of the epithlium is involved. Koilocytes near the top

12

CINII

less than 2/3 the thickness of the epithelium

13

CIN III

Just barely less than the entire thickness

14

What is koilocytic change?

Raisinoid nuclei

- 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

15

What are the most common subtypes of cervical carcinoma

Squamous cell (80%) and adenocarcinoma (15%)...both related to HPV

16

Best prognostic indicator for survival in cervical cancer?

clinical stage
Stage 1- 85-90% 5 year survival
stage 2- 75%
Stage 3- 35%
stage 4- 10%

17

CIN risk factors?

Early age at first intercourse
multiple partners
male partner with multiple partners
high parity, family history, other viruses

18

HPV vaccines use ..... to create HPV specific immunity

Virus Like Particles

19

Most common tumor of the female genital tract

Leiomyoma present in 75% of women over 40

20

Adenomyosis

presence of benign endometrial glands and stroma within the myometrium

21

Asherman's syndrome

secondary amenorrhea due to loss of basalis and scarring

22

What is the cause of an anovulatory cycle

No progesterone driven secretory phase

23

Endometrial glands and stroma outside of the endometrial lining

endometriosis

24

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.

25

Adenomyosis

endometriosis in the myometrium

26

Remember that there is increased risk of carcinoma at the site of endometriosis, especially the ovary

ok

27

Adenocarcinoma of the endometrium

Remember, it is a malignant proliferation of endometrial GLANDS. So you will see tons of glands to less less stroma.

28

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

29

What is the histological appearance of endometrial adenocarcinoma of the hyperplastic pathway called?

endometrioid because it looks like normal endoemtrium

30

Leiomyoma

smooth muscle mass arising from myometrium

31

Leiomyomas are dependent on what for growth

ESTROGEN....enlarge during pregnancy and shrink after menopause

32

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

33

CIN is now called what

SIL (squamous intrepithelial lesion)

Also important to note that high grade SIL covers CIN 2 and 3

34

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%)

35

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

36

Most common ovarian tumors are of what type

Surface epithelial (65-70%)
afer that
- Germ Cell
- Sex cord/Stromal
- Metastases to ovaries

37

Benign serous cystadenoma is what type of ovarian tumor

surface epithelial