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Flashcards in Pathology - Nichols 2 Deck (96):
1

High Risk in HPV to cause cancer?

-16,18,31,33,35

2

Low Risk Cancer, High Warts for HPV?

-6,11

3

Is HVP a DNA or RNA virus?

DNA

4

Molecular Pathology of Cervical Dysplasia/CIN/SIL

-high risk HPV E6 & E7 genes are important in development of high grade dysplasia and invasive cancer
-E6 gene product binds to and causes degeneration of the p53 (tumor suppressor) protein
-E7 gene binds/inactivates Rb protein, allowing up-regulation of Cyclin E and p16INK4
-lifespan of epithelial cells increases
-Koilocytotic changes (condyloma), dysplasia and cancer

5

Original Squamous Epithelium of Cervix

-smooth, shiny, featureless
-very fine vessels
-sharp squamous columnar junction separates the squamous epithelium from villous endocervix

6

Appearance of Epithelium of CIN/SIL

-add acetic acid and it turns white

7

Appearance of Invasive Squamous Cell Carcinoma

-nodular, with bizarre vessels and areas of hemorrhage
-if endophytic: cervix is barrel-shaped
-bleeds with acetic acid, does not stain with iodine

8

Features of Koilocytotic Change

-Cytomegaly
-Nucleomegaly
-Perinuclear Halo
-Irregular Nuclear Membrane
-Stipples (coarse) chromatin
-Increased mitotic activity

9

CIN I - Pap Smear

-mild dysplasia
-changes are seen in basal third of squamous epithelium

10

CIN II - Pap Smear

-moderate dysplasia
-lower and middle third of epithelium, still some epithelium differentiation

11

CIN III - Pap Smear

-severe dysplasia
-minimal differentiation in superficial epithelium

12

Microscopic Koilocytotic Changes

-epithelial cells with crisp, perimuclear intracytoplascmic halos
-nuclear mem is irregular resulting in wrinkled nucleus w/viral particles

13

Flat Condyloma with Koilocytes

-cells in intermediate layers are ballooned with copious clear cytoplasm in which viral particles reside
-once cell binucleated

14

Features of Intraepithelial Dysplasia/CIN/SIL

-maturation arrest (dec./missing superficial epithelial cells)
-blurred or missing distinction of basal cell layer
-loss of cellular orientation, polarity
-increased nuclear/cytoplasmic ratio
-hyperchromatic epithelium

15

Invasive Squamous Cell Carcinoma - Micro

-invading irregular squamous cell nests
-dysmoplastic stroma, irregular squamous nests with keratinization (sometimes)

16

Cervical Invasive Squamous Cancer

-predominately squamous cell carcinoma
-leading cause of cancer deaths in women 50y/o
-8th cause of cancer deaths
-survival depends on clinical stage

17

Stage I

confined to cervix
-85-90% 5 year survival

18

Stage II

-local invasion
-75% 5 year survival

19

CIN RIsk Factors

-early age at first intercourse
-multiple sexual partners
-a male partner with multiple previous sexual partners
-high parity, family history, other virusis
-immune status

20

Screening for Cervical Cancer

-Exfoliative cytology of cervix (pap smears)
-Bethesda nomenclature: normal, benign changes, LSIS, HSIL, ASCUS (atypical squamous cells of undetermined significance), atypical glandular cells, other

21

Micro CIN I

-large
-nucleus is hyperchromatic
-raisinoid and binucleated or multinucleated
-low nuclear/cytoplasm ration

22

Micro CIN II

-high nuclear/cytoplasm ration

23

Micro CIN III

-small cells
-very high nuclear/cytoplasmic ratio

24

Prevention of Cervical Cancer

-virus-like particles can be used to create & increase host immunity against HPV
-Increased immunity prevents HPV infection, dev of cervical dysplasia (precancerous condition) and cancer
-decrease HPV infection

25

Key to prognosis of Endometrial Cancer

-stage

26

Endometrial Cancer

-bleed earlier in cervical

27

Tumors of Uterine Corpus: Benign

-leiolyoma (smooth muscle)
-endometrial stromal nodule

28

Tumors of Uterine Corpus: Malignant

-adenocarcinoma of endometrium (endometrioid, serous papillary)
-mixed mullerian tumors
-leiomyosarcoma
-endometrial stromal sarcoma

29

Leiomyoma

-circumscribed nodules in myometrium
-white whorled surface
-cigar-shaped nuclei (smooth muscle)

30

Abnormal Uterine Bleeding

Baby girl: maternal estrogen
Post Menopause: tumor

31

Adenomyosis

-presence of benign endometrial glands and stroma within the myometrium

32

Endometriosis

-most common site is on ovary, then around ovary
-presence of benign endometrial glands and stroma outside the uterus

33

Ovarian Neoplasms/Surface Epithelial Stromal Tumors

-

34

Serous Tumors

Ovarian Neoplasms/Surface Epithelial Stromal Tumors
-cystadenoma
-cystadenocarcinoma
MOST COMMON 75%

35

Mucinous Tumors

Ovarian Neoplasms/Surface Epithelial Stromal Tumors
-cystadenoma
-cystadenocarcinoma

36

Endometrioid

Ovarian Neoplasms/Surface Epithelial Stromal Tumors
-adenocarcinoma
-epithelial-stromal tumor (mixed Mullerian tumor)

37

Transtional Cell Tumor

Ovarian Neoplasms/Surface Epithelial Stromal Tumors
-Brenner tumor

38

Benign Serous Cystadenoma

-large simple cyst, thin wall and serous fluid content
-epithelium is cuboidal-low columnar, ciliated

39

Serous papillary cystadenocarcinoma, gross

-tan-yellow-white with papillary projections and solid areas

40

Serous Carcinoma of Ovary

-invasive cell nests forming papillary fronds
-psammoma bodies are common

41

Ovarian neoplasma/sex cord-stromal tumors

-granulosa cell timors
-tumors of thecoma-fibroma group
-sertoli cell tumor
-sex cord tumors

42

Granulosa cell tumor, gross

-mustard-yellow with areas of necrosis

43

Granulosa cell tumor, microscopic

-coffee-bean shaped nuclei, nuclear grooves
-call-exner bodies (circular arrangement around a sparsely cellular space recapitulating ovarian follicle)

44

Mature cystic teratoma, gross pathology

-cystic mass with sebaceous content, hair, teeth

45

Mature cystic teratoma, microscopy

-keratin, skin, skin appendages and subcutaneous fat tissue

46

Placenta

-temporary organ connecting fetus and mother providing equivalent of respiratory services

47

Amnion

membranous sac surrounding fetus containing serous fluid essential for fetal development

48

Chorion

-plate-shaped tissue under part of amniotic sac containing fetal blood vessels that branch into villi projecting into space filled with maternal blood

49

Trophoblast

outter layer of blastocyst (from fertilized ovum) that implants in uterus and forms placenta

50

Decidua

outer layer of placenta that normally peels off myometrium and sheds with placenta

51

Syncytiotrophoblast

syncytium of cells forming outer covering of chorionic villi, which thin out their cytoplasm and let their clumped nuclei hang off villi in "syncytial knots" to minimize diffusion barrier

52

First Trimester Chorionic Villi

covered by double layer
(inner cytotrophoblast layer and outer syncytiotrophoblast layer)

53

Third Trimester Chorionic Villi

more efficient
-more blood vessels, less interstitium, thinner trophoblast covering

54

Ectopic Pregnancy

-implantation of placenta anywhere besides normal intrauterine location
(1 in 150)
90% in fallopian tube
-scarring from previous infection of tube, adhesions from appendicitis, endometriosis or surgery

55

Presentation of Ectopic Pregnancy

acute severe abdominal pain due to fallopian tube rupture and pelvic hemorrhage (6 weeks agter last menses)
-hemorrhagic shock, death

56

Diagnosis of Ectopic Pregnancy

-history, physical (signs of peritonitis), ultrasound, pregnancy test

57

Treatment/Prognosis of Ectopic Pregnancy

surgery, good with proper treatment

58

Spontaneous Abortion

Pregnancy loss before 20 weeks
-occurs in 15% of clinically recognized pregnancies but 22% more abort in first trimester
-11% in 22-24y/o to 51% in 40-44y/o

59

Cause of Spontaneous Abortion in First Trimester

-Genetic
1/2 with chromosomal abnormalities

60

Causes of Spontaneous Abortion in Second Trimester

-Infectious
acute chorioamnionitis

61

Causes of Spontaneous Abortion in Third Trimester

-Vascular
uteroplacental insufficiency, commonly associated with pre-eclampisa

62

Recurrent Spontaneous Abortion

>/= 3
immunologic (25%) (antiphospholipid syndrome)
anatomic (22%)
endocrinologic (20%)
microbiologic
genetic
unknown

-recurrent stillbirth associated with hypercoagulable states

63

Placenta Previa

implantation in lower uterus or cervix sometimes covering internal cervical os
-often results in severe bleeding, may result in placental rupture, massive bleeding, maternal death

64

Diagnosis/Treatment of Placenta Previa

ultrasound
C-section

65

Placenta Accreta

defective decidua, with adherence of villous tissue to myometrium
80%

66

Placenta Increta

defective decidua, with penetration of villous tissue into myometrium
15%

67

Placenta Percreta

defective decidua, with penetration of villous tissue through entire uterine wall
5%

68

Treatment of Placenta Accreta, Increta, Percreta

persistent postoartum
-hysterectomy, resection or oversewing

69

Hydatidiform Moles

-Abnormal gestations due to two sperm fertilizing one egg or 1 or 2 sperm fertilizing an "empty egg" with absent or nonfunctional DNA
-rare in US (1 in 1,000)
-east (1 in 100)
-women less than 20 or greater than 40

70

Complete Moles

diploid

71

Partial Moles

triploid

72

Morphology of Hydatidiform Moles

-cystic swelling of chorionic villi makes them resemble grapes
-trophoblast hyperplasia more prominent in complete moles (all the way around villi)

73

Diagnosis/Treatment of Hydatidiform Moles

-average 8.5 weeks from abnormal ultrasound showing diffuse villous enlargement or rapid and high beta-HCG
-Treated with curretage and monitoring beta-HCG to make sure its all out

74

Types of Twin Placentas

-Dichorionic Diamnionic
-Dichorionic Diamnionic (fused)
-Monochorionic Diamnionic
-Monochorionic Monoamnionic

75

Dichorionic Diamniotic Twin Placenta

-69% of twins
80% of these twins are dizygotic

76

Monochorionic Diamniotic Twin Placenta

-30% of twins
-all twins are monozygotic

77

Monochorionic Monoamniotic Twin Placenta

-twin twin diffusion syndrome
-unbalanced vascular anastomoses in monochorionic placentas can cause one twin to get to much blood and the other to get to little

78

Twin-Twin Transfusion Syndrome

-death of deprived "donor" twin can send necrotic procoagulant material into the anastomoses threatening the life of the other twin and then the mother

79

Placental Infections: Hematogenous

TORCH
T-Toxoplasm gondii
O-Other (syphillis, HIV)
R-Rubella (german measles)
C-Cytomeglovirus
H-Herpes Simplex Virus

ascending from vagina: acute chorioamnionitis

80

Toxoplasma gondii

-protozoan from cat feces, causes microcephaly, fever, rash, seizures in noenates

81

Other

-rare in US with prenatal care

82

Rubella

causes deafness, neurologic defects, cardiac malformations

83

Cytomegalovirus

-most common infection
-deafness and neurological defects, & jaundice

84

Herpes Simplex Virus

gotten from birth
-skin infection
-prevent with C-section

85

Acute Chorioamnionitis

-41% of women with premature rupture of membranes at <27 weeks and 15% at 28-36 weeks
-stages: maternal polys in intervillous space, then in chorion, then in amnion, then fetal polys in chorionic blood vessels (fetal vasculitis) where inflammation may lead to thrombosis b/c:
INFLAMMATION IS PROCOAGULANT

86

Funisitis

-extensive tan exudate (areas of congestion) on the amniotic surface, exudate and congestion of cord

87

Acute Chorioamnionitis: Infection

-assends from vagina and cervix
-mainly maternal neutrophils (so starts in intervillous space)
-causes premature rupture of membranes (PROM) and premature labor and delivery
-polymicrobial, with multiple vaginal flora bacteria

88

Acute Chorioamnionitis Syndrome

-fever, tachycardia (fetal/maternal), uterine tenderness, foul smelling amniotic fluid and leukocytosis

89

Acute Chorioamnionitis Diagnosis/Treatment

-Diagnosis is clinical
-Treatment: antibiotics and delivery
-Prognosis: usually good, but can cause fetal sepsis, cerebral palsy, endometritis

90

Acute Abdomen (surgical emergencies) Causes

1. ruptured ectopic pregnancy
2. corpus luteum rupture & hemorrhage
3. pelvic inflammatory disease
4. appendicitis
5. ovarian torsion

91

Ovarian Torsion

twisting on ligamentous support, cutting off venous outflow and then arterial inflow, causing ischemia and then infarction
-most common in women of childbearing age with ovarian mass or pregnancy (more in first trimester)

92

Ovarian Torsion Symptoms/Treatment

-acute onset of moderate-severe pelvic pain, often with nausea and vomiting
-treat with surgery

93

Appendicitis

-inflammation of appendix due to overgrowth of normal flora trapped by occluding fecalith
-1 in 800 pregnancies (more in 2nd trimester)
-periumbilical abdominal pain that migrates to right lower quadrant, anorexia, nausea, vomiting, fever with McBurney's tenderness, rebound tenderness

94

Volvulus

-twisting with intermittent cramping lower abdominal pain, progressive abdominal distension, passing no stool or flatus, with marked abdominal distension and tympany

95

Treatment of Volvulus

-untwisting by inserting tube

96

Diverticulitis

inflammation of transmural outpouching of colonic mucosa due to perforation +/- abscess
-common in elderly
-abdominal pain, often > day, left in 70% whites, right 75% asians, constipation 50%, nausea + vomiting, diarrhea, tenderness & leukocytosis