Pathology of the uterus, vulva, and vagina Flashcards Preview

Life Cycles Unit 1 > Pathology of the uterus, vulva, and vagina > Flashcards

Flashcards in Pathology of the uterus, vulva, and vagina Deck (52):
1

endophytic

enDophytic = DOWN into the tissue

2

exophytic

OUT from the surface

3

Pagetoid

Single cells/clusters PERCOLATING through the epithelium

4

Molluscum Contagiosum

In adults, usually genital Common in children on extremities via sharing of towels Flesh colored, pearly skin lesions 1-5 mm, PAINLESS Endophytic growth with eosinophilic inclusion bodie

5

Condyloma Acuminatum

HPV 6 and 11 Hyperkeratosis and parakeratosis Especially papillae tips Hypergranulosis and elongated rete ridges Koilocytes

6

Koilocytes

Raisonoid nuclei Perinuclear clearing HPV!!

7

Trichomonas

flagellated protozoan; frothy yellow d/c, dysuria, dyspareunia; “strawberry cervix” on colposcopy

8

Candida

normal vaginal flora, but can overgrow (DM, Abx, pregnancy); curdlike d/c and pruritis

9

Actinomyces

“sulfur granule” with clublike projection non-copper IUD non-pathogenic

10

Vulvar Intraepithelial Neoplasia

Nuclear atypia (koilocytic) and lack of maturation= DYSPLASIA HPV 16, 18, other high-risk

11

VIN III / SCCIS

Increased mitoses, full thickness dysmaturity (cells at the surface look the same as those near the base)

12

HPV-associated SCC

13

Inflammatory-associated SCC

♀ > 70 years HPV NEGATIVE Lichen sclerosus/d-VIN Prominent keratin “pearls” in well-differentiated carcinoma Increased mitoses, pink cytoplasm

14

Lichen Sclerosus

Smooth white plaques/papules, resembles parchment Dermal fibrosis with perivascular mononuclear infiltrate Thinned epidermis w loss of rete pegs, hydropic degeneration of basal cells & superficial hyperkeratosis

15

Extramammary Paget Disease

Adenocarcinoma variant Make sure it's not melanoma Red, crusted sharply demarcated map-like area Marked hyperkeratosis and “pale” basal epidermis Tumor cells with “halo” lie singly or in clusters (with occasional gland formation *) in epidermis NOT usually associated with underlying invasive carcinoma

16

Malignant Melanoma

17

Embryonal Rhabdomyosarcoma

Cambium layer: Dense zone of rhabdomyoblast present beneath the surface epithelium Grossly: Polypoid, rounded, bulky masses which fills and protrude from vagina, resembling GRAPE-LIKE clusters (sarcoma botryoides)

18

Adenosis

Glandular tissue in vagina +/- DES exposure Present in 35-90% of exposed women Mucinous epithelium Can progress to clear cell carcinoma

19

DES-associated: Clear Cell Carcinoma

Tubulocystic pattern of growth with dense hyaline stroma; clear cytoplasm with bland nuclei “kissing lesion”: Anterior upper 1/3 of vagina, often w discontinuous areas

20

Endocervical Polyps

2-5% adult women Can cause “spotting” Curettage curative Dilated glands, dense eosinophilic stroma

21

Squamous Cell Carcinoma

Increased mitoses, full thickness dysmaturity Infiltrating irregular nests of malignant squamous cells, eliciting a desmoplastic stromal response

22

How is the staging of cervical cancer done?

Unlike endometrial cancers, the STAGING of cervical cancers is based on clinical factors

23

Adenocarcinoma in situ (AIS)

Hyperchromasia Mucin Depletion Luminal Mitoses High N:C ratio Almost always HPV-related

24

Proliferative phase of menstrual cycle

Estrogen as mitogen Histology Straight tubular glands Mitoses (*) Nuclear stratification

25

Secretory Phase of menstrual cycle

↑ Progesterone, E2 falling Histology “S-shaped” tortuous, coiling glands, secretory activity Subnuclear vacuoles “piano keys”

26

Menstrual Phase

↓↓ E2 and Progesterone Histology Stromal/glandular breakdown Inflammation Intravascular fibrin

27

Exogenous Hormone Effect

Hypersecretory glands (short-term) Decidualized stromal cells Inactive glands (chronic)

28

Pregnancy

Hormones: Progesterone, hCG Histology: Stromal decidualization Arias-Stella Reaction Hypersecretory glands w architectural complexity, nuclear enlargement, no mitoses

29

Menopause

>6 months without menstruation Thin endometrium w/o mitoses ↓ Cervical mucous and glycogenation Cystic atrophy

30

Abnormal Uterine Bleeding

Irregularity in menstrual cycle Amenorrhea- lack of menstruation Menorrhagia- heavy or prolonged Metrorrhagia- irregular Dysfunctional: no pathologic cause identified

31

Endometrial Polyps

Dense pink stroma, haphazardly arranged glands Cystic dilatation, hormonally unresponsive

32

Endometritis

Clinically PID Acute ↑ polys in stroma & glands (top) Curettage curative Chronic Plasma cells (bottom) Infertility

33

Adenomyosis/Endometriosis

Endometrial glands and stroma in abnormal location Infertility, dysmenorrhea In uterine wall = adenomyosis Extrauterine = endometriosis Activated inflammatory cascade

34

Leiomyoma

Gross: Single or multiple Spherical, Firm “White, Whorled” Well circumscribed Most common uterine tumor Menometrorrhagia, infertility, mass Whorled bundles of bland smooth muscle cells Hormonally responsive Treatment: Surgery Embolization GnRH agonist Nothing

35

Leiomyosarcoma

Malignant smooth muscle tumor Infiltrating, polypoid mass HIGH GRADE BY DEFINITION Hemorrhage, necrosis Most common uterine sarcoma 40-60 years Behavior: Rapid increase in size Metastasizes to lungs 5-year survival: 15-40%

36

Type I Endometrial Cancer

Pre-menopausal Risk factors: Unopposed estrogen, Genetics Background hyperplasia Minimal invasion/spread ER/PR positive

37

HNPCC

Mutated mismatch repair genes: Microsatellite instability 4 genes: MLH1, PMS2, MSH2, MSH6 Heterodimers with dominant & “recessive” element ♂ present w colon cancer; ♀ w endometrial cancer Women: 25-50% lifetime risk colorectal CA, 25-70% LR endometrial, 10% LR ovarian or stomach

38

Endometrial Hyperplasia

Physiologic response to unopposed estrogen: polyclonal process or EIN: clonal proliferation (PTEN mutation) AUB or asymptomatic Treatment: Hormonal Curettage Surgery

39

Simple Hyperplasia

Increased gland to stroma ratio Rarely progresses to cancer Treated with progestins Crowded, hyperchromatic glands Thickened, “fluffy” endometrium

40

Complex Hyperplasia

+/- Atypia Glandular crowding and architectural complexity 5-30% progress to cancer Diffuse involvement of endometrial cavity

41

Endometrial Carcinoma

Usually PMB, but many asymptomatic Peak in 5th and 6th decades 85% endometrioid Resembles endometrial glands Exophytic (protruding) mass of tightly packed glands without intervening stroma

42

Prognosis of endometrial carcinoma

Depends on stage and spread

43

Treatment of endometrial carcinoma

Surgery Radiation Vaginal brachy Whole pelvis Chemotherapy

44

Type II Endometrial Cancer

Post-menopausal Aggressive 10-20% endometrial cancers p53 mutation

45

Serous Carcinoma

Type II cancer Papillary growth, atypia Disseminated at presentation

46

Malignant Mixed Müllerian Tumor (Carcinosarcoma)

Biphasic tumor Homologous (left) vs Heterologous (right)

47

What are the most important lesions to remember in a patient with abnormal uterine bleeding?

polyps, adenomyosis, leiomyomas, hyperplasia and carcinoma But most cases aren't due to lesions

48

Grade vs stage

GRADE is the degree of differentiation STAGE is the extent of spread

49

Difference between type I and type II endometrial cancers

Type I endometrial cancers occur in younger women and are estrogen-dependent with a generally good prognosis Type II endometrial cancers occur in older women, have higher grade histology and poorer prognosis

50

What gene(s) is (are) mutated in type II endometial cancers usually?

p53

51

What gene(s) is (are) mutated in type I endometial cancers usually?

BRAF, mismatch repair proteins (MLH-1), β-catenin

52

What is this?

Q image thumb

Lichen sclerosis