Reproductive - Female Pathology Flashcards Preview

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Flashcards in Reproductive - Female Pathology Deck (76)
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1

Bartholin cyst

P: unilateral, painful cystic lesion at lower vestibule adjacent to vaginal canal; in premenopausal women

M: inflammation and obstruction of gland -> cystic dilation

2

Condyloma

P: warty neoplasm of vulvar skin

M: HPV 6, 11 (condyloma acuminatum); secondary syphilis (condyloma latum)
Koilocytes (hallmark of HPV-infected cells)

Rarely progress to carcinoma

3

Lichen sclerosis

P: white patch (leukoplakia) with parchment-like (paper thin) valvular skin; post-menopausal women

M: thinning of epidermis and fibrosis (sclerosis) of dermis

Benign, slightly increased risk of squamous cell carcinoma

4

Lichen simplex chronicus

P: leukoplakia with thick, leathery vulvar skin

M: chronic irritation and scratching; hyperplasia of vulvar squamous epithelium

No increase risk of squamous cell carcinoma

5

Vulvular carcinoma

P: leukoplakia (biopsy to distinguish from other causes)

M: squamous epithelium lining vulva
1) HPV-related (type 16, 18) - vulvar intraepithelial neoplasia with koilocytic change, disordered cell maturation, nuclear atypia, mitotic activity

2) Non HPV-related - long-standing sclerosis (chronic inflammation/irritation); older women (> 70 yo)

6

Extramammary Paget Disease

P: erythematous, pruritic, ulcerated vulvar skin

M: malignant epithelial cells in epidermis of vulva

No underlying carcinoma (whereas in nipple there is underlying carcinoma)

7

Distinguishing Extramammary Paget Disease and Melanoma

Paget cells: PAS+, keratin+, S100-
Melanoma: PAS-, keratin-, S100+

PAS = mucous secreting
Keratin = epithelial

8

Adenosis

P: Focal persistence of columnar epithelium in upper 1/3 of vagina

(During development, squamous epithelium from lower 2/3 from urogenital sinus grows upward and replace columnar lining of upper 1/3 from Mullerian ducts)

Assoc. with exposure to diethystilbestrol in utero

9

Clear cell adenocarcinoma

M: malignant proliferation of glands with clear cytoplasm

Rare, but feared, complication of DES-associated vaginal adenosis

10

Embryonal rhabdomyosarcoma (Sarcoma botryoides)

P: bleeding and grape-like mass protruding from vagina or penis of child (usually < 5yo)

M: Malignant mesenchymal proliferation of immature skeletal muscles
Spindle-shaped tumor cells

Cytoplasmic cross-striations
Positive for desmin and myogenin

11

Vaginal carcinoma

Usually secondary to cervical squamous cell carcinoma

Squamous epithelium carcinoma lining vagina mucosa

Assoc. with high risk HPV (16, 18) -> vaginal intraepithelial neoplasia

Lower 2/3 of vaginal spreads to inguinal nodes
Upper 1/3 of vaginal spreads to regional iliac nodes

12

What is the histology of cervix?

Exocervix: nonkeratinizing squamous epithelium
Endocervix: single layer of columnar cells

Transformation zone = junction

13

HPV Infection

Sexually transmitted DNA virus that infects lower genital tracts, particularly cervical transformation zone

Persistent infection -> cervical dysplasia

High Risks: 16, 18, 31, 33
Low Risks: 6, 11

High risk HPV produce E6 (p53) and E7 (Rb) -> increase risk of CIN

14

Cervical intrapepithelial neoplasia

P: koilocytic change, disordered cellular maturation, nuclear atypia, increased mitotic activity

CIN I: < 1/3 thickness
CIN II: < 2/3 thickness
CIN: < 3/3 thickness
Carcinoma in situ: entire thickness

Progression not inevitable (CIN I often regress)

Higher grade more likely to progress to carcinoma and less likely to regress

15

Cervical carcinoma

P: middle-aged women with vaginal bleeding, postcoital bleeding, cervical discharge

M: invasive carcinoma from cervical epithelium; high-risk HPV infection
secondary factors: smoking, immunodeficiency (AIDS)

80% Squamous and 15% adenocarcinoma (both HPV related)

Can invade through anterior uterine wall into bladder -> blocks ureters -> hydronephrosis with postrenal failure common cause of death

16

What is the gold standard for screening cervical carcinoma?

Pap smear
Abnormal pap smear followed by confirmatory colposcopy (magnifying glass) and biopsy

Limitations: inadequate sampling, not for adenocarcinoma

17

Immunization for HPV infection

Quadrivalent: HPV 6, 11, 16, 18
Protection lasts 5 years

Pap smears still necessary due to limited number of HPV covered by vaccine

18

What are the layers of lining of uterine cavity? What hormones regulate the layers?

Myometrium: smooth muscle wall underlying endometrium

Endometrium: mucosal lining of uterine cavity
Hormone sensitive
- growth by estrogen, secretory phase by progesterone, shedding by loss of progesterone

19

Asherman syndrome

P: secondary amenorrhea after dilation and currettage (D&C)

M: overaggressive D&C -> loss of basalis (stem cell layer for regeneration of endometrium) and scarring

20

Anovulatory cycle

P: lack of ovulation, dysfunctional uterine bleeding during menarche and menopause

M: estrogen-driven proliferative phase without subsequent progesterone-driven secretory phase -> proliferative glands break down and shed

21

Acute endometritis

P: fever, abnormal uterine bleeding, pelvic pain

M: bacterial infection of endometrium; from retained products of conception (after delivery/miscarriage) -> acts as nidus for infection

Tx: gentamycin + clindamycin with or without ampicillin

22

Chronic endometritis

P: abnormal uterine bleeding, pain, infertility

M: chronic inflammation of endometrium (from products of contraception, chronic pelvic inflammatory - chlamydia, IUD, TB)

Lymphocytes and plasma cells (Plasma cells for diagnosis as lymphocytes are normally found in endometrium)

23

Endometrial polyp

P: abnormal uterine bleeding

M: hyperplastic protrusion of endometrium
Can arise from tamoxifen (pro-estrogenic on endometrium)

24

Endometriosis

P: dysmenorrhea (pain during menstruation), pelvic pain; may cause painful intercourse and infertility; cyclic bleeding from ectopic tissue

M: retrograde menstruation with implantation at ectopic site -> endometrial glands AND stroma outside of uterine endometrial lining -> cycle just like normal endometrium

Uterus is normal sized

Increased risk of carcinoma at site of endometriosis, especially the ovary

Tx: oral contraceptives, NSAIDs, leuprolide, danazol

25

Sites of Endometriosis

Ovary (chocolate cysts)
Uterine ligaments (pelvic pain)
Pouch of douglas (pain with defecation)
Bladder wall (pain with urination)
Bowel serosa (abdominal pain and adhesions)
Fallopian tube mucosa (scarring increases risk for ectopic pregnancy) - "gun-powder" nodules

26

Adenomyosis

Endometriosis involving uterine myometrium
Uterus is enlarged

Tx: hysterectomy

27

Endometrial hyperplasia

P: postmenopausal uterine bleeding

M: Unopposed/excessive estrogen stimulation (obesity, polycystic ovary syndrome, estrogen replacement) -> hyperplasia of endometrial glands relative to stroma

Risks: anovulatory cycles, HRT, polycystic ovarian syndrome, granulosa cell tumor

Cellular atypia is the most important predictor for progression to carcinoma
Simple hyperplasia progresses 30%; Complex hyperplasia rarely

28

Endometrial carcinoma

P: postmenopausal bleeding at 55-65 yo

M: malignant proliferation of endometrial glands (most common invasive carcinoma of female genital tract)

2 pathways: hyperplasia and sporadic
Increased myometrial invasion -> lower prognosis

29

Hyperplasic endometrial carcinoma

Estrogen exposure risks -> hyperplasia
Histology: endometrioid (normal endometrium-like)

60 yo

30

Sporadic endometrial carcinoma

Arise in atrophic endometrium with no evident precursor lesion
Histology: papillary structures, psammoma bodies, p53 mutation

70 yo, aggressive tumor