Reproductive - Pathology (1) Flashcards

Question

Cervical pathology: Dysplasia and carcinoma in situ * Definition * Associations * Findings * Risk factors

Answer 1

* Definition * Disordered epithelial growth * Begins at basal layer of squamocolumnar junction (transition zone) and extends outward. * Classified as CIN 1, CIN 2, or CIN 3 (severe dysplasia or carcinoma in situ), depending on extent of dysplasia. * Associations * Associated with HPV 16 and HPV 18, which produce both the E6 gene product (inhibits p53 suppressor gene) and E7 gene product (inhibits RB suppressor gene). * Findings * May progress slowly to invasive carcinoma if left untreated. * Typically asymptomatic (detected with Pap smear) or presents as abnormal vaginal bleeding (often postcoital). * Risk factors * Multiple sexual partners (#1), smoking, early sexual intercourse, HIV infection.

Answer 2

* Often squamous cell carcinoma. * Pap smear can catch cervical dysplasia (koilocytes [A]) before it progresses to invasive carcinoma. * Lateral invasion can block ureters, causing renal failure.

Answer 3

* Definition * Inflammation of the endometrium (with plasma cells and lymphocytes) [A] associated with retained products of conception following delivery (vaginal/C-section)/miscarriage/abortion or foreign body such as an IUD. * Retained material in uterus promotes infection by bacterial flora from vagina or intestinal tract. * Treatment * Gentamicin + clindamycin with or without ampicillin.

Answer 4

* Definition * Non-neoplastic endometrial glands/stroma outside of the endometrial cavity [A]. * Locations * Can be found anywhere * Most common sites are ovary, pelvis, and peritoneum. * In the ovary, appears as an endometrioma (blood-filled “chocolate cyst”). * Findings * Characterized by cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia (pain with defecation), infertility; **normal-sized** uterus * Due to... * Can be due to retrograde flow, metaplastic transformation of multipotent cells, or transportation of endometrial tissue via the lymphatic system. * Treatment * NSAIDs, OCPs, progestins, GnRH agonists, surgery.

Answer 5

* Adenomyosis * Definition * Extension of endometrial tissue (glandular) into the uterine myometrium. * Due to... * Caused by hyperplasia of the basalis layer of the endometrium. * Findings * Dysmenorrhea, menorrhagia. * Uniformly **enlarged**, **soft**, globular uterus. * Treatment * Hysterectomy * Adenomyoma (polyp) * Well-circumscribed collection of endometrial tissue within the uterine wall. * May contain smooth muscle cells. * Can extend into the endometrial cavity in the form of a polyp.

Answer 6

* Endometrial hyperplasia * Definition * Abnormal endometrial gland proliferation usually caused by excess estrogen stimulation. * Increased risk for endometrial carcinoma. * Findings * Clinically manifests as postmenopausal vaginal bleeding. * Risk factors * Anovulatory cycles, hormone replacement therapy, polycystic ovarian syndrome, and granulosa cell tumor. * Endometrial carcinoma * Definition * Most common gynecologic malignancy. * Peak occurrence at 55–65 years old. * Increased myometrial invasion --\> decreased prognosis. * Findings * Clinically presents with vaginal bleeding. * Typically preceded by endometrial hyperplasia. * Risk factors * Prolonged use of estrogen without progestins, obesity, diabetes, hypertension, nulliparity, and late menopause.

Answer 7

* Definition * Most common tumor in females. * Increased incidence in blacks * Benign smooth muscle tumor * Malignant transformation is rare * Does not progress to leiomyosarcoma * Peak occurrence at 20–40 years old * Findings * Often presents with multiple discrete tumors [A]. * Estrogen sensitive— tumor size increases with pregnancy and decreases with menopause. * May be asymptomatic, cause abnormal uterine bleeding, or result in miscarriage. * Severe bleeding may lead to iron deficiency anemia. * Whorled pattern of smooth muscle bundles with well-demarcated borders.

Answer 8

* Incidence * Endometrial \> ovarian \> cervical * Data pertain to the United States * Cervical cancer is most common worldwide * Worst prognosis * Ovarian \> cervical \> endometrial.

Answer 9

* Premature ovarian failure * Definition * Premature atresia of ovarian follicles in women of reproductive age. * Findings * Patients present with signs of menopause after puberty but before age 40. * Decreased estrogen * Increased LH, FSH. * Most common causes of anovulation * Pregnancy, polycystic ovarian syndrome, obesity, HPO axis abnormalities, premature ovarian failure, hyperprolactinemia, thyroid disorders, eating disorders, female athletes, Cushing syndrome, adrenal insufficiency.

Answer 10

* Definition * Hyperandrogenism due to deranged steroid synthesis by theca cells, hyperinsulinemia * Most common cause of infertility in women. * Hormones * Estrogen increases steroid hormone-binding globulin (SHBG) and decreases LH * Ultimately resulting in decreased free testosterone * Insulin and testosterone decreases SHBG --\> increased free testosterone. * Increased LH due to pituitary/hypothalamus dysfunction. * Increased LH, increased FSH (LH:FSH, 3:1), increased testosterone, increased estrogen (from aromatization). * Findings * Results in enlarged, bilateral cystic ovaries [A] * Presents with amenorrhea/oligomenorrhea, hirsutism, acne, infertility.

Answer 11

* Associations * Associated with obesity. * Increased risk of endometrial cancer 2° to increased estrogens from the aromatization of testosterone and absence of progesterone. * Treatment * For hirsutism, acne * Weight reduction * OCPs * Estrogen increases SHBG and decreases LH --\> decreased free testosterone * Antiandrogens * For infertility * Clomiphene citrate * Blocks negative feedback of circulating estrogen * Decreases FSH, LH * Metformin * Increases insulin sensitivity, decreases insulin levels --\> results in decreased testosterone * Enables LH surge * For endometrial protection * Cyclic progesterones (antagonizes endometrial proliferation)

Answer 12

* Follicular cyst * Distention of unruptured graafian follicle. * May be associated with hyperestrogenism and endometrial hyperplasia. * Most common ovarian mass in young women. * Corpus luteum cyst * Hemorrhage into persistent corpus luteum. * Commonly regresses spontaneously. * Theca-lutein cyst * Often bilateral/multiple. * Due to gonadotropin stimulation. * Associated with choriocarcinoma and moles.

Answer 13

* Hemorrhagic cyst * Blood vessel rupture in cyst wall. * Cyst grows with increased blood retention * Usually self-resolves. * Dermoid cyst * Mature teratoma. * Cystic growths filled with various types of tissue such as fat, hair, teeth, bits of bone, and cartilage. * Endometrioid cyst * Endometriosis within ovary with cyst formation. * Varies with menstrual cycle. * When filled with dark, reddish-brown blood it is called a “chocolate cyst.”

Answer 14

* Definition * Most common adnexal mass in women \> 55 years old. * Can be benign or malignant. * Arise from surface epithelium, germ cells, and sex cord stromal tissue. * Majority of malignant tumors arise from epithelial cells. * Majority (95%) are epithelial (serous cystadenocarcinoma most common). * Risk factors * Risk increases with advanced age, infertility, endometriosis, PCOS, genetic predisposition (BRCA-1 or BRCA-2 mutation, HNPCC, strong family history). * Risk decreases with previous pregnancy, history of breastfeeding, OCPs, tubal ligation. * Findings * Presents with adnexal mass, abdominal distension, bowel obstruction, pleural effusion. * Diagnosis * Diagnose surgically. * Monitor progression by measuring CA-125 levels (not good for screening)

Answer 15

* Type of tumor * Benign ovarian neoplasm * Definition * Most common ovarian neoplasm. * Often bilateral * Findings * Thin-walled, uni- or multilocular. * Lined with fallopian-like epithelium.

Answer 16

* Type of tumor * Benign ovarian neoplasm * Definition * Multiloculated, large. * Lined by mucus-secreting epithelium [A].

Answer 17

* Type of tumor * Benign ovarian neoplasm * Definition * Mass arising from growth of ectopic endometrial tissue. * Findings * Complex mass on ultrasound. * Presents with pelvic pain, dysmenorrhea, dyspareunia.

Answer 18

* Type of tumor * Benign ovarian neoplasm * Definition * Germ cell tumor, most common ovarian tumor in women 20–30 years old. * Can contain elements from all 3 germ layers * Teeth, hair, sebum [B] are common components. * Findings * Can present with pain 2° to ovarian enlargement or torsion. * Can also contain functional thyroid tissue and present as hyperthyroidism (struma ovarii) [C].

Answer 19

* Type of tumor * Benign ovarian neoplasm * Findings * Looks like **_b_**ladder. * Solid tumor that is pale yellow-tan in color and appears encapsulated. * “Coffee **_b_**ean” nuclei on H&E stain.

Reproductive - Pathology (1) Flashcards

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