Roveda- Benign and Malignant Disorders of female GU tract Flashcards
(200 cards)
1
Q
Reactive inflammation of vulva in response to an exogenous stimulus
A
Vulvitis
2
Q
HSV-2, N. gonorrhoeae, Treponema pallidum, and C. albicans, and M. contagiosum can cause what
A
vulvitis
3
Q
causative agent of a genital ulcerative lesion in the vulva
A
Herpes simplex
4
Q
causative agent of suppurative infection of vulva
A
N. gonorrhoeae
5
Q
causative agent of syphilis
A
Treponema pallidum
6
Q
fungus that causes a yeast infection in vulva
A
Candida albicans
7
Q
a cutaneous or mucosal lesion caused by poxvirus. (present in eyes and in vulva)
A
Molluscum contagiosum
8
Q
associated with condyloma acuminatum and vulvar intraepithelial neoplasia.
A
HPV
9
Q
stiffened labial folds with smooth white plaques-leukoplakia
postmenopausal
A
Lichenoid sclerosis
10
Q
epithelial THINNING
hyperkeratosis
classic for…
A
Lichen Sclerosis
11
Q
with ______ there is an increased risk of developing SCC in vulva
A
Lichen Sclerosis
12
Q
if you see leukoplakia in the mouth what are you trying to first exclude
A
SCC, then lichen lesions
13
Q
area of leukoplakia
epithelial THICKENING
A
Lichen simplex chronicus
14
Q
warty lesions
A
Condyloma
15
Q
squamous cells which become infected with HPV have nuclear wrinkling with cleared cytoplasm
A
koilocytes
16
Q
usually do not progress to invasive cancer; HPV subtypes 6 and 11 cause this
A
Condyloma acuminatum
17
Q
“stuck on pieces of cauliflower”
A
Condyloma acuminatum
18
Q
Marked thickening of epidermis; hyperkeratosis; turnover of cells
A
Condyloma
19
Q
90% of vulvar carcinomas are _____
A
SCC
20
Q
2 distinct forms of vulvar carcinoma (squamous cell carcinoma):
A
HPV subtypes 16 and 18
preceded by lichen sclerosis
21
Q
Young age at first intercourse
Intercourse with multiple partners
Intercourse with a male partner who has had multiple partners
A
risk factors for HPV related diseases in vulva and cervix
22
Q
A
HPV related vulvar carcinoma
23
Q
lesion will look grossly like ______ due to the hyperkeratosis overlying the areas of squamous dysplasia
A
leukoplakia
24
Q
normal on L side
vulva
A
vulvar intraepithelial neoplasia
25
vulva
vulvar squamous cell carcinoma
26
pretty good prognosis of vulvar _____ if you catch it while the lesion is small
vulvar carcinoma
27
Remember in Paget’s disease of the breast (which is referred to as mammary Paget’s), virtually 100% of patients have an underlying ______ ductal carcinoma of the breast.
invasive
28
About 30% of patients with perianal Paget’s have an underlying _____ carcinoma
invasive
29
Intraepithelial proliferation of malignant epithelial cells that can occur in the skin of the vulva (can also occur in the perianal area); most not associated with an underlying tumor
Extramammary Paget Disease
30
On gross image: red scaly crusted plaque
extramammary paget disease
31
red scaly crusted plaque
“area oozing, and see red scaly area, and frequently pruritic"
Extramammary Paget's disease
32
disease- large pale cells with intracytoplasmic mucin which infiltrate the epidermis of the vulva
Extramammary Paget's Disease
33
most people with ______disease do not have underlying invasive carcinoma
Extramammary Paget's disease
34
pigmented lesion on labia
vulvar melanoma
35
what 2 things could this be if in vulva
Paget's disease; vulvar melanoma
36
S-100 and HMB45 to stain for _____
melanoma
37
mucin stain to rule out_____
Paget's
38
inflammatory, transient condition associated with discharge which is known as leukorrhea
vaginitis
39
causes curdy white discharge from vagina
Candida albicans
40
watery grey green frothy discharge – the cervix is grossly described as strawberry cervix
Trichomonas Vaginalis
41
Normal _____ of vagina can become pathogenic in the setting of diabetes, antibiotic therapy, pregnancy, or immunodeficiency
flora
42
uncommon in patients, but is the most common cancer of vagina occurring in patients older than 60
SCC
43
Usually preceded by vaginal intraepithelial neoplasia which is associated with HPV infection
SCC of vagina
44
The most significant risk factor for squamous cell carcinoma of the vagina is a previously diagnosed squamous cell carcinoma of the _____ or ______
cervix or vulva
45
1970s cluster of young women whose mothers took diethylstilbestrol to prevent threatened abortion got _____ adenocarcinoma of vagina
clear cell adenocarcinoma of vagina
46
Embryonal rhabdomyosarcoma—rare form of vaginal cancer that manifests as polypoid masses of tissue protruding from vaginal os (in young patients)
Sarcoma botryoides
47
mesenchymal sarcoma of vagina
sarcoma botryoides
48
Small round blue cell neoplasm with skeletal muscle differentiation
Sarcoma Botryoides
49
may express muscle specific marker desmin
Sarcoma Botryoides
50
results in epithelial metaplasia in the endocervical transformation zone: stratified squamous of ecto and merges into glandular of endo
cervicitis
51
the spread of this infection requires direct contact with the mucosa of an infected individual; infects cervix
Neisseria gonorrhoeae
52
most common bacterial cause of STD in the US, dx is made not thru culture but rather by nucleic acid amplification on voided urine; infects the cervix
Chlamydia
53
patients infected with ____ can get reactive arthritis known as Reiter's syndrome
Chlamydia
54
will see Cowdry type A viral inclusions on pap smear
herpes
55
L: strawberry cervix
middle: grey green discharge
R: pap smear of organism
Trichomonas
56
____has a tropism for immature squamous cells of the transformation zone, basal layer at the squamocolumnar junction
HPV
57
where the ectocervical squamous mucosa meets the endocervical glandular mucosa
cervical transformation zone
58
if HPV infection persists, then can progress to SIL and CIN which are
squamous intraepithelial lesion
cervical intraepithelial neoplasia
59
Early age at first intercourse
Multiple sexual partners
Male partner with multiple previous sexual partners
Persistent infection with high risk strains of HPV
risk factors for squamous intraepithelial lesion
60
high risk strains of HPV for squamous intraepithelial lesions and cervical cancer
types 16 and 18
61
high risk subtypes of HPV______ into the host genome
integrate
62
low risk subtypes of HPV ___ and ___ are associated with condylomata and DO NOT integrate into the host genome
6 and 11
63
Persistent and long term infection of _____is what increases risk for developing SIL and cervical cancer
HPV
64
activation of E6 and E7 viral oncoproteins which inactivate p53 and Rb tumor suppressors resulting in uncontrolled cellular proliferation
high risk HPV
65
_____ usually precedes invasive carcinoma
squamous intraepithelial lesion
66
The higher grade of dysplasia, the greater the likelihood of progression to _____
cancer
67
grade for mild dysplasia
low grade SIL
68
grade for moderate, severe, in situ dysplasia
high grade SIL
69
full thickness dysplasia
carcinoma in situ
70
cervical transformation zone where what meets
endocervical glandular mucosa meets squamous mucosa
71
cervical squamous metaplasia (ecto and endo)
72
grade these
A. low grade
B and C: high grade
73
cervix---> how would you describe this
carcinoma in situ
74
in a pap smear, there is early detection of dysplastic changes in the cells scraped from the _____ zone
transformation
75
____ is usually asymptomatic and comes to attention because of an abnormal pap smear
SIL
76
cervical os (normal)
77
SIL patient (squamous metaplasia)
78
cervix
invasive SCC
79
L and R (squamous cells of cervical pap smear)
L: normal
R: HPV
80
____most common reason for having invasive carcinoma of cervix
HPV
81
most common type of invasive carcinoma of cervix
SCC
82
this type of cancer will not really be detected by pap smear due to being higher up than transition zone and tool can get
adenocarcinoma
83
Cone excision
Hysterectomy with or without lymph node sampling
Radiation and chemotherapy
treatment options for carcinoma of cervix
84
Most patients with advanced disease of carcinoma of cervix die as a result of ____ invasion rather than distant mets
local
85
cervix
invasive SCC
86
SCC
87
_____ phase endometrium- that which is prior to ovulation- this is the phase that can be of a variable length
proliferative
88
_____ phase endometrium is a fixed length of days which terminates in menses.
secretory
89
what phase of endometrium
proliferative
90
absence or suppression of menses
amenorrhea
91
Scanty or infrequent menstrual flow
oligomenorrhea
92
painful menses
dysmenorrhea
93
prolonged bleeding at menses
menorrhagia
94
irregular bleeding between menses
metrorrhagia
95
painful sexual intercourse
dyspareunia
96
Differential for abnormal uterine bleeding depends upon the _____ of the patient
age
97
Abnormal bleeding from the uterus in the absence of an organic uterine lesion
dysfunctional uterine bleeding
98
most common cause of dysfunctional uterine bleeding
anovulation
99
pre-puberty bleeding differential
precocious puberty
100
adolescence abnormal bleeding differential
Anovulation
101
reproductive age abnormal bleeding differential
complications of pregnancy
102
perimenopausal abnormal bleeding
dysfunctional uterine bleeding
103
postmenopausal abnormal bleeding
anatomic lesions
104
Most common at menarche and perimenopausal period
Anovulation
105
Corpus luteum fails to mature or may regress prematurely leading to a lack of progesterone
inadequate luteal phase
106
what happens if there is leftover placenta after giving birth
can lead to endometriosis, sepsis, or choriocarcinoma
107
Often a consequence of pelvic inflammatory disease
Infectious-N.gonorrhoeae, C.trachomatis, tuberculosis
IUD
genetic
causes of endometriosis
108
Refers to the growth of the basal layer of the endometrium downward into the myometrium
Adenomyosis
109
Induces reactive hypertrophy of the myometrium resulting in an enlarged uterus
Adenomyosis
110
reactive hypertrophy of myometrium in uterus
Adenomyosis
111
normal endometrial glands embedded in myometrium
Adenomyosis
112
Presence of endometrial glands and stroma in a location outside the endomyometrium
endometriosis
113
Adhesions can develop on fallopian tube, on ovary and cause fallopian tube to no longer float freely and grasp the egg at time of ovulation
endometriosis
114
ex. pt with _____didnt respond well to estrogen + progesterone COC so had to get ablation surgery (she had long and painful periods due to this)
endometriosis
115
chocolate cyst
endometriosis
116
"powder burns"
117
powder burns sign of
endometriosis
118
endometrial glands and stroma outside of uterus
endometriosis
119
Progestins and progesterone dominant oral contraceptives for this
endometriosis
120
precursor to some types of endometrial adenocarcinoma (endometrioid type)
endometrial hyperplasia
121
Excess of estrogen relative to progestin (unopposed estrogen)
endometrial hyperplasia
122
Failure of ovulation
Prolonged administration of therapeutic agents
Estrogen producing tumors (Granulosa-theca cell tumor) or syndromes (PCOS)
Obesity
can cause endometrial hyperplasia
123
Increased aromatase expression:
As ____ mass increases, so does the expression of aromatase, an enzyme complex that converts androgens into estrogens
fat
124
classified based upon presence of cytologic atypia
endometrial hyperplasia
125
endometrial hyperplasia may be associated with _____tumor suppressor gene inactivation
PTEN
126
normal what
endometrium
127
endometrial hyperplasia
128
If cytologic _____ is present on biopsy, up to 25% of those patients will harbor an unsampled endometrial carcinoma
atypia
129
In the US, the most frequent carcinoma of the genital tract in patients with a uterus; older population
endometrial adenocarcinoma
130
2 types of endometrial adenocarcinoma
endometrioid
serous
131
associated with estrogen excess and hyperplasia in the perimenopausal patient
endometrioid endometrial adenocarcinoma
132
associated with endometrial atrophy in the older postmenopausal patient
serous endometrial adenocarcinoma
133
accounts for 80% of ______ and msot risk factors are largely associated with increased estrogen
endometrioid adenocarcinoma
134
Association b/t mismatch repair gene who have HNPCC what other cancer do they develop
endometrioid adenocarcinoma
135
_____carcinoma-nearly all cases have mutations in the TP53 tumor suppressor gene
serous
136
P10 tumor marker for this adenocarcinoma
endometrioid
137
______ adenocarcinoma
endometrioid
138
_____ invading myometrium
endometrial adenocarcinoma
139
Microscopically-papillae with marked cytologic atypia
stain for p53
endometrial atrophy
serous adenocarcinoma
140
papillary tufts
endometrial atrophy
serous adenocarcinoma
141
”clinically referred to as fibroids”
Leiomyoma
142
Most common benign tumor of the uterus
Monoclonal with rearrangement of chromosomes 6 and 12
Leiomyoma
143
well circumscribed
Leiomyoma
144
Leiomyomata
145
fascicular pattern of smooth muscle cells
Leiomyoma
146
Leiomyomata
147
malignant; frequently metastasize to the lungs
Grossly-soft, hemorrhagic, and necrotic
Leiomyosarcoma
148
pronounced cytologic atypia
smooth muscle
Leiomyosarcoma
149
_____pregnancy is one of the most common findings in someone with pelvic inflammatory disease
ectopic
150
most common disorder of the fallopian tubes-occurs as a component of pelvic inflammatory disease (PID)
salpingitis
151
Clinically-present with fever, abdominal pain, pelvic pain, pelvic mass and cervical motion tenderness (Chandelier sign).
Salpingitis (fallopian tubes)
152
______carcinomas of the fallopian tube most frequently arise in the fimbriated end of the fallopian tube
serous
153
what kind of epithelium in fallopian tube
glandular
154
serous carcinomas of fallopian tube are associated with _____ mutation
BRCA
155
ectopic pregnancy
156
chorionic villi to the left and fallopian tube epithelium to the right.
ectopic pregnancy
157
2 types of physiologic ovarian cysts
follicular or luteal
158
produces excess estrogen and androgen (testosterone)
"string of pearls" on imaging
PCOS
159
Oligomenorrhea due to anovulation
Hirsutism-hyperandrogenism (facial hair)
Infertility
Obesity
Anemia
PCOS
160
PCOS
161
elevated _____stunt follicle growth which results in failure to trigger an LH surge resulting in failure to ovulate.
androgen (testosterone)
162
patients with PCOS can also experience _____ resistance
insulin
163
tumor that metastasized from GI tract to ovaries (bilateral)
Kruckenberg tumor
164
surface epithelial tumors of ovary can be what 3 things
benign
borderline
malignant
165
Positive family history- 5 to 10% of________cancers are familial (BRCA1 and BRCA2)
ovarian
166
most common of the ovarian epithelial tumors
serous tumors
167
Microscopically-benign tumors are lined by a single layer of columnar epithelial cells w/ cilia
serous tumors of ovary
168
_____cyst neoplasm
ovarian
169
see cilia
serous cystadenoma
170
low grade serous carcinomas associated with ____mutations
KRAS
171
high grade serous carcinomas associated with _____ mutations
TP53
172
_____ carcinoma; papillary tufts
serous carcinoma of ovary
173
____ carcinoma; papillary tufts
serous carcinoma of ovary
174
papillae and psamomma bodies
serous carcinoma of ovary
175
cyst with thick mucinous material
can be over 100 pounds
mucinous tumors (mucinous ovarian neoplasm)
176
mucinous ovarian neoplasm
177
mucinous ovarian neoplasm
178
mucinous cystadenoma (of ovary)
179
mucinous adenocarcinoma of ovary can look similar to what
colon cancer
180
implantation of tumor cells in the peritoneum with the production of copious amounts of mucin-jelly belly—most frequently caused by mets from the gastrointestinal tract-appendix
pseudomyxoma peritonei
181
metastatic ____ ring cell carcinoma of ovary
signet (Kruckenberg)
182
Of note Clear cell carcinoma of the ovary which is another high grade primary ovary carcinoma also is associated w/ _____
endometriosis
183
mutations in PTEN tumor suppressor gene
endometrioid tumors
184
germ cell tumor
mature are benign
all 3 germ cell layers
teratoma
185
Filled with sebaceous material, hair and teeth
teratoma
186
aka Dermoid cyst
teratoma
187
mature cystic teratoma (ovary)
188
teratoma
189
Foci of neuroepithelial differentiation are the aggressive components-these are the components which tend to metastasize
immature malignant teratoma
190
specialized teratoma composed entirely of mature thyroid tissue
Struma ovarii
191
thyroid tissue
Struma ovarii
192
may be asymptomatic
ascites; increasing abdominal girth
may have adb pain
ovarian tumors
193
most common malignant germ cell tumor in ovary
Elevated PLAP, LDH, hCG
Dysgerminoma
194
(looks similar to seminoma)
Dysgerminoma
195
elevated AFP
yolk sac tumor
196
Increased levels of hCG and AFP
May secrete estrogen and lead to precocious puberty
embryonal carcinoma
197
Cytotrophoblasts and syncytiotrophoblasts
Elevated levels of hCG
Choriocarcinoma
198
sex cord stromal tumor
granulosa cell tumor
199
serum markers for granulosa cell tumor
estrogen
inhibin
200
Call Exner bodies
Granulosa Cell Tumor
