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Reproductive > Vaginal, cervical and ovarian pathology (not malignant tumors) > Flashcards

Vaginal, cervical and ovarian pathology (not malignant tumors) Flashcards

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1
Q

Gynecologic tumor epidemiology - incidence

A

US: 1. endometrial 2. ovarian 3. cervical
Worldwide: cervical is more common (Lack of screening or HPV vaccination)

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2
Q

Gynecologic tumor epidemiology - worst prognosis

A
  1. ovarian
  2. endometrial
  3. cervical
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3
Q

vaginal tumors

A
  1. Squamous cell carcinoma
  2. Clear cell adenocarcinoma
  3. Sarcoma botryoides (embryonal rhabdomyosarcoma variant)
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4
Q

vaginal tumors - types and characteristics

A
  1. SCC: usually 2ry to cervical SCC (rare 1ry)
  2. clear cell adenocarcinoma: Women who had exposure to DES in utero
  3. Sarcoma botryoides: girls under 4. Hist: spindle-shaped cells, desmin (+). Gross: clear, grape-like polypoid mass emerging from vagina
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5
Q

vaginal tumors - SCC

A

usually 2ry to cervical SCC (rare 1ry)

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6
Q

vaginal tumors - clear cell adenocarcinoma

A

Women who had exposure to DES in utero

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7
Q

Sarcoma botryoides (embryonal rhabdomyosarcoma variant) - epidemiology and appearance

A

girls under 4. Hist: spindle-shaped cells, desmin (+). Gross: clear, grape-like polypoid mass emerging from vagina

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8
Q

Cervical dysplasia and carcinoma - definition, location

A

Disordered epithelial growth. Begins at basal layer of Squamocolumnar Junction (transformation zone) and extends outward

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9
Q

Cervical dysplasia and carcinoma - Classification

A

CIN 1, CIN 2, CIN 3 (severe dysplasia or carcinoma in situ), depending on extend of dysplasia

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10
Q

cervical dysplasia and carcinoma - pathogenesis

A

HPV 16, 18 –> both produce E6 (inh p53) and E7 (inh RB)

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11
Q

cervical dysplasia and carcinoma - May progress

A

slowly to invasive carcinoma i left untreated

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12
Q

cervical dysplasia and carcinoma - presentation

A
  1. typically asymptomatic (detected with Pap smear - koilocytes)
  2. presents as abnormal vaginal bleeding (often postcoital - after sexual intercourse)
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13
Q

cervical dysplasia and carcinoma - Risk factors (MC?)

A
  1. Multiple sexual partners (MC)
  2. Smoking
  3. Starting sexual intercourse at young age
  4. HIV infection
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14
Q

Koilocyte

A

squamous epithelial cell that has structural changes, as a result of infection HPV

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15
Q

Koilocyte - structural changes

A
  1. Nuclear enlargement
  2. Irregularity of the nuclear membrane contour
  3. darker nucleus (Hyperchromasia)
  4. perinuclear halo.
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16
Q

cervical invasive carcinoma - type

A

often SCC

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17
Q

cervical invasive carcinoma - Diagnosis

A

colposcopy and biopsy

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18
Q

cervical invasive carcinoma - complication

A

lateranl invasion –> block ureters –> renal failure

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19
Q

Premature ovarian failure - definition

A

premature atresia of ovarian follicles in women of reproductive age

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20
Q

Premature ovarian failure - presentation and endocrine profile

A

signs of menopause after puberty but before 40

endocrine profile: low estrogen, high LH, FSH

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21
Q

Polysystic ovarian syndrome is AKA

A

Stein-Leventhal syndrome

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22
Q

Polysystic ovarian (Stein-Leventhal) syndrome - mechanism

A

hyperinsulinemia and/or insulin resistance is hypothesized to alter hypothalamic hormonal feedback response –> high LH/FSH –> increased androgen production from theca cells (LH) (–> hirsutism) but low estrogen (no FSH on granulosa), low rate of follicular maturation –> unruptured follicles (cysts) + anovulation

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23
Q

Polysystic ovarian (Stein-Leventhal) syndrome - risk factors

A

obesity

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24
Q

Polysystic ovarian (Stein-Leventhal) syndrome - image

A

enlarged, bilateral cystic ovaties

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25
Polysystic ovarian (Stein-Leventhal) syndrome - presentation
1. amenorrhea/oligomenorrhea 2. hirsutism 3. acne 4. low fertility
26
Polysystic ovarian (Stein-Leventhal) syndrome - estrogen levels (mechanism)
1. low 17β -estradiol (low FSH --> no aromatization granulosa cells) 2. high estrone (aromatization of androgen on adiposse tissue)
27
Polysystic ovarian (Stein-Leventhal) syndrome - increased risk of ... (and mechanism)
1. endometrial cancer 2ry to unopposed estrogen from repeated anovulatory cycles 2. Ovarian neoplasm
28
Polysystic ovarian (Stein-Leventhal) syndrome - treatment
1. weight loss, 2. OCP 3. clomiphene citrate 4. ketoconazole 5. spironolactone
29
MCCs of anovulation (11)
pregnancy, polycystic ovarian syndrome, obesity, HPO axis abnormalities, premature ovarian failure, hyperprolactinemia, thyroid disorders, eating disorders, competitive athletics, Cushing syndrome, adrenal insuficiency
30
MC ovarian mass in young women
follicular cysts
31
Ovarian cysts - types
1. follicular cysts | 2. Theca lutein cyst
32
ovarian follicular cysts
distention of unruptured graafian follicle
33
graafian follicle?
Tertiary vesicular follicles or mature vesicular follicles
34
ovarian follicle cyst may be associated with
1. hyperestrogenism | 2. endometrial hyperplasia
35
Theca-lutein cyst - definition/mechanism
often bilateral/multiple due to gonadotropin stimulation
36
Theca-lutein cyst - associated with
1. choriocarcinoma | 2. hydatidiform moles
37
Most common adnexal mass in women over 55
Ovarian neoplasm
38
Ovarian neoplasms arises from
1. surface epithelium 2. germ cells 3. sex cord stromal tissue
39
Majority of malignant ovarian neoplasms
epithelial (serous cystedocarcinoma MC)
40
increased risk for ovarian neoplasm
1. advanced age 2. infertility 3. endometriosis 4. Polysystic ovarian syndrome 5. genetics (BRCA1/2 Lynch syndrome, family history)
41
genetic predisposition for ovarian neoplasm
BRCA1/2 Lynch syndrome, family history
42
decreased risk for ovarian neoplasm
1. previous pregnancies 2. history of breastfeeding 3. OCPs 4. tubal ligation
43
ovarian neoplasm - presentation
1. adxenal mass 2. abdominal distention 3. bowel obsruction 4. pleural effusion
44
ovarian neoplasm - marker and characteristics
CA-125 --> monitor to response to therapy/relapse | not good for screening
45
Benign ovarian neoplasms
1. serous cystadenoma 2. mucinous cystadenoma 3. endometrioma 4. mature cystic teratoma (dermoid cyst) 5. Brenner tumor 6. fibromas 7. thecoma
46
MC ovarian neoplasm
Serous cystadenom
47
Serous cystadenoma - histology/characteristics
- lined with fallopian tube-like epithelium | - often bilateral
48
Mucinous cystadenoma - histology/characteristics
- Multiloculated (many small covities), large | - lined by mucus-secreting epithelium
49
ovarian endometrioma - definition
endometriosis (ectopic endometrial tissue) within ovary with cystic formation
50
ovarian endometrioma - presentation
1. pelvic pain 2. dysmenorrhea 3. dyspareunia symptoms may vary with menstrual cycle
51
ovarian endometrioma - appearance
1. "chocolate cyst" - endometrioma filled with dark, redish-brown blood. 2. Complex mass on US
52
MC ovarian tumor in females 10-30
Mature teratoma of ovary (dermoid cyst)
53
Mature teratoma of ovary is AKA
dermoid cyst
54
Mature teratoma of ovary (dermoid cyst) - origin/appearance
germ cell tumor - cystic mass contating elements all 3 germ layers (eg. teeth, hair, sebum)
55
Mature teratoma of ovary (dermoid cyst) - presentation
1. pain 2ry to ovarian enlargement or torsion | 2. a monodermal form with thyroid tissue (stroma ovari) uncommonly presents with hyperthyroidism
56
A struma ovarii is
a rare form of monodermal teratoma that contains mostly thyroid tissue, which may cause hyperthyroidism
57
Brenner tumor - appearance
like bladder - solid tumor that is pale-yelllow tan and appearns encapsulated - coofee been nuclei on hemotaxelin-eosin stain
58
ovarian fibromas - definition/histology/presentation
bundles of spindle-shape fibroblasts | pulling sensation in groin
59
Meig syndrome
triad of 1. ovarian fibroma 2. ascites 3. hydrothorax
60
Thecoma - characteristic, presentation
like granulosa cell tumors --> may produce estrogen | usually presents as abnormal uterine bleeding in postmenopausal women

Reproductive (20 decks)

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