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189 Cards in this Set
- Front
- Back
what is it
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gonococcal infxn- worst outcome - PID leading to infertility
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what is it, vaginal
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vaginal adenosis
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what is it, vulva
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lichen sclerosus et atrophicus
multifocal Subepithelial homogenized zone Band of lymphocytes Not premalignant – predisposing factor |
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what is it, vulva
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lichen simplex chronicus
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does lichen sclerosus et atrophicus predispose one to malignancy
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yes
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what is it, vulva
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LSC, ddx is squamous hyperplasia, endpoint of many inflammatory dz
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what is it, vulva
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hidradenoma papilliferum - two cell types (with differential staining with IHC)
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ihc for hidradenoma papilliferum
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EMA+ (luminal layer)
Calponin, ASMA+ (basal layer) |
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clinical fx of VIN (traditional)
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HPV associated type
Younger age Multifocal associat with CIN Smoking |
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simplex VIN clinical fx
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HPV negative type
Associated with vulvar inflammatory disease (LS) Older age Unifocal Associated with p53 mutations Well differentiated simplex VIN |
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what is it, vulva
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extramammary paget's
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what is it vulva
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melanoma
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what is it vulva
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angiomyofibroblastoma
Benign, non recurring, Well circumscribed Alternating hyper and hypocellular zones; thin-walled vessels; Stromal cells, wavy collagen strands; Rare mitoses; Mast cells cd34 and smooth muscle markers |
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what age groups do angiomyofibroblastomas occur in
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Reproductive age
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ihc stains and EM for angiomyofibroblastoma
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Vimentin, desmin, actin, CD 34+
EM: myofibroblasts |
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what is it
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aggressive angiomyxoma
Large, > 10 cm Locally infiltrative Bulky, gelatinous Hypocellular, loose stroma Numerous thin and thick-walled blood vessels (only thin in angiomyofibroblastoma) Rare mitoses Mast cells (like angiomyofibroblastoma Indolent, tendency to recur (unlike angiomyofibroblastoma) |
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ihc for aggressive angiomyxoma
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stromal cells: SMA, HHF 35, ER / PR +
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cf angiomyofibroblastoma vs. aggressive angiomyxoma (4)
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angiomyofibroblastoma is distinguished from aggressive angiomyxoma
by: its circumscribed border higher cellularity frequent presence of plump stromal cells lesser degree of stromal myxoid change |
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what is it, vagina
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mesonephric/gartner's cyst - lateral wall; non
mucinous low-cuboidal epithelial cells |
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bartholin cyst location
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just review
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what is it, vagina
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bartholin cyst; transitional epithelium with adjacent mucous glands
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morphologic fx of simplex (differentiated) VIN
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prominent parakeratosis, thickened epidermis, elongated and branched rete ridges; abnormal keratinocytes with large vesicular nuclei; focal macronucleoli; abundant eosinophilic cytoplasm; prominent intercellular bridges; mitoses common in basal layer; basal layer cells have smaller hyperchromatic nuclei with irregular contours (folded)
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what constitutes microinvasion in scca of vulva
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<1mm= microinvasion
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stains for primary vulvar extramammary Paget's
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primary vulva pagets: + for CAM 5.2, CEA, EMA, CK7, G6PD and *HER2neu, positive for muscicarmine
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pagets what stain
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mucicarmine
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ddx for extramammary pagets in vulva
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melanoma (positive melanoma markers)
extramammary pagets (mucicarmine, CAM 5.2, CEA, EMA, CK7, G6PD and *HER2neu) anorectal primary extension- CK7 (-), CK20+ urothelial primary extension - CK7 and CK20 +; uroplakin + |
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distinguish between tumor thickness vs. depth of invasion in scca in vulva
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Tumor thickness: measurement from granular layer (or surface if nonkeratinized) to deepest point of invasion
-Depth of invasion: measurement from epithelial-stromal junction of adjacent most superficial dermal papillae to deapest point of invasion |
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when do a LN dissection for SCCA of vulva
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anything over 1mm gets a LN dissection
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hr hpv
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HPV- 16, 18, 31, 33, 35, 45
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lr hpv
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HPV- 6, 11, 40, 54
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cf depth of invasion of cervix vs. vulva
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Vulva: DOI measured from uppermost dermal papillae, not BM; critical level= 1mm
Cervix: DOI measured from BM of adjacent surface epithelium or endocervical gland |
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ais - see colposcopically or no
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visible lesion is absent/rare
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criteria for AIS
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must see mitoses and apoptosis
+/- stratification and hyperchromasia |
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most common hpv in ais
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HPV 18
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cervix, what is it
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mesonephric remnants, more at lateral walls
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cervix, what is it
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tunnel cluster
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what can microglandular hyperplasia be associated with
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pregnancy or hormone use
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what is it, endocervix/LUS
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villoglandular ca
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what is it, cervix
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adenoma malignum - very well-differentiated glands, with rare nucleoli, but multiple foci of loose desmoplastic stromal reaction in multiple fields
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uterus, what is it, association
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endometrium, associated w/ tamoxifen
tamoxifen polyps are large in size, typically multiple; with small, cystic glands, metaplasia, hyperplasia and myxoid changes |
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criteria for calling atypia in endometrium
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-nuclear enlargement (2-3x RBC)
Pleomorphism vesicular change Chromatin irregularity loss of polarity Prominent nucleoli Cellular stratification |
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what role does PTEN play in endometrium
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Loss of PTEN= neoplastic
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what is it, endometrium
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cystic atrophy
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What is Kurman and Norris' criteria for distinction between atypical hyperplasia and cancer
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Kurman and Norris:
1. Desmoplastic stromal response (=ca, but rare to find) 2. Cribriform pattern- fused glands= CA 3. Replacement of stroma by squamous epithelium 4. Extenisive papillary pattern |
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what is it, endometrium
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endometrial ca, sertoliform variant
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fx of type 1 endometrial ca
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- Endometrioid adenocarcinoma = 80-90%
--estrogen dependent ( obesity, anovulatroy bleeding, late menopause) --good prognosis --a/w endometrial hyperplasia --Surgical stage III and IV in <20% at dx --IHC: loss of PTEN; +mut Kras and Microsatellite instability (MSI) |
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fx of type II endometrial ca
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-Serous carcinoma (<10%)
--non-estrogen-dependent --poor prognosis --usually a/w atrophy (older pts) --surgical stage III and IV in75% at dx --IHC: retains PTEN; p53+ |
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what is it, endometrium
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Low-grade endometrial stromal sarcoma
-uniform cells, resembles proliferative stroma - must see mits - lvi common bag of worms - ddx: cellular leiomyoma |
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common age for low grade endometrial stroma sarcoma
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-75% are younger than 30 yrs old
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ihc for low grade endometrial low grade stromal sarcoma
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IHC: + for CD10, Vimentin, MSA, SMMT; rarely + for desmin
- ER/PR receptors, inhibin, CD99 (by contrast, leiomyoma- + for CD99 and SMA) |
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ovary
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granulosa cell tumor
have Call-Exner bodies = spaces contain cellular debris and the nuclei around them are not making gland structures; they are found in the most common growth pattern- microfollicular; -but GCT can have many growth patterns- solid, trabecular, etc. -Adult type- has nuclear grooves (coffee-bean nuclei) -the juvenile form does not have grooves |
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gross features of granulosa cell tumor
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grossly- are cystic and solid, with areas of hemorrhage and necrosis; and may frequently rupture intraoperatively
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other malignancy a/w granulosa cell tumor of ovary and why
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** They produce estrogen- causing stimulation of endometrium with hyperplasia or carcinoma possible.
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what is it, ovary
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gonadoblastoma; composed of nests of germ cells and sex cord cells
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what can gonadoblastoma be associated with
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most often a/w mixed gonadal dysgenesis, with some Y chromosome material present
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what can gonadoblastoma most commonly transform into
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a benign entity- but MAY undergo malignant transformation--> malignant germ cell tumor
-most commonly- will become dysgerminoma |
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cf depth of invasion of vulva melanoma to scca
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vulva: surface of the epithelium to deepest portion of tumor
* different from squamous cell ca- which is measured from the adjacent dermal papillae to the deepest portion of tumor. |
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what, ovary
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fibrothecoma;
if ascites/right hydrothorax, called meig's syndrome |
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what, ovary
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fibrothecoma
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what extraovarian malignancy can be assoc with fibrothecoma
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they have endocrine function- commonly estrogen--> unopposed estrogen stimulation of the endometrium--> hyperplasia or carcinoma
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most common type of malignant ovary histologic type
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serous
frequently bilateral (60%) |
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ihc for serous ovarian ca
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-IHC: CK7 and WT-1 + (to determine if primary or secondary- ie from endometrium)
-p53 + (high-grade have p53 mutations) |
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morphologic appearance of implant of serous borderline tumor (invasive implant)
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Invasive: irregular infiltration; fibrotic, edematous or myxoid stroma; solid or cribriform nests; substantial atypia
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morphologic appearance of implant of serous borderline tumor (non-invasive)
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Non-invasive: sharp demarcation from normal tissue; fibrotic or inflammatory response; glands, papillary clusters or single cells; moderate atypia
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what, ovary
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serous borderline tumor
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what, uterus, no mits, no necrosis
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symplastic leiomyoma
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significance, uterus
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tumor necrosis in smooth muscle tumor (real not infarction type)
tumor cells abut necrosis |
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important mit counts in stratifying leiomyomas, atypical leiomyomas and leiomyosarcomas
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mit>10/10hpf; if only focal atypia, criteria of >20/10 can be used to call atypical leio in absence of tumor necrosis
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what is HHF35
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muscle specific actin
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what, vagina
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adenosis
Benign glandular epithelium with metaplasia |
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associations/causes adenosis; at risk for
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DES exposure
at risk for: clear cell carcinoma |
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location at which adenosis is most likely found
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upper 1/3, anterior wall
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what, vagina, what associations, what 3 fx are favorable for prognosis
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clear cell carcinoma, vagina
from adenosis (associated with DES) could also occur in cervix Favorable prognosis: low stage, low mitotic activity, mild nuclear atypia |
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in whom does clear cell carcinoma of vagina/cervix occur in
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<40, associated with DES exposure
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what, vagina
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fibroepithelial stromal polyp
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risk factors CIN (5)
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Early age at first intercourse
Multiple partners (multiple partners!) Smoking Immunodeficiency Poor hygiene, STDs |
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morphologic fx of microglandular hyperplasia
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Closely packed glands with mucin and
mixed inflammation; subnuclear vacuoles, rare mitoses |
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how often see CIN if have AIS
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CIN in 50 to 70% cases, 20% have history of CIN
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what, cervix
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adenoma malignum
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associated syndrome adenoma malignum
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Peutz jeghers
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vagina
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barrel shaped cervix; adenosquamous cell carcinoma, glassy cell variant (eos) - more aggressive
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what, uterus, associations
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chronic endometritis, IUD, actinomyces
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what, endometrium
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granulomatous endometritis - most often TB, rarely fungal (eg.coccidiomycosis), viral (CMV)
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endometrium
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early secretory day 17 (pod 3)
decidualization around arteries pod9-10 |
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endometrium
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secretory - supranuclear vacuoles
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endometrium
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menstrual phase - exodus is 6-10 of menstrual cycle
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endometrium 1:1 gland stroma ratio - 3 "causes"
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Normal cycling endometrium
Dysfunctional uterine bleeding Infertility |
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endometrium >1:1 gland stroma ratio - 2 "causal spectrums"
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- hyperplasia/carcinoma
-late secretory/menstrual |
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endometrium <1:1 gland stroma ratio - 3 "causes"
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- atrophy
- stromal proliferation/tumors - decidua |
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uterus, what
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adenomyosis
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risks for EM hyperplasia
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Nulliparity
unopposed estrogen stimulation (exogenous, endogenous) PCO – Stein Leventhal syndrome Diabetes mellitus Hypertension – related to obesity Obesity |
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uterus, what
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atypical polypoid adenomyoma (if lots of fibrosis could call atypical polypoid adenofibroma)
features - Endometrial glands -Squamous morules - Myofibromatous stroma |
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where are atypical polypoid adenomyomas most commonly found
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LUS
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in what age group can you find atypical polypoid adenomyomas
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reproductive age
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what syndrome can atypical polypoid adenomyomas be found
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turners
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uterus, what
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clear cell carcinoma
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uterus, what
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villoglandular endometrial ca
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what histological fx is essential in an endometrial stromal nodule to distinguish it from a sarcoma
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pushing border
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in an undifferentiated endometrial sarcoma, which two of the three following features are most important, necrosis, mitoses or nuclear pleomorphism
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necrosis and nuclear pleomorphism
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what, uterus
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endometrial stromal sarcoma
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ihc for endometrial stromal sarcoma
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Vimentin +
CD 10 + Actin – focally + Desmin – ER / PR +, low grade ESS |
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carcinosarcoma
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Mixture of malignant epithelium and sarcomatous stroma (latter usually predominating)
Homologous component is usually high grade (spindle cells, roundcells or giant cells). May resemble FS or LMS Heterologous - chondrosarcoma, osteosarcoma or RMS |
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of a carcinosarcoma, which component is most likely to metastasize
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Epithelial component of the tumor usually shows the most capability for invasion and metastases
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what, uterus
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adenosarcoma - Epithelial and stromal elements with stromal hypercellularity
● Epithelial component appears benign; glands are usually large and dilated with periglandular stromal cuffing, 80% have cambium layer (stromal condensation) beneath surface epithelium and adjacent to glands (most characteristic histologic feature); mitotic activity and cytologic atypia are more common in this zone ● Epithelium is usually endometrioid but also ciliated, mucinous and even squamous ● Stroma has polypoid or leaf-like projections into glandular lumina, resembling phyllodes tumor of breast |
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prognosis of verrucous ca
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locally invasive, rarely distant metastases, better prognosis,
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for cervix, depth of invasion for scca
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recall, 3mm/5mm/7 mm review
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what is this
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splendore-hoeppli phenomenon - assoc with ab-ag rxn.
means its causing infection |
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really ugly cells - wondering about serous, what stain
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p53
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in heterologous elements of carcinosarcoma, what is the most common type
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rhabdomyosarcoma
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msot common site emosis
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ovary
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how does tb get to ft
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hematogenous
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fallopian tube
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adenomatoid tumor
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fallopian tube, where most common
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ectopic pregnancy, ampulla
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turners for review
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for review
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most common cancers from emosis
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clear cell
secondary endometrioid low grade ESS |
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explain ovarian cysts in choriocarcinoma of uterus
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lutein cysts bilateral
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ovary
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PCOS, stein leventhal
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ovary
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papillary serous cystadenoma
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ovary
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serous borderline
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microinvasion for serous borderline
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<3 mm (10mm length?)
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ovary, significance
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micropapillary serous carcinoma, medusa head; very elongated papillary structures
more likely bilateral, more likely to have surface involvement, more likely to have invasive implants |
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peritoneum
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noninvasive serous papillary implant - superficial, stuck on
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peritoneum
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desmoplastic, noninvasive implant - still superficial
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peritoneum
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invasive serous papillary implant
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ovary
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at least borderline (at least!!)
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ovary
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cystadenofibroma
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ovary
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mucinous cystadenoma, can be among the largest tumors you can get in ovary, intestinal type (more common; worse prognosis if malignancy)
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ovary
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mucinous cystadenoma, endocervical more often associated with emosis
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ovary how far would you go
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mucinous low malignant potential/borderline
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when do you see these
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mucinous tumors - can have sarcomas (elderly, aggressive behavior) or sarcoma-like mural nodules (young, no impact on course, can be osteoclast-like giant cells, spindle cells or histiocytic)
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pseudomyxoma peritoneum source
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extraovarian, look at apx
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keratins in helping with ddx for mucinous tumor in peritoneum
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ck7+CK20+ mucinous ovary
CK7+CK20- other ovarian epithelial CK20+ colon/apx |
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what does pseudomyx. peritonei usually spare
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small intestine
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what does borderline endometrial tumor look like
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complex hyperplasia
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fx of ovarian clear cell ca
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Cells with abundant, pale, vacuolated cytoplasm
Hyaline cytoplasmic inclusions pleomorphic macronucleoli |
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em of what
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clear cell carcinoma, ovary
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ovary
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brenner tumor
groove nuclei/coffee bean borderline: like low grade papillary ue malignant: transitional - if classic brenner, then malignant otherwise transitional - TCC has worse prognosis |
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ovary, note some yellow color
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granulosa cell tumor (malignant)
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ovary
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granulosa cell tumor; malignant, can have mets up to twenty years later
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what in the ddx for granulosa cell tumor
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sertoli leydig cell tumor
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ihc for granulosa cell tumor
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inhibin, CD99, maybe Ck but EMA-
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significance of juvenile granulosa
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no grooves, excellent prognosis, looks scary
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ovary
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granulosa cell tumor
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ovary
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juvenile granulosa cell - scary, no grooves
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ovary
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juvenile granulosa cell tumor
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ovary
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juvenile granulosa cell tumor
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syndrome, ovary
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meigs, fibroma (could have thecoma component - test with oil red o stain)
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oil red o stain, ovary
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looking for thecoma component in fibrothecoma
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ovary
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sertoli-leydig: Leydig cells have abundant eosinophilic or light pink cytoplasm. The Sertoli cells have a pale/clear cytoplasm
most typical is composed of tubules lined by Sertoli cells and interstitial clusters of Leydig cells. |
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ihc in sertoli-leydig
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inhibin-alpha
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ovary, tumor type, what is shown
|
leydig cell tumor, reinke's crystals
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germ cell tumor chart
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just for review
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ovary, classic gross
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cerebriform appearance, dysgerminoma/seminoma
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ovary
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dysgerminoma
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ihc for dysger
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plap
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cytology for dysgerminoma
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tigroid background, fragile
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cytology
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dysgerminoma, tigroid background
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cytology, ovary
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dysgerminoma, tigroid background
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lace like reticular network, neoplasm, ovary
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yolk sac
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schillar duvall bodies
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yolk sac tumor
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ovary
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yolk sac tumor
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ihc yolk sac
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afp
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when pure yolk sac
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young
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when embryonal pue
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really rare
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ovary
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embryonal - necrosis, epithelioid/glandular features
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stains for embryonal
|
beta hcg, afp, keratin and CD30 (!)
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what, ovary or testis
|
polyembryoma - yolk sac tumour and undifferentiated teratoma/embryonal carcinoma, with a characteristic finding of embryoid bodies lying in a loose mesenchymal stroma
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associated syndrome - polyembryoma
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klinefelters
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what % of thyroid tissue is necessary to call struma ovarii
|
50%
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what is struma ovarii assoc
|
pseudoMeigs - most common cause
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what else do you see associated with ovarian teratomas (outside of thyroid)
|
carcinoids
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what, peritoneum, associted with
|
gliomatosis peritonei, teratoma of ovary but not coming "from"
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if this is a teratoma, what should you think
|
not likely benign, most common malignancy in IMMATURE teratoma; neuroectodermal component
in MATURE: scca |
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what, ovary
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immature teratoma
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what ovary/testis
|
immature teratoma
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ovary/testis
|
immature teratoma
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ovary, syndrome
|
gonadoblastoma - mixture of teratoma/sex cord stromal tumors
benign but propensity to malignant transformation |
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ovary
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gonadoblastoma, propensity for malignant transformation
|
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what is a gynandroblastoma
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mix of sex cord stromal tumors containing at least 10% of both male and female sex cord stromal elements (aka sertoli-leydig and granulosa cells)
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ovary, association, age clue
|
small cell carcinoma
hypercalcemia YOUNG (like 20s) if associated with hypercalcemia can be older if not hypercalcemic (postmenopausal) |
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ovary
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small cell carcinoma
|
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hypercalcemia in malignancy
|
lung - squamous cell, clear cell
small cell carcinoma, young, ovary |
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if get carcinosarcoma in ovary, what is the most common heterologous element
if get carcinosarcoma in uterus, what is the most common heterologous element |
in ovary: cartilage
in uterus: rhabdo component |
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ovary
|
carcinosarcoma
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ovary
|
krukenberg tumor, premenopausal, primary gastric/breast/gi tract, pancreas
often bilateral |
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when see amnion nodusum
|
any cause of oligohydramnius
|
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what, placenta
|
placenta accreta - no intervening endometrium
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|
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syncytiotrophoblastic proliferation in complete mole
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all the way around the villi
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where is scalloping seen partial or complete moles or both
|
partial
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