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127 Cards in this Set
- Front
- Back
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this is epithelium invaginates and fuses to form bilateral Mullerian ducts
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Coelmoic epithelium
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Coelomic epithelium gives rise to what structures
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endometrium
fallopian tube mucosa ovarian surface epithelium |
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When the distal portions of the Mullerian ducts fuse they become what structures
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Uterus and upper portion of the vagina
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Coelomic epithelium is derived from which germ layer
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mesoderm
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germ cell are derived from what germ layer
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endoderm
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where are germ cells originally located in the fetus
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yolk sac
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all fetuses start off with what reproductive structure
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Mullerian duct - need MIS to digress this process
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three common organisms associated with PID
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Neisseria gonorrhoeae (#1)
chlamydia actinomyces |
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an ascending infection of the female genital tract characterized by: pain, tenderness, fever, vaginal discharge
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PID
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what two things can PID result in
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female infertility
ectopic pregnancy |
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cysts in these glands located on the medial aspect of the labia minora
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Bartholin gland cyst
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sexually transmitted infection with squamous epithelial proliferation (exophytic) that is non pre-malignant and has koilocytosis (perinuclear cavitation)
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condyloma accuminatum
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which HPV subtypes are associated with condyloma accuminatum
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HPV 6 and 11
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most common malignant neoplasm of the vulva
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squamous carcinoma
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precursor lesions associated with development into squamous carcinoma of the vulva
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vulvar intraepithelial neoplasia (VIN)
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premalignant epithelial changes associated with HPV 16 and 18 and smoking in young women
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VIN
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known as carcinoma in-situ of the vulva
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Bowen's disease
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what are two vulvar epithelial changes seen in older women that are pre-malignant
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lichen sclerosus
squamous hyperplasia |
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associated with atrophy of the over epidermis and underlying chronic inflammation of the vulva in an older woman
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lichen sclerosus
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associated with hyperkeratosis and mild inflammation of the dermis in an older woman
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squamous hyperplasia
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invasive squamous cell carcinoma of the vulva associated with a large fungating mass that does not metastasize
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verrucous carcinoma
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vulva seen with red, elevated, crusted lesions
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extramammary Paget disease
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what is different about the Paget's disease of the vulva than the breast
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Paget's disease in the vulva is only 30% associated with underlying invasive adenocarcinoma
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what do the tumor cells of Paget's disease stain positive for
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Mucin
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this lesion is associated with women whose mothers took diethystilbesterol during pregnancy
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adenosis (vagina)
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what is adenosis associated with
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increased risk for adenocarcinoma of the vagina
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fibroepithelial poly in the vagina
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squamous epithelium overlying edematous myxois stroma with bizarre nuclei
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what are most squamous cell carcinomas of the vagina associated with
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HPV infection
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what part of the vagina does SCC most commonly affect
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upper 1/3 of the vagina
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what must be checked before diagnosis of primary vaginal carcinoma is made
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cervical carcinoma must be excluded first
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what is adenocarcinoma of the vagina associated with
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diethylstilbeserol (DES) exposure
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most common malignant vaginal tumor in children
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sarcoma botryoides (embryonal rhabdomyosarcoma)
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child presents with benign epithelium of the vagina with closely packed spindle-shaped cells underneath that stain positive for desmin
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sarcoma botryoides
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most common location cervical carcinomas develop
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squamocolumnar junction
endocervix - columnar cells ectocervix - squamous cell |
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what is microglandular hyperplasia of the cervix associated with
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birth control pills - progesterone
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obstructed endocervical glands
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nabothian cysts
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risk factors for squamous neoplasia of the cervix
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multiple sex partners
HPV infection smoking |
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differentiate what HPV 16, 18, and 31 are associated with
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16 - precancerous lesions of vulva, vagina, and cervix
18 - adenocarcinoma and small cell carcinomas of the cervix 31 - cervical neoplasia |
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associated with koiocytoic atypia
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squamous cell HPV infection
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accounts for approximately 90% of cervical carcinomas
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invasive carcinoma
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precancerous lesions of the cervix
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cervical intraepithelial neoplasia
I - mild dysplasia II - moderate III - severe dysplasia known as carcinoma in-situ |
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three invasive carcinomas of the cervix
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large cell nonkeratinizing
large cell keratinizing small cell carcinoma |
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most common invasive squamous carcinoma of the cervix
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large cell nonkeratinizing
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how do invasive squamous cell carcinomas spread
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lymphatics
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what is cervical adenocarcinoma associated with
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HPV 18
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what cells are seen in Pap smear
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squamous cells (superficial, intermediate, parabasal)
endocervical endometrial |
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when should endometrial cells not be seen on Pap smear
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after day 12 of cycle
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what else is Pap smear useful for detecting besides cervical dysplasia
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disturbances of endocrine function or assessing effecting of hormonal therapy - best site to sample is lateral vaginal wall
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best site to sample for hormone function during Pap smear
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lateral vaginal wall
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differentiate low and high grade squamous intraepithelial lesions (SIL) on Pap smear
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low grade - associated with mild dysplasia or CIN (I), low risk HPV subtypes
high grade - contain significant parabasal atypia |
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differentiate ASCUS and AGCUS
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ASCUS - atypically squamous cells - most of these are low grade and don't meet criteria for SIL
AGCUS - atypical glandular cells - most have SIL, endometrial, or endocervical lesions |
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functionalis and basalis of the endometrium
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functionalis - upper 2/3 that slough with hormonal variations
basalis - lower 1/3 in which regeneration occurs following menstruation |
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which hormones are involved with proliferation and differentiation of endometrial cycle
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estrogen - proliferation
progesterone - differentiation (gland secretion and stromal predecidualization) |
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part of the endometrial cycle in which the glands become complex with pseudostratified epithelium
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proliferative phase - under estrogen stimulation
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what day of the cycle is associated with subnuclear vacuoles and evidence that ovulation has occurred
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day 17
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what day of the cycle does menstrual phase begin
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day 28
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Arias-Stella reaction (gestational endometrium)
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bizarre hypersecretory changes with nuclear hyperchromatism and pleomorphism
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prolonged unopposed administration of what hormone may result in glandular hyperplasia of the endometrium
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estrogen
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taking this substance results in prominent stromal precedidual changes
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oral contraceptives
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endometrial infection associated with group A streptococi
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acute endometritis
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associated with plasma cells in the endometrium
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chronic endometritis
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4 causes of chronic endometritis
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1. chronic PID
2. TB 3. retained placental fragments 4. IUD |
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most common cause of dysfunctional uterine bleeding
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anovulatory cycles - found near menarche and menopause
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common cause of postmenopausal uterine bleeding
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endometrial polyps
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endometrial glands and stroma occurring outside the uterus
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endometriosus
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3 common locations of endometriosus
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1. ovaries
2. pelvic peritoneum 3. appendix |
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what should you think of in women with dysmenorrhea, pelvic pain, that is infertile
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endometriosus
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general cause for endometrial hyperplasia
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prolonged estrogen levels with decreased/absent progesterone activity
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causes of endometrial hyperplasia
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1. functioning granulosa and theca cell tumors of ovary
2. exogenous estrogen use 3. abnormalities of adrenal cortical function |
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% risk of adenocarcinoma in complex hyperplasia with atypia of the endometrium
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30%
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postmenopausal carcinoma associated with increased estrogen (DM, obesity, HTN, infertility, late menopause)
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endometrioid adenocarcinoma
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what other metaplasia is common in endometrioid carcinomas
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squamous metaplasia - adenosquamous carcinoma
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tumor with mixture of carcinoma and sarcoma in endometrium
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mixed Mullerian tumor
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differentiate homologous and heterolgous Mixed Mullerian tumors
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homologous- sarcoma are tissues normally found in uterus - leiomyosarcoma
heterologous - sarcoma tissues are not normally found in uterus (osteosarcoma, chondrosarcoma, rhabdomyosarcoma) |
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what does prognosis of esdometrial adenocarcinomas depend on
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both grade and stage
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endometrial stroma is present within multiple vascular spaces in the myometrium
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stromal sarcoma
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presence of benign endometrial glands and stroma within myometrium
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adenomyosis
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patients present with pelvic pain, abnormal menstrual bleeding, and dysmenorrhea; enalarged uterus found on exam due to smooth muscle hyperplasia
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adenomyosis
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most common tumor of the uterus
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leiomyoma
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Do leiomyosarcomas tend to arise from preexisting leiomyomas
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No, arise de novo
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acute salpingitis
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fallopian tube infection with chlamydia or gonorrhoeae
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what is chronic salpingitis associated with
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infertility
ectopic pregnancy |
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IUDs are associated with increased risk of PID via what organisms
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actinomyces
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woman presents with amenorrhea, vaginal bleeding, and pelvic pain; what test should be done
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B-hCG to look for ectopic pregnancy
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inflammation of the uterus, fallopian tubes, and/or ovaries
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PID
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ovarian cyst associated with invagination of surface (coelomic) epithelium
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inclusion cyst
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ovarian cysts linked by granulosa cells
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follicular cells
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ovarian cysts lined by luteinized cells that occasionally rupture causing Mittelschmerz
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luteal cysts
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associated with the triad of obesity, hirsutism, and secondary amenorrhea
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polycystic ovaries
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ovarian nodule associated with being yellow and large; mild virilization may be present
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luteoma of pregnancy
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three main groups of ovarian tumors
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1. surface epithelial tumors (#1)
2. sex cord-stromal tumors 3. germ cell tumors |
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differentiate serous and mucinous tumors of the ovary
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serous - more common, epithelium of oviduct (columnar), bilateral, psammoma bodies, serous fluid
mucinous - endocervical mucosa (mucinous), may be much larger, less commonly bilateral |
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what is associated with pseudomyxoma peritonei
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mucinous tumors with borderline histology
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endometriois tumors of the ovary are associated with what
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20-30% of patients have co-existent carcinoma of the endometrium
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what is thought to cause pseudomyxoma peritonei
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appendix is primary tumor, then metastasizes to ovary and peritoneum
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Brenner tumor of ovary
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epithelial nests surrounded by fibrous stroma
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most common functioning tumors in the ovary
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sex cord-stromal tumors
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this ovarian tumor is associated with producing estrogen and having numerous Call-Exner bodies resembling small follicles
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granulosa cell tumor
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Mieg's syndrome
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triad of:
ovarian fibroma ascites right-sided pleural effusion |
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solid yellow ovarian tumor that produces estrogen
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thecoma
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ovarian tumor with spindle cells of stromal origin predominating
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fibroma
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most common ovarian cancers in children
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germ cell tumors
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germ cell tumor associated with children, nests of germ cells (proliferation of ova), and lymphocytes
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dysgerminoma
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most common germ cell tumor
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mature teratoma
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these germ cell tumors contain all three germ cell layers
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mature teratoma
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ovarian tumor associated with secretion of thryoid hormones
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struma ovarii
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immature teratoma
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malignant neoplasm composed of wide variety of tissue elements that tends to metastasize early
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ovarian tumor associated with a-FP and Schiller-Duval body
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endodermal sinus tumor
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ovarian tumor that resembles tissues of the yolk sac microscopically
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endodermal sinus tumor
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these ovarian tumors secrete high levels of hCG
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embryonal choriocarcinoma
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massive enlargement of the ovaries bilaterally with signet ring that stain positive for mucin
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Krukenberg tumor
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common sites that metastisize to the ovary
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breast
GI (Krukenberg) |
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inflammation of the fetal membranes
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chorio-amnionitis
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infection of the umbilical cord, often accompanied by what
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funisitis
chorioamnionitis usually precedes |
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Dizygotic twins always have separate placentas
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**
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monochorionic is associated with what
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monozygotic twins
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abnormal adherence of the placenta to the uterine wall due to absence of decidua basalis
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placenta accreta
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invasion of the myometrium by placental villi
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placenta increta
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implantation of the placenta overlying the cervix, may cause serious bleeding
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placenta previa
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premature separation of the normally situated placenta
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abruptio placentae
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differentiate complete and partial hydatidiform mole
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complete - No embryo present, two parental chromosomes (46XX)
partial - fertilization of an egg by two sperm (69 XXX,XXY) |
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neoplasm of both cytotrophoblast and synctialtrophoblast with no chorionic villi present; hematogenous metastases occur early and are widespread
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choriocarcinoma
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associated with triad of HTN, proteinuria, and edema
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preeclampsia
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associated with HTN, proteinuria, edema, convulsions, and DIC
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eclampsia
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when does preeclampsia typically occur
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during third trimester of first pregnancy
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initiating event for preeclampsia
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placenta ischemia resulting in arterial constriction
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treatment for severe cases of preeclampsia
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delivery
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