Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
109 Cards in this Set
- Front
- Back
|
what are the pathological conditions of the vulva
|
vulvitis
non-neoplastic epithelial disorders tumors |
|
|
what are common eitologies of vulvitis
|
microbes: HPV, HSV, gonorrhea, syphilis
dermatological: contact dermatitis (irritant and allergic form) |
|
|
what are the non-neoplastic conditions of the vulva
|
acanthosis (hyperplasia) or
atrophy of the squamous epithelium lichen sclerosus lichen simplex chronicus |
|
|
what is leukoplakia
|
white plaque of keratin seen on the surface; it can overlie an invasive cancer in gyn; also non specific
|
|
|
what is lichen simplex chronicus
|
thickening of epithelium with keratinization due to "itch scratch itch" cycle
-not preneoplastic has hyperkeratosis and areas of ulcerations due to scratching |
|
|
what is the histological finding of lichen simplex chronicus
|
thickening of the epithelium
hyperkeratosis (thickend layer of keratin) inflammation in a band like pattern in dermis |
|
|
what is lichen sclerosis
|
thinning of epithelium with loss of rete pegs and homogenization of the dermis
|
|
|
what age groups does lichen sclerosus affect
|
all ages, esp postmenopausal women
|
|
|
what is the eitology of lichen sclerosus
|
unknown but believed to be an autoimmune disease since activated T cells are in lesions and pts often have hashimotos thyroditis or hemolytic anemia
|
|
|
lwhich non-neoplastic lesion of the vulva predisposes to cancer
|
lichen sclerosus
|
|
|
what is whitening of vulva due to
|
hyperkeratosis
|
|
|
what are histological finidngs of lichen sclerosus
|
thinning of epithelium
loss of rete pegs in dermis homonigzed dermis band of lymphocytes in dermis |
|
|
what are the neoplastic conditions of the vulva
|
genital warts
vulvar intraepithelial neoplasia (predisposes to cancer) paget's disease vulvar cancer |
|
|
what is paget's disease of the vulva
|
intraepithelial neoplasia of a glandular component; assoc 25% of the time with an invasive carcinoma underlying the epithelium
|
|
|
what virus causes genital warts
|
HPV 6 and HPV 11
|
|
|
what are infectious properties of genital warts
|
older warts less infectious
1-3 month incubation time |
|
|
what is the histological findings of HPV productive infection (genital wart)
|
thickening of epithelium (acanthosis)
perinuclear halos nuclei in squamous epithelium |
|
|
what is the natural hx of genital warts
|
go away unless you are immunosuppressed
|
|
|
which neoplasit conditon of the vulva is a precursor to invasive cancer
|
vulvar intraepithelial neoplasia
|
|
|
what are the two types of VIN
|
one assoc with HPV
none not assoc with HPV |
|
|
what is the usual type of VIN
|
assoc with younger women, high risk HPV (E6/E7), smoking, immunosuppression,
|
|
|
what is the simplex type of VIN
|
assoc with older women, lichen sclerosus, p53 mutations
|
|
|
pts with lichen sclerosus who develop cancer get
|
VIN
|
|
|
histology of VIN usual type
|
perinuclear halos (koilocytes)
multinucleation thickening of the basal cells extening up to epithelium hyperkeratosis |
|
|
histology of VIN simplex/well differentiated type
|
elongation of rete pegs
differentation of rete pegs minimal atypia |
|
|
1/3 of VIN
|
progress to invasive carcinoma
|
|
|
what is the incidence of invasive carcinoma
|
3% of genital cancer; usually in women over 60; most are squamous cell carcinomas
|
|
|
what is the major prognostic indicator for invasive carcinoma
|
size: under 2cm has 75% 5 yr survival
lgr than 2cm has 10% 10 yr survival |
|
|
what is the exocervix
|
the part that is visable to eye with a spectulum
|
|
|
what is the endocervix
|
bridges exocervix and uterus
|
|
|
what is the cell type of the outer cervix
|
stratified squamous epithelia
-a mucosa similar to the vaginal epithelium |
|
|
what is the cell type of the endocervix
|
mucin producing columnar epithelium
|
|
|
what is the squamocolumnar junction
|
where the columnar and stratified squamous meet; can moove throughout life
|
|
|
how does the transformation zone move thoughout life
|
birth and child bearing: a lot of columnar epithelium on outer surface
1yr-menarche: less columnar epithelium on outer surface; only stratified squamous exposed to vagina |
|
|
stratified squamous epithelium exposed to the vagina
|
is more protective than columnar
|
|
|
what is squamous metaplasia
|
when the columnar epithelium gets replaced by stratifed squamous epithelium
|
|
|
what is ectopy
|
columnar epithelium on the exocervix
|
|
|
what is the transfomration zone
|
the area from the orignal SCJ and current SCJ
|
|
|
what is the significance of the transformation zone
|
it consists of immature squamous metaplasia and is the region where cervical intraepithelia neoplasia and cervical cancers develop
-highly susceptible to high risk HPV |
|
|
why are younger women with early sex or first birth more vulnerable to developing cervical cancer
|
they are developing the squamous metaplasia of the transformation zone
|
|
|
what does mature squamous epitheilum look like
|
squamous metaplasia overlying endocervical glands
|
|
|
what are the pathological conditions of the cervix
|
cervicitis (aka vaginitis)
cervical intraepithelial neoplasia invasive carcinoma of cervix |
|
|
what is cervical intraepithelial neoplasia
|
a precursor to invasive cerbical squamous cell and adenocarcinoma
|
|
|
where does cervical intraepithelial neoplasias typically occur
|
transformation zone
|
|
|
what causes CIN
|
infection with a high risk HPV
|
|
|
what are the most common HPV in cervical cancer
|
16
18 |
|
|
what is the natural hx of HPV infections
|
-cervix is exposed
-mild cystological abnormalties as virus replicates which causes cytologic changes in cells -transient infection (abnormalites clear and cervix looks normal) -10% women develop high grade persistant lesions which can lead to cancer |
|
|
what are the classic cytological effects of HPV
|
clearing of cytoplasm
multinucleation perinuclear halos of epitheiul cells (koilocytosis) |
|
|
how do pts clear HPV
|
T cells
|
|
|
HPV can be cleared or
|
possibly kept latent
|
|
|
what characteristics of invasive HPV carcinoma
|
immature basal cells in outer epithelial layer
nuclear enlargement mitosis in epithelium |
|
|
how commonly do pts develop high grade nuclear lesions (CIN2,3)
|
27% if infected with HPV 16 or 18, in 14mths from HPV detection
|
|
|
what is histology of CIN 1
|
productive HPV; HPV cytopathology
|
|
|
what is histology of CIN2
|
more immature
atypical parabasal cells in middle third of epithelium |
|
|
what is histology of CIN3
|
upper third of epithelium has basal cells
|
|
|
what is the bethsda sx of CIN1,2, and 2
|
1 = LSIL
2,3 = HSIL low grade squamous intraepitheali lesions |
|
|
what are the distinguishing features of CNI1 and 2,3
|
1: any HPV type
2,3: high risk HPV 1: prominent koilocytes 2,3: minimal koilocytes 1: variable clonality 2,3: monoclonal 1: polyploid 2,3: monoclonal 1: no AMF 2,3: AMF (abnormal mitotic figures) 1: LOH at tumor suppresor genes uncommon 2,3: LOH common (loss of herterozygosity) |
|
|
what is the most common type of cervical cancer
|
squamous cell carcinoma
|
|
|
why is cervical cancer carcinoma a high cause of cancer death in developing countries
|
lack of screening problem
|
|
|
what are the two vaccine against HPV
|
6, 11, 16, 18 =quadravalent
16,18 = bivalent nonavalent is being developed |
|
|
what are the non-neoplastic conditions of the endometrium
|
-inflammatory conditions
-abnormal loc -iatrogenic endometrium -metaplasias -abnormal uterine bleeding -endometrial hyperplasia |
|
|
what is endometritis
|
an infection of the endometrium
can be a part of PID assoc with retained gestational products (acute), instrumentation and IUD (chronic) acute and chronic form |
|
|
what is endometriosis
|
endometrial stroma, glands, and hemorrahage ectopically located
often multifocal and can involve umbilicus or skin |
|
|
what is the incidence of endometriosis
|
10% women
50% of infertile women |
|
|
what is the clincial manifestations of endometriosis
|
dysmenorrhea
pelvic pain mass |
|
|
what are the 3 eitologies of endometriosis
|
-metaplasia
-regurgation during menses -vascular or lymphatic dissemination |
|
|
what are iatrogenic conditions of the endometrium
|
hormone administration
tamoxifin IUD with chronioc endometriosis |
|
|
endometrium tx with progestational agents leads to what histological finding
|
pseudodecidualization of stroma
glands are small with no secretory activity -decidualization = endometrium transforms into a dense cellular matrix, typically during pregnancy |
|
|
what are three condtions of abnormal bleeding
|
disturbances in mentral function
dysfunctioanl bleeding postmenopausal bleeding |
|
|
what is dysfunctional bleeding
|
abnormal bleeding in absence of organic lesion
esp common in perimenopausal women |
|
|
what are the most common cuases of dysfunctional bleeding
|
anovulatory bleeding (estrogen proliferates endometrium but absence of LH to cause ovulation)
inadequate luteal phase (progesterone isn't enough for normal bleeding) contraceptive induced bleeding endomyometrial disorders |
|
|
an inrregularly developed endometrium can lead to
|
dysfunctional bleeding
|
|
|
what is the histology of irregularly developed endometrium
|
pseudodecudiation of stroma
secretory type glands co-existing with proliferative glands progesterone is not enough for menses |
|
|
what are common causes of postmenopausal bleeding
|
endometrial polyps
leiomyomas endometrial carcinoma endometrial hyperplasia endometritis ovulation |
|
|
endometrial hyperplasia is a precursor to
|
invasive cancer
|
|
|
what are the three types of endometrial hyperplasia
|
simple
complex atypical |
|
|
how is the type of endometrial hyperplasia defined
|
extent of cytologic and architectural atypia
|
|
|
what is the cause of non-atypical forms of endometrial hyperplasia
|
excess of estrogen relative to progestin
|
|
|
how does atypical endometrial hyperplasia arise
|
repeated unopposed estrogen on endometrium leading to complex hyperplasia; other cellular events lead to development of atypical hyperplasia
|
|
|
what is the gross finding of endometrial hyperplasia
|
huge folds of endometrium
|
|
|
what is the histological finidng of endometrial simple hyperplasia
|
dilated proliferative type glands that are irregular and too numerous with pseudostratification
incrd gland stroma ratio and some budding |
|
|
what is the histological finidng of endometrial complex hyperplasia
|
glands don't look normal
some glands have papillary projectiosn into them gland outlines are comples |
|
|
what is the histological finding of endometrial atypical hyperplasia
|
cytological and architectural atypia present
glands cells have abnormal nuceli and chromatin cribriforming (glands withing glands) |
|
|
what is the progression of hyperplasia
|
simple and complex rarley progress to invasive cancer and usually regress as pt b/cms postmenopausal
atypical hyperplasia progress ot cancer |
|
|
what are the endometrial neoplastic disorders
|
endometrial polyps
mesenchymal tumors endometrial carcinomas [stromal lesions and mixed tumors = rare] |
|
|
what drives the formation of uterine leiomyoma
|
estrogen
|
|
|
what is uterine leiomyoma
|
proliferation of smooth muscle cells
occurs in reproductive years 30-50% of women common in blacks |
|
|
how does uterine leiomyoma present
|
bleeding
pain pressure |
|
|
how are leiomyomas tx
|
GnRH agonists
|
|
|
what is the pathogenesis of uterine leiomyoma
|
-have estrogen and progesterone receptors
-monoclonal lesions -assoc with have non-random chromosomal abnormalites (assoc with rhabdomyomas) |
|
|
what is the gross finding of the fibroid uterus
|
distorted by multiple intramural leiomyomas
|
|
|
what is the gross finding of a leiomymo
|
a well demarcated firm mass with a whorled appearance
|
|
|
what is the histological finding of uterine
|
fasciles of smooth muscle cells
no necrosis or atypia b/c benign |
|
|
what is endometrial carcinoma
|
most common gential tract cancer
-uncommon under age 40 -assoc with ERT, obesity, diabetes, HTN, infertility and tamoxifin |
|
|
what is the etiology of endometiral carcinoma
|
exogenous estrogen and estrogen producing ovarian tumors incr risk
(the precurse is complex endometrial hyperplasia) |
|
|
what are the two types of endometrial cancers
|
type I: estrogen excess, perimenopausal women, obesity, endometriod histology, DNArepair and PTEN mutations, low grade, low stage, good survival
type II: occurs in older women, not assoc with estrogen, diabets or obesity, of serous histology (meaning looks like epithelium of fallopian tube like an ovarian cancer), mutations in p53, high grade, high stage, poor prognosis |
|
|
what is the gross finding of endometrial adenocarcinoma
|
a necrotic mass from uterus wall
invades myometrium |
|
|
when does endometrial adenoccarcinoma have a poor prognosis
|
when it invades through the outer half of the myometrium
|
|
|
when does endometiral adenocarcinoma have a better prognosis
|
when it invades through endometrium up to less than half of myometrium
|
|
|
what are the histological characteristics of endometrial adenocarcinoma (type I)
|
well differentiated
back to back glands with little stroma btwn no solid areas difficult to identify stromal invasion so hard to tell if its hyperplasia or carcinoma but back to back glands is sign of carcinoma pseudostratified glands with multiple layers larged prominent nucleoli coarse chromatin |
|
|
what is the histology of uterine serous carcinoma (type II)
|
papillary
looks like ovarian CA high nuclear grade |
|
|
what are the most common diseases of the ovaries
|
infrequent site of significant disease except neoplasms
non-neoplastic cysts common but rarely significant infections are usually secondary to fallopian tube or another structure |
|
|
cysts can form from
|
follicles or corpus luteum or endometrium cysts
|
|
|
what are follicle and luteal cysts
|
-extremely common
-result from unruptured graafian follicles or ruptured follicles that reseal -often multiple and under serosal surface -usually small (1-2cm) |
|
|
gross findings of hemorrhagic cystic follicle
|
several small subcortical follicle cysts
--the follicle ovulated and then there was hemorrhage into the follicle causing enlargement and pain |
|
|
histology of follicular cyst of ovary
|
looks like a normal follicle but enlarged
|
|
|
gross findings of luteal cyst of ovary
|
orange boarder dilated cystic structure
|
|
|
histological findings of luteal cyst
|
luteanized granulosa cells
|
|
|
what is Stein-Leventhal syndrome
|
PCO, oligomenorrhea, persistant anovulation, hirsutism, obesity
|
