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;
241 Cards in this Set
- Front
- Back
|
what is a bartholin cyst?
|
vaginal cyst that results from an obstruction of the Bartholin ducts
not an infection not transmissable |
|
|
what are the complications of a bartholin cyst?
|
secondary infection most commonly with:
1) N. gonorrhoeae 2) Staphylococcus |
|
|
what are vulvar dystrophies?
|
group of disorders of epithelial growth that often present with leukoplakia (white, patch-like lesion)
|
|
|
histologic forms of vulvar dystrophies
|
1) lichen sclerosus and hyperplastic dystrophy (NO MALIGNANT POTENTIAL)
2) atypical hyperplastic dystrophy (PRE-MALIGNANT) |
|
|
clinical characteristics of vulvar dystrophies
|
pruritis (itching)
leukoplakia (white, patch-like lesion; can be a manifestation of several diverse processes & should be biopsied) |
|
|
what is the most common form of vaginitis?
|
candidiasis (caused by C. albicans)
- associated with immunosuppression in various forms |
|
|
what conditions are associated with candidiasis?
|
diabetes mellitus
pregnancy broad-spectrum antibiotics oral contraceptive use immunosuppression |
|
|
what are the characteristics of vaginal candidiasis?
|
- white, patch-like mucosal lesions
- thick, white discharge - vulvovaginal pruritis |
|
|
what is the second most common form of vaginitis?
|
trichomoniasis (caused by Trichomonas vaginalis)
- transmitted by sexual contact |
|
|
what is the most common cause of vaginal discharge?
|
bacterial vaginosis
- caused by Gardnerella vaginalis - characteristic thin, homogeneous vaginal discharge with a malodorous, fishy amine odor (esp. on addition of 10% KOH) |
|
|
what is the cause of bacterial vaginosis?
|
loss of the normal vaginal lactobacilli allows overgrowth of anaerobes (Prevotella bivia, Mobiluncus spp., Peptostreptococcus spp.) and results in superficial polymicrobial vaginal infection
|
|
|
what type of vaginitis accounts for many cases formerly classified as nonspecific vaginitis?
|
bacterial vaginosis
- Gardnerella vaginitis - sexually transmitted |
|
|
what histologic feature is characteristic of bacterial vaginosis?
|
appearance of clue cells (vaginal epithelial cells that have a stippled appearance caused by adherent Gardnerella vaginalis coccobacilli) in Pap smear preparations
|
|
|
toxic shock syndrome
|
- initially associated with the use of highly absorbent tampons
- caused by exotoxin produced by S. aureus, which grows in tampon - presentation: fever, vomiting, diarrhea, generalized rash followed by desquamation - complications: renal failure and hypovolemic shock |
|
|
what are the frequent etiologic agents of pelvic inflammatory disease?
|
N. gonorrhoeae
C. trachomatis enteric bacteria |
|
|
presentation of gonorrhea?
|
- asymptomatic, but infectious
- disease can ascend to infect the endocervix, uterine canal, and fallopian tubes - characterized by purulent acute inflammation, initially of the urethra, paraurethral and Bartholin glands, and Skene ducts |
|
|
extragenital infections associated with Gonorrhea?
|
1) pharyngitis - orogenital sexual contact
2) proctitis - anal intercourse 3) purulent arthritis - one large joint, such as the knee - consequence of blood borne infection 4) ophthalmia neonatorum - neonatal conjunctival infection acquired at delivery |
|
|
what are the two types of chlamydial infections?
|
chlamydial cervicitis (most common STD)
lymphogranuloma venereum |
|
|
what is the most common sexually transmitted disease?
|
chlamydial cervicitis
- caused by certain serotypes of C. trachomatis - frequently causes PID - most often asymptomatic |
|
|
in what geographic location does lymphogranuloma venereum primarily occur?
|
tropics
|
|
|
what is the cause of lymphogranuloma venereum?
|
C. trachomatis L1, L2, or L3 serotypes
|
|
|
presentation and complications of lymphogranuloma venereum
|
presentation: initially, a small papule or ulcer, followed by superficial ulcers and enlargement of regional lymph nodes, which become matted together
complication: rectal stricture as a result of inflammatory reaction and scarring |
|
|
what strain of HSV accounts for the majority of genital herpes cases?
|
HSV type 2
- transmitted by sexual contact |
|
|
presentation of HSV infections
|
small vesicles and shallow ulcers that can involve the cervix, vagina, clitoris, vulva, urethra, and perianal skin
multinucleated giant cells with viral inclusions are found in cytologic smears from lesions |
|
|
syphilis
|
caused by Treponema pallidum, transmitted by sexual contact
primary: firm, painless ulcer (chancre) that is usually not clinically apparent secondary: condyloma lata (gray, flattened, wart-like lesions) latent: no symptoms tertiary: gummas, neurosyphilis, cardiovascular (aortitis) |
|
|
what disease is characterized by Argyll-Robertson pupils?
|
bilateral small pupils that constrict when the person focuses on near objects, but do not constrict when exposed to bright light
characteristic finding in neurosyphilis (tertiary syphilis) |
|
|
what is tabes dorsalis?
|
slow degeneration of the sensory neurons in the dorsal columns (posterior columns) of the spinal cord and carry information that help maintain a person's sense of position (proprioception), vibration, and discriminative touch that carry afferent information
caused by demyelination secondary to untreated syphilis |
|
|
why is syphilis a hazard during pregnancy?
|
Treponema pallidum spirochetes can cross the placenta and result in fetal malformation
|
|
|
Chancroid
|
- caused by Haemophilus ducreyi
- transmitted by sexual contact - most common in tropical areas; rare in US - characterized by a soft and painful ulcerated lesion |
|
|
how does chancroid differ from primary syphilis?
|
the ulcerated lesion of chancroid is soft and painful
the ulcerated chancre of primary syphilis is firm and painless |
|
|
granuloma inguinale
|
- caused by Calymmatobacterium (Donovania) granulomatis (gram-neg rod)
- transmitted sexually - characteristic donovan bodies - initially a papule, which becomes superficially ulcerated and progresses by adjacent lesions coalescing to form large genital or inguinal ulcerations, sometimes with lymphatic obstruction or genital distortion |
|
|
presentation of granuloma inguinale
|
initially a papule, which becomes superficially ulcerated and progresses by adjacent lesions coalescing to form large genital or inguinal ulcerations, sometimes with lymphatic obstruction or genital distortion
|
|
|
what are donovan bodies?
|
large histiocytes filled with multiple Calymmatobacterium (Donovania) granulomatis organisms
characteristic, important histopathologic feature of granuloma inguinale |
|
|
what types of neoplasms affect the vulva?
|
1) papillary hidradenoma
2) condyloma acuminatum 3) squamous cell carcinoma 4) paget disease of the vulva 5) malignant melanoma |
|
|
what is the most common benign tumor of the vulva?
|
papillary hidradenoma
- originates from apocrine sweat glands - presents as a labial nodule that may ulcerate and bleed |
|
|
papillary hidradenoma
|
- originates from apocrine sweat glands
- presents as a labial nodule that may ulcerate and bleed - cured by excision |
|
|
condyloma acuminatum
|
benign squamous cell papilloma caused by HPV types 6 and 11
STD presentation: multiple wart-like lesions (venereal warts) in the vulvovaginal and perianal regions, sometimes on the cervix histology: koilocytes (expanded epithelial cells with perinuclear clearing) |
|
|
what is the most common malignant tumor of the vulva?
|
squamous cell carcinoma
|
|
|
presentation of squamous cell carcinoma
|
- peak occurrence in older women
- often preceded by pre-malignant changes (vulvar intraepithelial neoplasia 1-3) and/or vulvar dystrophy |
|
|
what virus is associated with squamous cell carcinoma of the vulva?
|
HPV type 16, 18, 31, or 33
|
|
|
paget disease of the vulva
|
similar to Paget disease of the breast
sometimes associated with underlying adenocarcinoma of the apocrine sweat glands |
|
|
malignant melanoma of the vulva
|
accounts for 10% of malignant tumors of the vulva
|
|
|
what neoplasms affect the vagina?
|
- squamous cell carcinoma
- clear cell adenocarcinoma - sarcoma botryoides |
|
|
squamous cell carcinoma of the vagina
|
most often caused by extension of squamous cell carcinoma of the cervix
the vagina is infrequently the primary site |
|
|
vaginal clear cell adenocarcinoma
|
- rare malignant tumor of the vagina
- increased incidence in daughters of women who received diethylstilbestrol (DES) therapy during pregnancy - sometimes preceded by vaginal adenosis (a benign condition characterized by mucosal columnar epithelial-lined crypts in areas normally lined by stratified squamous epithelium |
|
|
sarcoma botryoides
|
rare variant of rhabdomyosarcoma that occurs in children younger than 5 years of age
presentation: multiple polypoid masses resembling a "bunch of grapes" projecting into the vagina, often protruding from the vulva |
|
|
what non-neoplastic disorders affect the cervix?
|
erosion
cervicitis cervical polyps |
|
|
cervical erosion
|
columnar epithelium replaces squamous epithelium, grossly resulting in an erythematous area
sometimes a manifestation of chronic cervicitis |
|
|
what part of the cervix is most commonly affected in cervicitis?
|
endocervix
|
|
|
what are the causes of cervicitis?
|
Staphylococci
Enterococci Gardnerella vaginalis Trichomonas vaginalis Candida albicans Chlamydia trachomatis |
|
|
presentation of cervicitis
|
often asymptomatic
may be manifest by cervical discharge most often involves the endocervix |
|
|
cervical polyps
|
inflammatory proliferations of cervical mucosa (NOT TRUE NEOPLASMS)
|
|
|
what portion of the cervix is most often involved in cervical dysplasia/carcinoma in situ?
|
squamocolumnar junction
|
|
|
what virus is strongly associated with cervical dysplasia and carcinoma in situ?
|
HPV types 16, 18, 31, and 33
|
|
|
histology of cervical dysplasia
|
loss of cellular polarity and nuclear hyperchromasia, beginning at the basal layer and extending outward
|
|
|
at what age does the occurrence of invasive cervical carcinoma peak?
|
middle-aged women
|
|
|
what type of cancer is the most common type of invasive cervical carcinoma?
|
squamous cell carcinoma
adenocarcinoma (5%) |
|
|
how does carcinoma most frequently arise?
|
preexisting cervical intraepithelial neoplasia at the squamocolumnar junction
evolves through a series of increasing epithelial abnormalities proceeding from dysplasia to carcinoma in situ and then to invasive arcinoma |
|
|
what has been the effect of the implementation of the papanicolaou screening?
|
caused a striking decrease in the mortality associated with squamous cell carcinoma
|
|
|
epidemiologic factors of invasive cervical carcinomas
|
1) early sexual activity and multiple sexual partners
2) cigarette smoking |
|
|
role of HPV in etiology of invasive cervical carcinomas
|
dysplastic cells frequently demonstrate koilocytosis
HPV sequences are often integrated into genomes of dysplastic or malignant cervical epithelial cells HPV types 16, 18, 31, and 33 are most common viral proteins E6 and E7 bind and inactivate the gene products of p53 and Rb, respectively |
|
|
acute endometritis
|
most often caused by S. aureus or Streptococcus spp.
most often related to intrauterine trauma from instrumentation, IUDs, or complications of pregnancy (postpartum retention of placental fragments) |
|
|
chronic specific (granulomatous) endometritis
|
most often caused by tuberculosis
|
|
|
endometriosis
|
presence and proliferation of ectopic endometrial tissue
caused by retrograde dissemination of endometrial fragments through fallopian tubes during menstruation, with implantation on the ovary or the other peritoneal structures, or blood-borne or lymphatic-borne dissemination of endometrial fragments characteristically responsive to hormonal variations of the menstrual cycle menstrual-type bleeding occurs into the ectopic endometrium, resulting in blood-filled (chocolate) cysts |
|
|
where does endometriosis occur most frequently?
|
pelvic area
1) ovary (most common site) 2) uterine ligaments 3) rectovaginal septum 4) pelvic peritoneum |
|
|
what is the clinical manifestation of endometriosis?
|
severe menstrual-related pain
|
|
|
what is the major complication of endometriosis?
|
infertility
ENDOMETRIOSIS IS NON-NEOPLASTIC AND HAS NO RELATION TO ENDOMETRIAL CANCER |
|
|
adenomyosis
|
islands of endometrium (glands and stroma) within the myometrium
|
|
|
endometrial hyperplasia
|
abnormal proliferation of endometrial glands
usually caused by excess estrogen stimulation and in turn may cause anovulatory cycles, polycystic ovary disease, estrogen-secreting ovarian tumors |
|
|
what is the most common clinical manifestation of endometrial hyperplasia?
|
post-menopausal bleeding
|
|
|
what is the correlation of endometrial hyperplasia with endometrial cancer?
|
endometrial hyperplasia is sometimes the precursor lesion of endometrial adenocarcinoma; risk of carcinoma varies with the degree of cellular atypia
|
|
|
endometrial polyp
|
benign lesion that usually occurs in women older than 40 years of age
may result in uterine bleeding |
|
|
leiomyoma (fibroid)
|
most common uterine tumor
most common of all tumors in women estrogen-sensitive benign neoplasm (malignant transformation is rare) occur in multiple separate foci in most cases increase in size during pregnancy and decrease in size after menopause often manifests as menorrhagia (esp. if subendometrial) |
|
|
leiomyosarcoma
|
infrequently-occurring malignant tumor that arises de novo and is almost never caused by malignant transformation of a leiomyoma
|
|
|
endometrial carcinoma
|
most common gynecologic malignancy
incidence is increasing in association with nulliparity peak occurrence in older women (affected more by endometrial carcinoma than by cervical carcinoma) clinical manifestation: post-menopausal bleeding (often leads to early diagnosis) often preceded by endometrial hyperplasia, esp. higher grade dysplasias |
|
|
predisposing factors for endometrial carcinoma
|
1) prolonged estrogen stimulation (exogenous estrogen therapy or estrogen-producing tumors)
2) obesity 3) diabetes mellitus 4) hypertension |
|
|
how does obesity predispose a woman to endometrial carcinoma?
|
estrone can be synthesized in peripheral adipose tissues and prolonged estrogen stimulation leads to endometrial carcinoma
|
|
|
salpingitis
|
inflammation of the fallopian tubes
most often associated with inflammation of the ovaries and other adjacent tissue (PID) but can be caused by trauma (surgical manipulation) caused by N. gonorrhoeae, anaerobic bacteria, C. trachomatis, Streptococci, and other pyogenic organisms common complications: pyosalpinx or hydrosalpinx or tubo-ovarian abscess |
|
|
pyosalpinx
|
tube filled with pus caused by salpingitis
|
|
|
hydrosalpinx
|
tube filled with watery fluid caused by salpingitis
|
|
|
hematosalpinx
|
bleeding into the fallopian tube
most common cause is ectopic pregnancy |
|
|
what are the types of fallopian tube tumors?
|
adenomatoid tumor (most frequent)
adenocarcinoma (most often results from direct extension or metastasis from tumors originating elsewhere) |
|
|
what are the types of ovarian cysts?
|
1) follicular cyst (caused by distention of unruptured graafian follicle)
2) corpus luteum cyst (caused by hemorrhage into a persistent mature corpus luteum) 3) theca-lutein cyst (caused by gonadotropin stimulation) 4) chocolate cyst (caused by ovarian endometriosis with hemorrhage) 5) polycystic ovary (Stein-Leventhal) syndrome |
|
|
ovarian follicular cyst
|
caused by distention of the unruptured graafian follicle
sometimes associated with hyperestrinism and endometrial hyperplasia |
|
|
corpus luteum cyst
|
results from hemorrhage into a persistent mature corpus luteum
symptomatically associated with menstrual irregularity, occasionally with intraperitoneal hemorrhage |
|
|
theca-lutein cyst
|
results from gonadotropin stimulation
can be associated with choriocarcinoma and hydatiform mole often multiple and bilateral and lined by luteinized theca cells |
|
|
ovarian chocolate cyst
|
blood-containing cyst resulting from ovarian endometriosis with hemorrhage
ovary is the most frequent site of endometriosis |
|
|
Stein-Leventhal syndrome
|
aka polycystic ovary syndrome
characteristically occurs in young women important cause of infertility clinical characteristics: amenorrhea, infertility, obesity, and hirsutism causes: excess LH and androgens associated with insulin resistance with an increased risk of diabetes mellitus; hyperinsulinemia may lead to increased ovarian androgen production, which may in turn lead to increased LH |
|
|
morphologic characteristics of Stein-Leventhal (polycystic ovary) syndrome
|
1) markedly thickened ovarian capsule
2) multiple small follicular cysts containing a granulosa cell layer and a luteinized theca interna 3) cortical stromal fibrosis with islands of focal luteinization |
|
|
what are the ovarian tumors that arise from surface epithelial origin?
|
occur in women older than 20yo
a) serous tumors (serous cystadenoma, serous cystadenocarcinoma) b) mucinous tumors (mucinous cystadenoma, mucinous cystadenocarcinoma) c) endometrioid tumors d) clear cell tumors e) brenner tumors |
|
|
serous cystadenoma
|
benign cystic tumor lined with cells similar to fallopian tube epithelium
approximately 20% of all ovarian tumors and is frequently bilateral |
|
|
serous cystadenocarcinoma
|
malignant tumor
50% of ovarian carcinomas and is frequently bilateral |
|
|
mucinous cystadenoma
|
benign tumor characterized by multilocular cysts lined by mucus-secreting columnar epithelium and filled with mucinous material
|
|
|
mucinous cystadenocarcinoma
|
malignant tumor that can result in pseudomyxoma peritonei through rupture or mets if there are multiple peritoneal tumor implants, all producing large quantities of intraperitoneal mucinous material
|
|
|
pseudomyxoma peritonei
|
most commonly caused by mucinous cystadenocarcinoma of the ovary
can be caused by mucinous cystadenoma, carcinomatous mucocele of the appendix, and other mucinous tumors |
|
|
endometrioid tumors
|
histologically resemble the endometrium
usually malignant |
|
|
clear cell tumors
|
rare ovarian tumors
almost always malignant |
|
|
brenner tumors
|
rare, benign ovarian tumors characterized by small islands of epithelial cells resembling bladder transitional epithelium interspersed within a fibrous stroma
|
|
|
what are the ovarian tumors of germ cell origin?
|
1/4 of ovarian tumors (account for most ovarian tumors occurring in women younger than 20yo)
a) dysgerminoma b) endodermal sinus (yolk sac) tumor c) teratomas d) ovarian choriocarcinoma |
|
|
dysgerminoma
|
malignant ovarian tumor
generally occurs <20yo analogous to testicular seminoma |
|
|
endodermal sinus (yolk sac) tumor
|
ovarian tumor that resembles extraembryonic yolk sac structures
produces alpha-fetoprotein analogous to endodermal sinus tumor of the testis |
|
|
ovarian teratomas
|
characteristically demonstrate 2-3 embryonic layers
immature, mature, and monodermal forms |
|
|
immature ovarian teratoma
|
aggressive malignant tumor that occurs <20yo and demonstrates 2-3 embryonic layers
includes immature cellular elements |
|
|
mature teratoma (dermoid cyst)
|
most frequent benign ovarian tumor
accounts for approximately 20% of ovarian tumors and 90% of germ cell tumors cyst lined by skin, including hair follicles and other skin appendages, bone, teeth, cartilage, GI, neurologic, resp, and thyroid gland tissues radiographically, focal calcifications are visible may arise by reduplication of meiotic maternal chromosomes, giving rise to 46,XX cells of maternal origin |
|
|
monodermal teratoma
|
ovarian cystic tumors that contain only a single tissue element
ex. struma ovarii (entirely thyroid tissue and can cause hyperthyroidism) |
|
|
ovarian choriocarcinoma
|
aggressive malignant tumor
secretes hCG |
|
|
what are the tumors of ovarian sex cord-stromal origin
|
account for a small percentage of ovarian neoplasms
affects women of all ages a) thecoma-fibroma group (fibroma, thecoma) b) granulosa cell tumor c) sertoli-leydig cell tumor |
|
|
ovarian fibroma
|
solid tumor that affects women of all ages
consists of bundles of spindle-shaped fibroblasts Meigs syndrome: triad of ovarian fibroma, ascites, hydrothorax |
|
|
thecoma
|
ovarian tumor that affects women of all ages
demonstrates round lipid-containing cells in addition to fibroblasts occasionally secretes estrogen |
|
|
granulosa cell tumor
|
estrogen-secreting ovarian tumor
causes precocious puberty in children associated with endometrial hyperplasia or endometrial carcinoma in adults |
|
|
histology of granulosa cell tumor
|
consists of small cuboidal, deeply staining granulosa cells arranged in anastomotic cords
call-exner bodies (small follicles filled with eosinophilic secretion) are an important diagnostic feature |
|
|
sertoli-leydig cell tumor
|
aka androblastoma; aka arrhenoblastoma
androgen-secreting ovarian tumor associated with virilism (masculinization) |
|
|
ovarian tumor mets
|
account for about 5% of ovarian tumors
frequently of GI tract, breast, or endometrial origin Krukenberg tumors: ovaries are replaced bilaterally by mucin-secreting signet-ring cells (site of origin is the stomach) |
|
|
Krukenberg tumors
|
ovarian mets in which the ovaries are replaced bilaterally with mucin-secreting signet-ring cells
site of origin: stomach |
|
|
abruptio placentae (placental abruption)
|
premature separation of the placenta
important cause of antepartum bleeding and fetal death often associated with DIC |
|
|
placenta accreta
|
attachment of the placenta directly to the myometrium (decidual layer is defective)
predisposed by endometrial inflammation and old scars from prior C-sections or other surgery manifest clinically by impaired placental separation after delivery, sometimes with massive hemorrhage |
|
|
placenta previa
|
attachment of the placenta to the lower uterine segment, partially or completely covering the cervical os
may coexist with placenta accreta often manifest by bleeding |
|
|
ectopic pregnancy
|
most common location is fallopian tubes; can occur in the ovary, abdominal cavity, or cervix
most frequently predisposed by chronic salpingitis, often gonorrheal; other predisposing factors are endometriosis and postoperative adhesions; frequently no obvious cause most common cause of hematosalpinx; tubal rupture may result |
|
|
toxemia of pregnancy
|
disorder of pregnancy characterized by severe HTN that most often occurs de novo during pregnancy or complicates preexisting hypertensive disease
typically occurs during the third trimester, most often in the first pregnancy, and affects kidneys, liver, and CNS two forms are preeclampsia and eclampsia |
|
|
preeclampsia
|
milder form of toxemia of pregnancy
characterized by HTN, albuminuria, and edema HELLP syndrome: preeclampsia variant that includes Hemolysis, Elevated Liver enzymes, and Low Platelets |
|
|
HELLP syndrome
|
preeclampsia variant that includes Hemolysis, Elevated Liver enzymes, and Low Platelets
|
|
|
eclampsia
|
severe form of toxemia of pregnancy
characterized by HTN, albuminuria, edema, convulsions, and DIC reverses rapidly on termination of pregnancy, but can be fatal |
|
|
amniotic fluid embolism
|
caused by tear in the placental membranes and rupture of maternal veins
characterized by sudden peripartal respiratory difficulty progressing to shock and often death can cause DIC marked by masses of debris and epithelial squamous cells in the maternal pulmonary microcirculation |
|
|
amniotic fluid aspiration syndrome
|
disease of the neonate in which they are unable to expel amniotic fluid at birth
characterized by squamous epithelial cells of amniotic origin in fetal terminal air spaces and larger bronchi frequently associated with prematurity |
|
|
Sheehan syndrome
|
aka postpartum anterior pituitary necrosis
consequence of severe hypotension, most often from blood loss manifested by the insidious onset, over weeks to months following delivery, of anterior pituitary hypofunction |
|
|
chorioamnionitis
|
follows premature rupture of membranes
usually caused by ascending infection from the vagina or cervix |
|
|
what are gestational trophoblastic diseases?
|
disorders characterized by degenerative or neoplastic changes of trophoblastic tissue
a) hydatidiform mole b) gestational choriocarcinoma |
|
|
hydatiform mole
|
manifest by enlarged, edematous placental villi in a loose stroma, grossly resembling a bunch of grapes
marked by diagnostically significant increase in hCG characteristically occurs in early months of pregnancy and eventuates to choriocarcinoma in 2-3% of cases |
|
|
in what conditions is hCG elevated?
|
hydatiform mole
ectopic pregnancy gestational choriocarcinoma germ cell tumors |
|
|
clinical presentation of hydatiform mole
|
vaginal bleeding
rapid increase in uterine size can be mistaken for a normal pregnancy, but uterus is often too large for the supposed state of gestation |
|
|
two variants of hydatiform mole
|
1) complete hydatidiform mole: no embryo is present (46,XX karyotype of exclusively paternal derivation)
2) partial hydatidiform mole: embryo is present (triploidy and rarely tetraploidy occur); thought to be due to fertilization of the ovum by two or more spermatozoa; typically results in 69,XXY |
|
|
gestational choriocarcinoma
|
aggressive malignant neoplasm that occurs more frequently than ovarian choriocarcinoma
increased serum concentration of hCG is an important diagnostic sign characteristics include early hematogenous spread to the lungs responsive to chemotherapy |
|
|
what lesions precede gestational choriocarcinoma?
|
hydatidiform mole (50% of cases)
abortion of ectopic pregnancy (20% of cases) normal-term pregnancy (20-30% of cases) |
|
|
what is the most common disorder of the breast?
|
fibrocystic disease
|
|
|
what is the most common cause of a palpable breast mass in pts between 25 and 50 years of age?
|
fibrocystic disease
uncommon before adolescence or after menopause |
|
|
clinical characteristics of fibrocystic disease
|
usually bilateral lumpy breasts with midcycle tenderness
postulated to result from increased activity of, or sensitivity to, estrogen or to decreased progesterone activity |
|
|
what forms of fibrocystic disease increase the risk of breast cancer?
|
epithelial hyperplasia (with atypia) or sclerosing adenosis carries a slightly increased risk
clear risk of cancer when hyperplastic epithelium demonstrates atypia nonproliferative forms (stromal fibrosis and cyst formation) are not associated with increased risk of breast cancer |
|
|
morphologic characteristics of fibrocystic disease
|
fibrosis of varying extent
cysts (either grossly visible or evident only on histologic examination) that may be fluid filled, which may appear blue when seen through the cyst wall (blue dome cyst) epithelial changes - flattened epithelial lining, may show apocrine metaplasia, or may be hyperplastic - hyperplastic epithelium may show varying degrees of cellular atypia |
|
|
what is breast adenosis? how does it differ from sclerosing adenosis?
|
proliferation of small ducts and myoepithelial cells
becomes sclerosing adenosis when the proliferation is combined with fibrosis |
|
|
fibroadenoma of the breast
|
most common breast tumor in women <25yo
entirely benign (not pre-cancerous) firm, rubbery, painless, well-circumscribed lesion delicate fibrous stroma encloses the epithelial component consisting of gland-like or duct-like spaces lined by cuboidal/columnar cells |
|
|
two types of breast fibroadenoma
|
intracanalicular fibroadenoma (stroma compresses and distorts glands into slitlike spaces)
pericanalicular fibroadenoma (glands retain round shape) |
|
|
what is the most common breast tumor in women <25yo?
|
fibroadenoma
|
|
|
phyllodes tumor
|
large, bulky mass of variable malignancy with ulceration of overlying skin
cystic spaces containing leaf-like projections from the cyst walls and myxoid contents are characteristic |
|
|
adenoma of the nipple
|
presents with serous or bloody discharge and a palpable mass
can be mistaken for malignancy |
|
|
intraductal papilloma
|
benign tumor of the major lactiferous ducts that must be distinguished from carcinoma
clinically manifest by serous or bloody discharge from the nipple |
|
|
carcinoma of the breast
|
second most common malignancy in women, behind carcinoma of the lung
most common cause of a breast mass in postmenopausal patients occurs most frequently in the upper outer breast quadrant |
|
|
what is the second most common malignancy of women?
|
carcinoma of the breast
first is carcinoma of the lung |
|
|
what is the most common cause of a breast mass in postmenopausal patients?
|
carcinoma of the breast
|
|
|
what are the common sites of metastases for carcinoma of the breast?
|
axillary lymph nodes
lung liver bone |
|
|
what histologic type of breast carcinoma occurs most frequently?
|
invasive ductal carcinoma
|
|
|
what are the prognostic indicators for breast carcinoma?
|
demonstration of estrogen and progesterone receptors is correlated with a better prognosis and is thought to be a predictor of the efficacy of antiestrogen therapy
type and size of tumor extent of lymph node involvement DNA ploidy hyperexpression of c-erbB2 (HER-2/neu) is associated with a poorer prognosis |
|
|
what are the predisposing factors for breast cancer?
|
old age
family history hx of breast cancer in one breast early menarche/late menopause obesity nulliparity first pregnancy after 30yo high animal fat content in diet proliferative fibrocystic disease with atypical epithelial hyperplasia |
|
|
histologic characteristics of intraductal carcinoma in situ (comedocarcinoma)
|
tumor cells fill ducts
tumor cell necrosis results in a cheese-like consistency |
|
|
histologic characteristics of invasive ductal carcinoma (scirrhous carcinoma)
|
most common type
characterized by tumor cells arranged in cords, islands, and glands embedded in a dense fibrous stroma abundant fibrous tissue results in firm consistency |
|
|
characteristics of paget disease of the breast
|
eczematoid lesion of the nipple or areola
neoplastic Paget cells (characteristic large cells surrounded by a clear halo-like area) invade the epidermis underlying ductal carcinoma almoast always present |
|
|
histologic characteristics of lobular carcinoma in situ
|
clusters of neoplastic cells fill intralobular ductules and acini
may lead to invasive carcinoma (often many years later) in the same or contralateral breast often bilateral at the time of initial diagnosis |
|
|
histologic characteristics of invasive lobular carcinoma
|
often multicentric or bilateral
tends to have cells arranged in a linear fashion (indian-file appearance) better prognosis than that for invasive ductal carcinoma |
|
|
histologic characteristics of mucinous (colloid) carcinoma
|
pools of extracellular mucus surrounding clusters of tumor cells
gelatinous consistency prognosis is better than that for invasive ductal carcinoma |
|
|
histologic characteristics of inflammatory carcinoma of the breast
|
lymphatic involvement of the skin by the underlying carcinoma, causing red, swollen, hot skin resembling and inflammatory process
poor prognosis |
|
|
what bacteria most frequently causes Bartholin gland abscesses?
|
Neisseria gonorhoeae
|
|
|
lichen sclerosis
|
thinning of the epidermis of the vulva (gives a parchment-like appearance to the skin)
usually occurs in post-menopausal women small risk for developing into squamous cell carcinoma |
|
|
lichen simplex chronicus
|
white plaque-like lesion (leukoplakia) on the vulva caused by squamous cell hyperplasia
small risk for developing squamous cell carcinoma |
|
|
papillary hidradenoma
|
benign tumor of an apocrine sweat gland of the vulva that presents as a painful nodule on the labia majora (there are no hair follicles on the labia minora, so it can't occur here)
|
|
|
vulvar intraepithelial neoplasia (VIN)
|
dysplasia ranges from mild to carcinoma in situ
strong association with HPV type 16 frequently develops into squamous cell carcinoma |
|
|
squamous cell carcinoma of the vulva
|
most common cancer of the vulva
risk factors: HPV type 16 or 18, smoking cigarettes, immunodeficiency metastasizes first to the inguinal nodes |
|
|
extramammary Paget's disease
|
red, crusted vulvar lesion
intraepithelial adenocarcinoma - tumor derives from primitive epithelial progenitor cells - malignant Paget's cells contain mucin (which is PAS-positive) - spreads along the epithelium (rarely invades dermis) |
|
|
malignant melanoma of the vulva
|
melanoma cells are histologically similar to Paget's cells, but are PAS-negative
|
|
|
Calymmatobacterium (Donovani) granulomatis
|
gram-neg coccobacillus that causes granuloma inguinale
transmitted by sexual contact organism is phagocytized by macrophages (Donovan bodies) presents as a creeping, raised sore that heals by scarring; no lymphadenopathy Tx: doxycycline or trimethoprim-sulfamethoxazole |
|
|
Candida albicans
|
yeasts and pseudohyphae that are part of the normal vaginal flora and account for the second most common cause of vaginitis
presents as a pruritic vaginitis with a white discharge and a fiery red mucosa Tx: fluconazole (single dose) risk factors: diabetes mellitus, antibiotics, pregnancy, oral contraceptive pills |
|
|
Chlamydia trachomatis
|
STD that often coexists with N. gonorrhoeae (45% of cases)
incubation period is 7-12 days after exposure in males, causes NSU (sterile pyuria), epididymitis, and proctitis in females, causes urethritis (sterile pyuria), cervicitis, PID, perihepatitis, bartholin gland abscess in newborns, causes conjunctivitis (ophthalmia neonatorum) and pneumonia DNA probe test for quick dx Tx: azithromycin (single 1g dose); doxycycline |
|
|
life cycle of C. trachomatis
|
incubation period of 7-12 days after exposure
red inclusions (reticulate bodies) are found in infected metaplastic squamous cells reticulate bodies divide to form elementary bodies, which are the infective bodies |
|
|
lymphogranuloma venereum
|
STD caused by C. trachomatis subspecies
presents as papules with no ulceration; inguinal lymphadenitis with granulomatous microabscesses and draining sinuses lymphedema of scrotum or vulva (women may also develop rectal strictures) Tx: doxycycline |
|
|
Gardnerella vaginalis
|
gram-negative rod that causes bacterial vaginosis
most common cause of vaginitis presents with a malodorous vaginal discharge and a vaginal pH > 4.5; causes increased incidence of preterm delivery and low birth weight organisms adhere to squamous cells producing "clue cells" Tx: metronidazole (same tx in pregnancy) |
|
|
Haemophilus ducreyi
|
gram-negative rod that causes chancroid
male dominant disease with high incidence of HIV incubation period of 4-7 days and then presents as painful genital and perianal ulcers with suppurative inguinal nodes dx with gram stain (school of fish appearance) and culture tx: ceftriaxone or azithromycin (single 1g dose) |
|
|
HSV-2
|
virus remains latent in sensory ganglia
presents as recurrent vesicles that ulcerate (locations: penis, vulva, cervix, perianal area) - dx with Tzanck smear baby delivered by c-section if virus is shedding in mother tx: acyclovir (decreases recurrences) |
|
|
tzanck smear
|
scrapings removed from the base of an ulcer
see multinucleated squamous cells with eosinophilic intranuclear inclusions |
|
|
HPV
|
types 6 & 11 are associated with condyloma acuminata (venereal warts; fernlike or flat lesions in genital areas)
types 16 & 18 are associated with dysplasia and squamous cancer most common overall STD (80% of sexually active women have acquired by age 50) vaccine decreases risk for developing cervical cancer tx: topical podophyllin; alpha-IFN injection; imiquimod cream |
|
|
histologic appearance of HPV
|
virus produces koilocytic change in squamous epithelium
cells have wrinkled pyknotic nuclei surrounded by a clear halo approximately 90% spontaneously clear within 2 yrs (most within 8 months); older women will more often have persistent disease |
|
|
Neisseria gonorrhoeae
|
gram-negative diplococcus that infects glandular or transitional epithelium
sx appear 2-7 days after sexual exposure complications include ectopic pregnancy, male sterility, disseminated gonococcemia (C6-C9 deficiency risk factor), septic arthritis, FHC syndrome DNA probe test for dx Tx: ceftriaxone |
|
|
FHC syndrome
|
scar tissue between peritoneum and surface of liver from pus from PID
complication of C. trachomatis and N. gonorrhoeae infections |
|
|
disseminated gonococcemia
|
disseminated infection with N. gonorrhoeae
septic arthritis (knee) tenosynovitis (hands, feet) pustules (hands, feet) more common in women than in men |
|
|
Treponema pallidum
|
gram-negative spirochete that causes syphilis
nonspecific screening tests: RPR or VDRL (titers dec. after tx) confirmatory test: FTA-ABS (positive w/ or w/o tx) tx: penicillin |
|
|
stages of syphilis
|
primary syphilis: solitary, painless, indurated chancre on penis, labia, or mouth
secondary syphilis: maculopapular rash on trunk, palms, soles with generalized lymphadenopathy, condylomata lata (flat lesions in same areas as condylomata acuminata), and alopecia tertiary syphilis: neurosyphilis, aortitis, gummas |
|
|
Jarisch-Herxheimer reaction
|
intensification of the rash of primary or secondary syphilis that occurs due to proteins released from dead T. pallidum spirochetes after tx with penicillin
|
|
|
Trichomonas vaginalis
|
flagellated protozoan with jerky motility
produces vaginitis, cervicitis, and urethritis presents as a strawberry colored cervix and fiery red vaginal mucosa; greenish, frothy discharge from vagina tx: metronidazole (must treat both partners) |
|
|
Rokitansky-Kuster-Hauser (RKH) syndrome
|
absence of the upper vagina and uterus
causes primary amenorrhea |
|
|
Gartner's duct cyst
|
remnant of the wolffian (mesonephric) duct
presents as a cyst on the lateral wall of the vagina |
|
|
rhabdomyoma
|
benign vaginal tumor of skeletal muscle
other locations are the tongue and heart |
|
|
embryonal rhabdomyosarcoma
|
tumor of the vagina that occurs in girls <5yo
presents as a necrotic, grape-like mass that protrudes from the vagina |
|
|
clear cell adenocarcinoma of the vagina
|
rare (1:1000) vaginal cancer that occurs in women with intrauterine exposure to diethylstilbestrol (DES), which was used to prevent a threatened abortion
DES inhibits mullerian differentiation of the fallopian tubes, uterus, cervix, and upper 1/3 of vagina vaginal adenosis is a precursor lesion - remnants of mullerian glands that produce red, superficial ulcerations in the upper portion of the vagina can affect upper vagina or cervix |
|
|
histology of clear cell adenocarcinoma of the vagina
|
clear, vacuolated cells with ill-defined glandular spaces
|
|
|
what abnormalities are associated with intrauterine diethylstilbestrol (DES) exposure?
|
vaginal clear cell adenocarcinoma
abnormally shaped uterus that thwarts implantation cervical incompetence that causes recurrent abortions |
|
|
vaginal squamous cell carcinoma
|
primary squamous cell carcinoma has an association with HPV type 16
most cancers are an extension of a cervical squamous cancer into the vagina |
|
|
clinical anatomy and histology of the cervix
|
cervix includes the endocervix and exocervix (begins at the cervical os)
exocervix is normally lined by squamous epithelium endocervical glands are normally lined by mucus-secreting columnar cells endocervical epithelium normally migrates down to the exocervix - exposure to the acid pH of the vagina produces squamous metaplasia |
|
|
cervical transformation zone
|
site where squamous dysplasia and cancer develop
|
|
|
acute cervicitis
|
acute inflammation of the cervix, normally present in the transformation zone
causative agents: C. trachomatis, N. gonorrhoeae, T. vaginalis, C. albicans, HSV-2, HPV clinical findings: VAGINAL DISCHARGE, pelvic pain, dyspareunia, painful on palpation, bleeds easily when obtaining cultures, cervical os is erythematous and may be covered by exudate |
|
|
diagnosis for acute cervicitis
|
DNA probe for C. trachomatis and N. gonorrhoeae (>50% of acute cervicitis)
wet mount T. vaginalis obtain a cervical Pap smear |
|
|
treatment for acute cervicitis
|
if culture or DNA probe is positive, treat with appropriate antibiotic
if culture is negative, cryosurgery is an option advise safe sex with the use of condoms |
|
|
chronic cervicitis
|
occurs when acute cervicitis persists
|
|
|
follicular cervicitis
|
caused by C. trachomatis
pronounced lymphoid infiltrate with germinal centers chlamydia infects metaplastic squamous cells cervicitis is the primary source of conjunctivitis and pneumonia in newborns |
|
|
what is the primary source of chlamydia conjunctivitis and pneumonia in newborns?
|
cervicitis
|
|
|
what does it look like when C. trachomatis infects metaplastic squamous cells?
|
cells contain vacuoles with red inclusions (reticulate bodies)
reticulate bodies develop into elementary bodies, which are the infective particles |
|
|
purpose of the cervical pap smear
|
screening test to rule out squamous dysplasia and caner
evaluate the hormone status of the patient |
|
|
sample sites for cervical pap smear
|
vagina
exocervix transformation zone (site for squamous dysplasia and squamous cancer, therefore must be adequately sampled) |
|
|
interpretation of pap smear
|
superficial squamous cells indicate adequate estrogen
intermediate squamous cells indicate adequate progesterone parabasal cells indicate a lack of estrogen and progesterone normal nonpregnant adult woman: 70% superficial squamous cells, 30% intermediate squamous cells pregnant women: 100% intermediate squamous cells from progesterone effect elderly women with lack of estrogen & progesterone: atrophic smear with parabasal cells and inflammation woman with continuous exposure to estrogen w/o progesterone: 100% superficial squamous cells |
|
|
epidemiology of cervical (endocervical) polyps
|
non-neoplastic polyp that protrudes from the cervical os (NOT CANCEROUS OR PRE-CANCEROUS)
arises from the endocervix, NOT the cervix most commonly present in perimenopausal women and multigravida women; most commonly 30-50yo |
|
|
pathogenesis of cervical (endocervical) polyps
|
essentially unknown
inflammation, trauma, pregnancy have been implicated |
|
|
clinical findings and tx of cervical (endocervical) polyps
|
postcoital bleeding
vaginal discharge surgical excision |
|
|
epidemiology of cervical intraepithelial neoplasia (CIN)
|
majority of cases are associated with HPV (6&11 are low risk; 16&18 are high risk)
peak incidence is 35 yo risk factors: early age of onset of intercourse, multiple/high-risk partners, high-risk types of HPV in biopsy, smoking, OCPs, immunodeficiency |
|
|
how does HPV look in squamous cells?
|
produces koilocytosis (clear halo containing a wrinkled, pyknotic nucleus)
|
|
|
classification of CIN
|
CIN I: mild dysplasia involving the lower 1/3 of the epithelium
CIN II: moderate dysplasia involving the lower 2/3 of the epithelium CIN III: severe dysplasia to CIS involving the full thickness of the epithelium |
|
|
progression from CIN I to CIN III
|
NOT inevitable
reversal to normal is more likely in CIN I requires about 10 years to progress from CIN I to CIN III requires about 10 years to progress from CIN III to invasive cancer (average age for cervical CA is about 45yo) |
|
|
clinical findings of cervical intraepithelial neoplasia (CIN)
|
dysplasia is not usually visible to the naked eye; colposcopy is required (occasionally, flat to warty appearing condyloma acuminata are visible)
colposcopy findings, after application of acetic acid: acetowhite areas with punctation, mosaic pattern, or abnormal vascularity |
|
|
Tx for CIN
|
electrocoagulation
cryotherapy laser ablation local surgery (conization) |
|
|
epidemiology of cervical cancer
|
least common gynecologic cancer b/c of early detection of CIN with Pap smears
higher incidence in developing countries incidence in descending order: hispanic, black, white majority are SCC (75-80%) same causes and risk factors as for CIN |
|
|
clinical findings of cervical cancer
|
abnormal vaginal bleeding (most common), usually postcoital
malodorous vaginal discharge |
|
|
characteristics of cervical cancer
|
extends down into the vagina
extends out into the lateral wall of the cervix and vagina infiltrates the bladder wall and obstructs the ureters, causing postrenal azotemia leading to renal failure (leading COD) distant mets, e.g. lungs |
|
|
treatment of invasive cervical cancer
|
surgery, radiation, or both
chemotherapy in selected cases prognosis: 1YS is 88%, 5YS is 72% |
|
|
sequence of menarche
|
1. breast budding (thelarche)
2. growth spurt 3. pubic hair 4. axillary hair 5. menarche - mean age of 12.8 yrs - anovulatory cycles for 1-1.5 yrs |
|
|
phase sequence in the normal menstrual cycle
|
1. proliferative (follicular) phase
2. ovulation 3. secretory phase 4. menses |
|
|
proliferative (follicular) phase of normal menstrual cycle
|
estrogen-mediated proliferation of glands
most variable phase of the menstrual cycle estrogen surge occurs 24-36 hrs before ovulation - stimulates LH release (positive feedback) - stimulates FSH release (positive feedback on FSH & LH; LH > FSH) - LH surge initiates ovulation |
|
|
ovulation in normal menstrual cycle
|
occurs btwn days 14 & 16
indicators: - inc. in body temp (b/c of progesterone) - subnuclear vacuoles in endometrial cells - mittelschmerz (b/c of peritoneal irritation from blood of ruptured follicle) |
|
|
secretory phase of normal menstrual cycle
|
progesterone-mediated
least variable phase of the cycle increased gland tortuosity and secretion edema of stromal cells |
|
|
changes in the secretory phase after fertilization has occurred
|
fertilization usually occurs in the ampullary portion of the fallopian tube
fertilized egg spends 3 days in the fallopian tube and then 2 days in the uterine cavity before it implants in the endometrial mucosa on day 21 exaggerated secretory phase occurs in pregnancy; this is called the Arias-Stella phenomenon |
|
|
what is the Arias-Stella phenomenon?
|
the exaggerated secretory phase that occurs during pregnancy
|
|
|
in fertility workups, when are endometrial biopsies performed? why?
|
day 21
performed to see if ovulation has occurred presence of secretory endometrium on day 21 confirms that ovulation has occurred |
|
|
menses
|
initiated by drop-off in serum levels of estrogen and progesterone
- signal for the endometrial cells to undergo apoptosis plasmin prevents menstrual blood from clotting (excess clotting is a sign of menorrhagia) |
|
|
why do newborn baby girls commonly have vaginal bleeding?
|
they have a sudden drop of maternal hormones with delivery
|
|
|
functions of FSH
|
a. prepares the follicle of the month
b. increases aromatase synthesis in granulosa cells c. increases the synthesis of LH receptors |
|
|
functions of LH
|
a. in the proliferative phase:
- inc. the synthesis of 17-ketosteroids in theca interna - DHEA is converted to androstenedione - oxidoreductase converts androstenedione to testosterone - testosterone enters granulosa cells and is aromatized to estradiol b. LH surge is induced by a sudden inc. in estrogen (ovulation occurs when LH > FSH) c. in the secretory phase: - theca interna primarily synthesizes 17-hydroxyprogesterone |
|
|
hormone changes in pregnancy
|
human chorionic gonadotropin (hCG)
- synthesized in the syncytiotrophoblast lining the chorionic villus - acts as an LH analogue by maintaining the corpus luteum of pregnancy - corpus luteum synthesizes progesterone for 8-10 weeks corpus luteum involutes after 8-10 weeks - placenta synthesizes progesterone for the remainder of the pregnancy - spontaneous abortion may occur if placental production of progesterone is inadequate |
|
|
oral contraceptive pills (OCPs)
|
mixture of estrogen and progestins (progesterone)
- baseline levels of estrogen prevent the midcycle estrogen surge, thereby preventing the LH surge and ovulation - progestins arrest the proliferative phase and cause gland atrophy - progestins inhibit LH, which also prevents he LH surge OCPs render the cervical mucus hostile to sperm OCPs alter fallopian tube motility |
|
|
estradiol
|
primary estrogen in nonpregnant women
derived from aromatization of testosterone in granulosa cells |
|
|
estrone
|
weak estrogen produced during menopause
derived from adipose cell aromatization of androstenedione - androstenedione is synthesized by the adrenal cortex |
|
|
estriol
|
end-product of estradiol metabolism
primary estrogen of pregnancy - derived from fetal adrenal glands, placenta, and maternal liver |
|
|
androstenedione
|
equally derived from ovaries and adrenal cortex
|
|
|
DHEA
|
mainly synthesized in the adrenal cortex (80%)
remainder is synthesized in the ovaries |
|
|
DHEA-sulfate
|
almost exclusively synthesized in the adrenal cortex
|
|
|
testosterone
|
derived from conversion of androstenedione to testosterone
synthesized in the ovaries and adrenal glands peripherally converted to dehydroxytestosterone |
|
|
sex hormone-binding globulin (SHBG)
|
binding protein for testosterone and estrogen
- synthesized in the liver in both men and women - synthesis increased by estrogen - androgens, obesity, hypothyroidism dec. synthesis greater binding affinity for testosterone than estrogen - inc. SHBG decreases free testosterone - dec. SHBG increases free testosterone (common cause of hirsutism in women) |
|
|
follicular cervicitis
|
caused by C. trachomatis
pronounced lymphoid infiltrate with germinal centers chlamydia infects metaplastic squamous cells cervicitis is the primary source of conjunctivitis and pneumonia in newborns |
