Pathology Iii: Notes: Gynopathology

Front 1

condyloma accuminata

Back 1

wartlike lesions, vulva, vagina, cervix.

assoc. w/ HPV 6, 11.

Mic: Koilocytosis: vacuolization around nucleus, acanthosis, hyperkeratosis, parakeratosis

Front 2

Papillary hidradenoma

Back 2

benign tumor, along milk line, histo similar to intraductal papilloma.

Front 3

Extramammary Paget Dz of vulva

Back 3

usually labia majora

Micro: intraepidermal malignant cell with pagetoid cells

Front 4

Vaginal adenosis and clear cell carcinoma of vagina

Back 4

Rare, assoc w/ DES exposure in utero

Front 5

Sarcoma botryoides (embryonal rhabdomyosarcoma (vagina)

Back 5

infants and children
gross: poypoid, "grape like" soft tissue protruding from vagina

Micro: cells with cross-striations (strap cells).

grow underneath vaginal epithelium.

POS for "desmin" marker!

Front 6

PID (cervix)

Back 6

ascending infection, usually STD (gonorrhea and/or chlamydia).

Endometritis, salpingitis, pelvic abscess

Front 7

Fitz-Hugh-Curtis Syndrome

Back 7

aka perihepatitis, characterized by violin-string adhesion between fallopian tube and the liver capsule SEEN IN PID.

Front 8

Complications of PID

Back 8

tubo-ovarian abscess, tubal scarring resulting in infertility and ectopic tubal preg. Also intestinal obstruction

Front 9

Icidence of Cancer

Back 9

Endometrial > Ovarian > Cervical

Front 10

Mortality

Back 10

Ovarian > endometrial > cervical

Cervical number one in the world.

Front 11

Cervical carcinoma

Back 11

Risky behavior (sex) of contracting HPV, smoking, STD's, immunosupression.

Peaks in the 40's.

Front 12

HPV

Back 12

High risk ones are Type 16, 18, 31, 33, 45.

E6 binds p53
E7 binds Rb

Front 13

Progression of Cervical Squamous cell carcinoma

Back 13

CIN (cervical Interaepithelia Neopplasia): CIN I (mild dysplasia), CIN II: moderate, CIN III Severe, CIS (in situ) and then invasion of basement membrane.

Front 14

Cervical Cancer: Clinical presentation

Back 14

Postcoital (after sexual untion) vaginal bleeding, pain during intercourse (dyspareunia), malodorous discharge, or asymptomatic.

Front 15

Endometritis

Back 15

Chronic: PLASMA cell in endometrium (should not be normally there). Assoc w/ PID, IUDs etc.

Acute: ascending infection from cervix, preg, abortion.

Front 16

Endometriosis

Back 16

presence of endometial stroma and glands outside the uterus. commonly in ovary, pouch of douglas behind uterus,.

Gross: ovarian "CHOCOLATE" cyst.

red brown serosal nodules: "poweder burn".

Front 17

Endometriosis: clinical presentation

Back 17

chronic pelvic pain, dysmenorrhea, dyspareunia, infertility, rectal pain, constipation.

Front 18

Leiomyoma (fibroids)

Back 18

most common tumor of genital tract in females.

Huge in African Americans. responsive to Estrogen.

"rubbery white tan appearance, well circumcised, multiple".

"Whorl-like trabeculated appearance on cut section."

may goto Leiomyosarcoma

Front 19

Endometrial carcinoma

Back 19

Most common malignant tumor. common in POST-MENOPAUSAL females.

risk factors: nulliparity, obesity, estrogen RT, tamoxifen, E2 producing ovarian tumors (granulosa cell tumors).//

Front 20

Lynch Syndrome

Back 20

colon, endometrial and Ovarian cancers.

Front 21

Endometrial carcinoma: gross and CP

Back 21

Clin Presentation: Post-menopausal bleeding.

Gross: polypoid, TAN

Most common type: Endometriod adenocarcinoma

Front 22

Polycystic Ovarian Dz

Back 22

aka Stein-Leventhal Syndrome

benign, bilateral, follicular cysts.

young female, oligo, amenorrhea, hirsuitism, infertility, obesity.

Lab: high LH, Low FSH, High Testosterone

Tx: with BC or Provera

Front 23

Epithelial Ovarian Tumors

Back 23

Most common form of Ovarian tumor.

1. Cystadenoma: benign, unilocular, simply serous or mucous. can be MASSIVE

2. borderline tumors: low malignant potential

3. Cystadenocarcinoma: most common malignant ovarian tumor.

Front 24

Cystadenocarcinoma

Back 24

complex multioculated cysts, nodular and solid areas.

Micro: papillary structures with PSAMOMMA BODIES, stromal invasion.

Spread via seeding peritoneal cavity.

Front 25

Heridatary risk factors: cystadenocarcinoma of ovary

Back 25

BRCA-1, Lynch Syndrome

Marker: **CA 125**.

Presenation: vague, late presenation

Front 26

Ovarian Germ cell tumors

Back 26

Teratoma, Dysgerminoma, Yolk sac tumor, choriocarcinoma

Front 27

Teratoma of ovary

Back 27

aka dermoid cysts. Have all three germ cell components, mostly benign, common in younger women.

May have hair, teeth, bone, cartillage etc.

Front 28

Struma Ovarii

Back 28

preponderonce of thyroid tissue in teratoma, causes hyperthyroidism

Front 29

immature teratoma

Back 29

some elements are immature and is troublesome because it can become malignant via transformation.

Front 30

Complications: teratoma

Back 30

torsion, rupture, malignant tranformation (1%) usually SCC.

Front 31

Dysgerminoma

Back 31

female equivalent of seminomas.//

young adults, radiosensitive.

High risk in: Turner syndrome, pseudohermaphrodites.//

Front 32

Ovarian Sex-cord stromal tumors

Back 32

ovarian fibroma, granulosa cell tumor, sertoli-leydig cell tumor (androblastoma)

Front 33

Ovarian fibroma

Back 33

firm, WHITE masses, most common stromal tumor

may present as Meigs syndrome

Front 34

Meig syndrome

Back 34

fibroma + ascites + pleural effusion (right-sided)

Front 35

Granulosa cell tumor

Back 35

potentially malignant, CAN PRODUCE ESTROGEN.

precocious puberty, irregular cycles,

Postmenopausal; bleeding again.

Gross: YELLOW white mass.

Micro: polygonal tumor cells, follicle like structure (CALL-EXNER BODIES)

complication: endometrial hyperplasia, and cancer.

Front 36

sertoli-leydig cell

Back 36

ANDROGEN producing., risk of pseudohermaphrodite offspring, virilization

Front 37

Metastatic tumors of ovary

Back 37

KRUKENBERG tumor: a metastatic carcinoma of the ovary, usually bilateral and secondary to a mucous carcinoma of the stomach, which contains signet-ring cells filled with mucus.breast, colon, endometrial.

Front 38

Gestational Trophoblastic Disease

Back 38

Hydatidiform mole (molar pregnancy), invasive moles, choriocarcinoma.

Front 39

Hydatidiform Mole (molar pregnancy)

Back 39

tumor of trophoblastic (placental) tissue.

Result from fertilization of an ovum that has lost all of its chromosomes.

at extremes of reproductive life, higher in Asia than US

CC: Size greater than dates (uterus), vaginal bleeding, passage of grapelike soft tissue

Micro: edematous chorionic villi, trophoblast proliferation, fetal tissue (in partial mole)

Tx; curettage, follow with beta hCG levels.

about 1 in 1000 pregnancies.

Front 40

Complete Mole

Back 40

diploid, 46 all paternal chromosomes, elevated hCG, NO fetal tissue, 2% to choriocarcinoma.

Front 41

Partial Mole

Back 41

69 chromosomes (23X maternal, 23X one sperm, 23Y the other sperm) XXY (triploid cells)

somewhat elecated hCG, fetal tissue present, rarely goes to choriocarcinoma.

Front 42

Choriocarcinoma

Back 42

most malignant tumor in humans, derived from trophoblast

Responsive to chemotherapy

Hematogenous spread to lungs, brain and liver etc.