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79 Cards in this Set
- Front
- Back
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Unilateral painful cystic lesion adjacent to the vaginal canal
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Bartholin Cyst
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What is the embryological origin of Bartholin Cyst?
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urogenital sinus<div><br /></div><div>Urethal and paraurethral glands(Skene) also derive from this. Analogous to male prostate
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Condyloma Acuminatum
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HPV 6, 11
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Koilocytic Change
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Raisined cells
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Condyloma Lata
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Secondary Syphilis<div><br /></div><div>not genital necessarily
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Lichen Sclerosis demographic
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Most commonly seen in menopausal women<div><br /></div><div>white patch(leukoplakia) with parchment("paper-like) like vulvar skin. Thinning of the epidermis and fibrosis of the dermis
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Lichen Simplex Chronicus
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Leukoplakia with thick, leathery vulvar skin associated with chronic irritation and scratching.<div><br /></div><div>hyperplasia of the vulvar squamous epithelium
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Vulvar carcinoma
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Carcinoma arising from the squamous epithelium lining the vulva. Presents as leukoplakia, just like Lichen Simple Chronicus and Lichen Sclerosis, so a biopsy must be done.<div><br /></div><div>2 Pathways<div><br /></div><div>-- HPV exposure: risk factors are multiple sexual partners, early age of intercourse<div><br /></div><div>-- Non-HPV exposure: long standing lichen sclerosis
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Extramammary Paget Disease Presents as? Key point?
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Malignant epithelial cells in the epidermis of the vulva. Presents as erythematous, pruritic and ulcerated. <div><br /></div><div>MUST be distinguished from melanoma!<div><br /></div><div>1.) Paget cells are PAS+, keratin+, and S100-<div><br /></div><div>2.) Melanoma is PAS-, keratin-, and S100+
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Describe embryology of vagina
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lower 2/3s is squamous epithelium derived from urogenital sinus while upper 1/3 is simple columnar and arises from muellerian duct.(paramesonephric). Normal development replaces the simple columnar cells of muellerian duct to simple squamous.
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Adenosis<div><br /></div><div>What is it?<div><br /></div><div>a/w?
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persistence of simple columnar epithelium in upper 1/3 of vagina<div><br /></div><div>a/w exposure to DES
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DES
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Increases risk for clear cell adenocarcinoma arising from adenosis
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Embryonal Rhabdomyosarcoma
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'grape-like' mass protruding from vagina or penis of a child less than 5. Positive for desmin(IMF in muscle cell) and myoglobin.
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Vaginal Carcinoma Lymph node spread
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lower 2/3 of vagina goes to inguinal lymph nodes <div><br /></div><div>upper 1/3 of vagina goes to regional iliac nodes
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Key place in lower genital tract where HPV likes to infect?
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Transformation Zone
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Only when persistent infection occurs will you likely develop complications from HPV
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important factoid
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High Risk HPV virulenceish factors
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E6 and E7<div><br /></div><div>E6 blocks p53 -- p53 regulates G1 to S by checking for DNA damage and recruiting repair enzymes. If irreparable, p53 calls up BAX which breaks BCL2 which destabalizies mitochondrial membrane and induces apoptosis<div><br /></div><div>E7 blocks Rb<div><br /></div><div>Rb regulates E2f. Normally you have to phosphorylate Rb to let go of E2f and proceed through the cell cycle. If Rb never attaches, then you have cancer.
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SECONDARY risk factors for cervical cancer?
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Smoking and immunodeficiency<div><br /></div><div>Cervical Carcinoma is an AIDS defining illness
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A common cause of death with advanced cervical carcinoma?
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Invasion through anterior uterine wall into the bladder, blocking ureters causing hydronephrosis leading to death.
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Limited efficacy of pap smear?
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Not useful for adenocarcinoma
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What do you follow up a pap smear with?
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Colposcopy(visualization of cervix with magnifying glass)
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Immunization is effective in preventing HPV. Which subtypes does the vaccine work against?
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6, 11, 16, 18. Protection lasts 5 years. Pap smears are STILL necessary due to other subtypes of virus that aren't covered.
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What characterizes chronic endometritis?
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Plasma cells.<div><br /></div><div>Lymphocytes are normal to endometrium, but Plasma cells are NOT.
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Endometrial Polyp can arise as a side effect of?
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Tamoxifen - anti-estrogenic in breast but slightly proestrogenic in endometrium
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Endometriosis theories of etiology
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1.) Retrograde menstruation<div><br /></div><div>2.) Metaplasia<div><br /></div><div>3.)<div><br /></div><div>Lymphatic/Hematogenous spread
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What is endometrium in the myometrium called?
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Adenomyosis
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'chocolate' cyst
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Ovarian endometriosis
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'pain with defecation'
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endometriosis in the pouch of douglas
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Mutiple well defined white whorly masses
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leiomyoma<div><br /></div><div>(multiple indicates benign)
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Most important predictor for progression to cancer in endometrial hyperplasia
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cellular atypia<div><br /></div><div>Simple hyperplasia with atypia often progresses to cancer, wheras complex hyperplasia without atypia rarely does
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Two pathway for endometrial carcinoma
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Hyperplasia sequence(excess unopposed estrogen) leads to endometrioid cancer. Generally arises in 50-60 year olds. <div><br /></div><div>Sporadic pathway - no hyperplasia, cancer arises from atrophic endometrium. Serous histology(papillary serous). Generally found in elderly.
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What is the sporadic pathway of endometrial carcinoma a/w?
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elderly<div><br /></div><div>serous papillary histology p53 mutation<div><br /></div><div>psammoma bodies - necrosis of fingerlike growth that calcifiy<div><br /></div><div>Aggressive
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Psammoma Bodies
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---Papillary carcinoma of the thyroid<div><br /></div><div>---Meningioma<div><br /></div><div>---Mesothelioma<div><br /></div><div>---Papillary carcinoma of endometrium or ovary
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single lesion with areas of necrosis and hemorrhage
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leiomyosarcoma
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What hormone stimulate theca cells?
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LH - hits theca cells which induce production of androgen<div><br /></div><div>FSH - hits granulosa cells which converts androgen from theca cells into estradiol<div><br /></div><div>estradiol hits egg and stimulates maturation<div><br /></div><div>Functional unit of ovary is follicle<div><br /></div><div>Oocyte surrounded by granulosa cells, which are themselves surrounded by theca cells
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What secretes progesterone after ovulation?
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Corpus luteum
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Etiology of polycystic ovarian disease
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hormone imbalance - excess LH<div><br /></div><div>LH:FSH > 2<div><br /></div><div>increased LH increased androgen production in theca cells, which causes hirsutism after entering blood. Some of androgen transforms to estrone via adipose tissue. Estrone goes to pituitary and shuts down FSH which causes granulosa cells to not convert androgen to estradiol. This causes degeneration and cystic growth of follicle.
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Obese women with anovulation and hirsutism
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PCOD
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Women with Type II Diabetes
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PCOD due to obesity
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Types of ovarian tumors
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deleted picture
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Most common type of ovarian tumor
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Surface Epithelial Tumor(Coelomic epithelium)<div><br /></div><div>2 most common types of epithelial tumors?<div><br /></div><div>Serous and mucinous cystic
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benign cystic adenoma demographic
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can be serous or mucinous and will present in<div><br /></div><div>PREmenopausal women 30-40 years.
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cystadenocarcinoma demographic
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most commonly arises in POSTmenopausal women 60-70 years.
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Classic tumor arising in BRCA1 mutation carriers
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surface epithelium tumor that is malignant--serous<div><br /></div><div>carcinoma of the ovary AND fallopian tube.
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Types of surface epithelial tumor
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serous and mucinous<div><br /></div><div>endometrioid(usually malignant) and brenner<div><br /></div><div>tumors(urothelial, usually benign)
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Brenner's Tumor
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epithelial tumor of the ovary that is urothelial
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Serum tumor marker for ovarian cancer?
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CA-125
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2nd most common ovarian tumor? Demographic?
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germ cell tumor<div><br /></div><div>most common germ cell tumor is teratoma<div><br /></div><div>Woman 15-30 -- Germ cell tumor<div><br /></div><div>Woman 35-40 -- Benign epithelial ovarian tumor<div><br /></div><div>Woman 60-70 -- Malignant epithelial ovarian tumor
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Tumors that can arise from germ cells
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Can arise from fetal tissue --> teratoma OR embryonal carcinoma<div><br /></div><div>Can arise from yolk sac --> yolk sac tumor<div><br /></div><div>Can arise from germ cells --> dysgerminoma(similar to seminoma)<div><br /></div><div>Can arise from placenta --> choriocarcinoma
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What indicates malignancy in teratoma?
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presence of immature tissue(usually neural) or somatic malignancy(most commonly squamous cell carcinoma of the skin)
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Struma ovarii
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a teratoma composed primarily of thyroid tissue
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Large cells, clear cytoplasm and central nuclei resembling oocytes
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dysgerminoma<div><br /></div><div>testicular counterpart is seminoma
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Most common MALIGNANT ovarian carcinoma. Lab finding?
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dysgerminoma<div><br /></div><div>LDH may be elevated
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most common ovarian germ cell tumor in children. Lav finding?
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Endodermal sinus tumor<div><br /></div><div>malignant tumor that mimics yolk sac. Thus, serum AFP may be elevated.
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glomerulus like structures
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Schiller-Duval bodies -- classic for endodermal sinus tumor(yolk sac)<div><br /></div><div>deleted picture
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Small hemorrhaic tumor of ovary with early hematogenous spread. Lab finding?
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Choriocarcinoma. Mimics placental tissue but LACKS villi. High beta-HCG.
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Poor response to chemotherapy
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germ cell choriocarcinoma of ovary
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large primitive cells, aggressive with early metastasis
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embryonal carcinoma
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Tumor causing precocious puberty
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Granulosa-theca cell tumor<div><br /></div><div>causes excess production of estrogen
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Presentations of granulosa-theca cell tumors
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prior to puberty - precocious puberty<div><br /></div><div>reproductive age - menorrhagia or metrorrhagia<div><br /></div><div>postmenopause(most common) -- endometrial<div><br /></div><div>hyperplasia with postmenopausal uterine bleeding
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Sertoli-leydig cell tumor. Characteristic lab finding?
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may produce androgen and present with hirsutism and virilization<div><br /></div><div>Reinke crystal
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fibroma is associated with what triad?
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pleural effusions and ascites(Meigs syndrome)
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Kruckenberg Tumor
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bilateral mucinous tumor that arises due to diffuse type of gastric carcinoma(signet ring cells)
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Pseudomyxoma peritonei
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massive amounts of mucus in the peritoneum due to a mucinous tumor of the appendix. Can metastasize to ovary.
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jelly belly
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Pseudomyxoma peritonei
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lower quadrant abdominal pain weeks after missed period
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ectopic pregnancy
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Spontaneous abortion is most likely due to?
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Chromosomal abnormalities(trisomy 16), hypercoagulable state
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Placenta previa
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"preview of the placenta" <div><br /></div><div>placenta implants near the cervical os
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3rd trimester bleeding and fetal insufficiency
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Placenta Abruption<div><br /></div><div>also, common cause of stillbirth
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bloody maternal surface of placenta
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placenta abruption
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Placenta Acrreta
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Improper implantation of placenta into the myometrium with little or no intervening decidua
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Preeclampsia
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hypertension, edema and proteinuria
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Complication of preeclampsia
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Hypertension can be malignant and lead to fibrinoid necrosis of placental vessels
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HELLP
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Hemolysis, Elevated liver enzymes, Low platelets<div><br /></div><div>Preeclampsia with thrombotic microangiopathy involving the liver
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SIDS risk factors
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sleeping on stomach, smoking in household and prematurity<div><br /></div><div>Between 1 month and 1 year
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Complete Mole
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46 chromosomes, 2 sperm from dad enter egg and empty maternal egg. No fetal tissue, completely edematous and has a slight risk for choriocarcinoma.
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Hyaditidiform Mole Findings
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Higher than normal beta-HcG and bigger than normal uterus.
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Partial Mole
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69 chromosomes, partial fetal tissue present.
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Choriocarcinoma
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can arise from spontaneous germ cell tumor<div><br /></div><div>OR<div><br /></div><div>from a complication from gestation(spontaneous abortion, hyatidiform mole, normal pregnancy)<div><br /></div><div>Notably, the GESTATIONAL pathway responds WELL to chemotherapy.
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