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102 Cards in this Set
- Front
- Back
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What embryologically forms the ovaries?
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Germ cells migrating to the urogenital ridges
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What does the mullerian duct form?
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Uterus
Cervix Fallopian Tubes Upper 2/3rd of Vagina |
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What does the Urogenital Sinus become?
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lower 1/3rd of vag
vestibule |
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What lines the mesothelium? tubes? surface of ovary?
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MESOTHELIUM
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Normal vulvar/vaginal mucosa histo?
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Non-keratinized stratified squamous
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location of ovaries?
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hide posterior to tubes
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Normal histo of ectocervix
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stratified squamous
glycogenated squamous cells (estrogenic effect) |
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Normal histo of endocervix?
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add mucinous glands
Columnar epithelium |
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what is between endo and ecto ?
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Transformation Zone
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Importance of transformation zone?
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location of earliest signs of dysplastic change in cancer
most susceptible to HPV |
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Transmission of HPV?
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CONTACT which can get around condom
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low risk HPV subtypes?
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6, 11
low risk...but WARTS! |
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High risk HPV subtypes?
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16
18 31 33 35 |
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which two subtypes cause the majority of cancer?
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16
18 |
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where can HPV cause lesions?
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cervix
vulva vagina look similar histo |
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Different cervical tissues that can be affected
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Squamous epithelium
Glandular Epithelium |
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What lesions affect the squamous?
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condyloma and CIN 1
CIN 2 and 3 |
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difference between condyloma/CIN1 and CIN2/3?
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Condyloma and CIN 1 are low grade caused by 6,11
CIN2/3 are high grade caused 16,18,31,33,35 and progress to cancer |
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what lesions affect glandular epithelium?
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Adenocarcinoma in situ
Precursor to cervical adenocarcinoma |
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Risk factors for developing cervical cancer?
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Smoking
OCP (persistence of transformation zone) High parity Time |
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other half of:
some low grade lesions are caused by high grade HPV |
but no high grade lesions are caused by low grade HPV
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what do you want to see on a slide of cervical squamous cells?
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High cytoplasm:nucleus ratio
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Kickers for Condylomas?
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Benign exophytic lesion
Koliocytes |
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Proliferative zone in normal-->CIN 3?
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Normal: just BM
CIN1: into lower 1/3 CIN2: into lower 2/3 CIN3: all of it |
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Stain to determine where the prolif is going on?
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Ki67
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Rx for different CIN's?
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CIN1: follow it closely
CIN2/3: cut it out (LEEP) Persistent 2 or 3: hysterectomy |
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how often do you see squamous dysplasia and carcinoma together?
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35-71% of AIS
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Sx's of cervical cancer?
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vag bleeding
vag discharge pelvic pain dysparenuria |
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Progression of Cervical Cancer
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Invade vag and parametrium
Metastasize to pelvic LN's Invade bladder and rectum and head elsewhere |
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5 year survival for stage 1 and 4?
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1: 80-90%
4: 10-15% |
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what is the hallmark of an HPV infection?
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Koliocytic change
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What the crap is a bartholin cyst?
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Obstruction of bartholin duct
acute infection-->abscess has transitional epithelium |
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Lichen sclerosis kickers?
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Chronic atrophic vulvitis
Gray Atrophy of skin (thinning epidermis) Narrowing of introitus Subepithelial fibrosis band-like lymphocytic infiltrate |
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Cancer risk w/ lichen sclerosis?
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1-4%
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what are the non-neoplastic vulvar conditions
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bartholin cyst
leukoplakia lichen sclerosis |
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Benign Vulvar lesions?
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Vulvar Condyloma Acuminatum
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what's up w/ Vulvar Condyloma Acuminatum?
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benign, wart-like
HPV 6, 11 Single or multiple Perineal, perianal, cervix doesn't progress to cancer |
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Histo of Vulvar Condyloma Acuminatum?
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branching, tree-like prolif of fibrovascular core
Koliocytic atypia |
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what does koliocytic atypia look like?
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enlarged nuclei w/ hyperchromasia
irregular nuclear contours binucleation |
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Most common complaint w/ VIN?
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pruritis
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how much VIN has CIN or VAIN?
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10-30%
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how much VIN has HPV DNA?
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90%
16, 18 usually |
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Rx for VIN?
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cut it out
vulvectomy |
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majority of Vulvar cancer is?
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SCC (85%)
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Two groups of vulvar SCC?
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High risk HPV (16,18)
Lichen Sclerosis and squamous hyperplasia |
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what's up w/ Lichen Sclerosis and squamous hyperplasia?
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not HPV ass
p53 mutation masked by inflammation Worse prognosis More differentiation than HPV associated vulvar SCC |
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5 year survival based on stage (1,4)
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1: 90%
4: 10% |
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What's up with Vulvar Paget's?
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-pruritic, red, well-demarcated lesion on labia majora
-usually no underlying carcinoma -recurrence common |
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Histo for Vulvar Paget's?
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RARE
Large tumor cells present singly or in clusters PAS positive cytoplasm CEA positive tumor cells |
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Vulvar Malignant Melanoma kickers?
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rare
30% survival >1mm invasion = bad px S100 stain for melanocytes |
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what is bowen's disease?
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VIN 3
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Benign conditions of Vagina
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Congential
Gartner duct cysts Vaginitis |
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What's up with Gartner Duct Cysts?
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Lateral wall of vagina
derived from wolffian duct remnants |
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differences w/ VAIN?
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less common
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dx of VAIN?
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no other tumor in cervix or vulva
5-10 yrs must laps to exclude recurrence from elsewhere |
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Rx for VAIN?
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radiation
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5 year survival for VAIN?
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42%
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What's up w/ diethylstilbestoerol (DES)?
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was an estrogen give to prevent miscarriage
instead caused vaginal and cervical clear cell carcinoma Seen in daughters of mothers treated w/ DES |
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what's up w/ vaginal adenosis and DES?
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vaginal adenosis (glandular epithelium shows up under squamous epithelium) precededs the clear cell carcinoma
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Rx for clear cell carcinoma
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cut it out
radiate |
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what is embyronal rhabdomyosarcoma?
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sarcoma botryoides
most common vaginal sarcoma < 5 yrs old kids |
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Histo of embyronal rhabdomyosarcoma?
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Cambium layer (spindle cells)
Malignant embryonal rhabdomyoblasts (strap cells) Cross striation |
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Rx for embyronal rhabdomyosarcoma?
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wide local excision
chemo |
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3 year survival for embyronal rhabdomyosarcoma?
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85%
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Non-neoplastic conditions of uterus?
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DUB
Endo Polyp Endometriosis |
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Rx for DUB?
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OCP's
resistant: hysterectomy |
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Possible etiology of Endometrial polyps?
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Tamoxifen for breast cancer
but polyps are supposed to be estrogen driven... |
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Rx for endometriosis?
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OCP's
Danazol (androgen...bad for preggers) |
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Marker for endometriosis?
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CA-125
also for ovarian cancer |
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3 mechanisms for endometriosis?
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1) regurg of endo during menstruation
2) metaplastic epithelium 3)Lymphatic dissemination (can go as far as lung) |
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what is adenomyosis?
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endo in myo
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Causes of Endometrial hyperplasia?
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Prolonged estrogen stimulation
menopause PCOS granulosa cell tumor ERT |
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What can predispose you to endo hyperplasia?
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Loss of PTEN (tumor supporessor gene that turns off prolif)
seen in 63% of endo hyper 50-80% of endo carcinomas |
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Types of Endo Hyperplasia
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SIMPLE
inc gland:stroma ratio rare cancer progression COMPLEX complex gland dev no atypia carcinoma < 5% COMPLEX ATYPIA atypia 25-50% progress |
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rx for complex atypia endo hyperplasia?
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hysterectomy
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most common cancer of female genital tract?
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endo carcinoma
uncommon under 40 |
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Risk factors for endo carcinoma?
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Fat
Diabetes Infertility (PCOS) Hyperestrinism |
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2 types of endo carcinoma?
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TYPE 1
ass w/ endo hyper and estrogen dependent well diff PTEN ass favorable px TYPE 2 not E2 dep poor px serous carcinoma ass w/ microsatellite instability and p53 mutation |
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what's up with Malignant Mullerian Mixed tumor?
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malignant gland
+ malignant stroma |
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most common benign tumor in women?
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leiomyoma
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leiomyoma aka?
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fibroids
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Kickers for leiomyoma?
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whitish nodules
Whorled bundles of smooth muscle rarely --->malignant |
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what if it does become malignant?
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Leiomyosarcoma
has atypia mitotic figures inc cellularity necrosis metastasis > 50% poor px not well-defined like leiomyoma |
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Main type of ovarian cancer?
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Epithelial tumors
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risk factors for ovarian?
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nulliparity
BRCA1&2 --> 20-60% |
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Clinical presentation for ovarian cancer?
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Abd pain
Ascites Cachexia Urinary frequency, diarrhea Asymptomatic till BIG (so present late III) CA-125 |
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Types of Surface Epithelial Tumors?
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Serous (30%)
Mucinous (25%) Endometroid divided into benign, borderline, malignant |
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Serous Tumor kickers...
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75% benign
often bilateral most common malignant ovarian tumor good px w/ benign and borderline malignant...not so much |
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kicker for borderline vs malignant?
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borderline hasn't invaded stroma
malignant has psammoma bodies |
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kickers for mucinous
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80% benign/borderline
95% unilateral |
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What is Pseudomyxoma Peritoneii
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Mucinous Ascites (bad)
primary: mucinous cystadenoma of appendix secondary: ovarian involvement intestinal obstruction-->death poor px |
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Brenner Tumor Kickers
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rare
yellow cut surface resembles transitional epithelium |
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Kickers for metastatic tumor to ovary
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bilateral
small nodular ovaries less cystic |
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what's up with the Krukenberg tumor?
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metastasis from gastric signet ring carcinoma
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types of teratomas?
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Mature (dermatoid cyst)
Immature (neural tissue) Specialized aka stroma ovarii (thyroid tissue) |
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kicker for Dysgerminomas
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the malignant germ cell tumor
lympoid infiltrates good px |
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what's up with the Yolk Sac Tumor?
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YOung women
Elevated AFP Schiller-Duval Body (central blood vessel w/ germ cells around it) |
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What do sex cord stromal tumors arise from?
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Ovarian Stroma
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what do granulosa and leydig cell tumors arise from?
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gonadal mesenchyme
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kickers for thecoma
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benign
fibroblastic prolif ascites and hydrothorax = Meig's |
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Granulosa cell tumor kickers?
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make estrogen-->
endo hyper, carcinoma PP in girls Unpredictable Call-Exner bodies |
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Kickers for sertoli-leydig cell tumors?
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young women
virillizing confined to ovary good px |
