Path: Female Repro – Flashcards
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36-year-old woman w symmetrically enlarged uterus, no nodularity or palpable masses. Menorrhagian and pelvic pain for several months. Normal uncomplicated pregnancy 10 years ago. Most probable cause? Endometriosis, leiomyoma, endometrial hyperplasia, adenomyosis, chronic endometritis?
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Adenomyosis. When endometrial glands extend from endometrium into myometrium it's called adenomyosis. It can be superficial, or extensive, in which case the uterus myometrium gets enlarged up to 2 -4 times the normal size. Dont confuse with endometriosis where uterine glands and stroma are found outside the uterus in the peritoneum, ovaries etc. A leyomyoma is a myometrial tumor that can grow large and produce an asymmetric mass. Endometrial hyperplasias do not increase uterine size. Chronic endometritis doesnt increase uterne size or extend into myometrium.
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A 24-year-old woman wtih mucopurulent vaginal discharge. Exam shows a reddened cervical os, but no erosions or mass lesions. Pap shows many neutrophils with no dysplasia. What is cervicitis and MCC?
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Redness and presence of inflammatyory cells in cervical discharge. C trachomatis is MCC in sexually active women. Other posisitlities are gonorrhea, trichomiasis, and candiiasis.
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A 45 year old female w menometrorrhagia for 3 months. D and C removes tissue and stops the bleeding. What was causing the symptoms? Ovarian mature cystic teratoma,Chronic endometritis, failure of ovulation, Pregnancy, Use of oral contraceptives.
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Endometrial hyperplasia due to Excessive estrogenic stimulation. Can occur at time of menopause along with failure of ovulation. Estrogen-secreting ovarian tumors can produce endometrial hyperplasia. Teratomas do not do this, nor does endometritis. The estrogen dose of oral contraceptives is small and doesnt cause endometrial hyperplasia.
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Healthy 52 year old femle with a feeling of pelvic heaviness. No history of abnormal bleeding. Palpation reveals a enlarged, nodular uterus on bimanual exam. Pap is normal. Ultrasound revelas multiple solid uterine masses wtih no necrosis or hemorrhage. Total abdominal hysterectomy is performed. Does she have metastases, endometriosis, infiltrative leiomyosarcoma, multiple leiomyomas or adenomyosis?
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Well circumscribed masses suggest presence of multiple benign tumors. Leiomyomas are the MCC of tumors in uterus. Mets of large size would be an unlikely answer due to the healthy appearance of the woman. Leiomyosarcoma is a rare rumor and usually large and solitary. Adenomyosis enlarges the uterus diffusely.
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What is the appearance of a dysgerminoma versus dermoid cyst or choriocarcinoma?
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The female equivalent of male testicular seminoma, dysgerminomas are solid tumors, lubulated, tan-white masses. Dermoid cysts aka teratomas are full of weird tissues. Choriocarcinomas are gestational in origin adn are aggreeive, usually hemorrhagic.
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After an abnormal pap, a woman has colposcopy and biopsy. The has cervical dysplasia throughy the entire cervix to the BM but not beyond. What is her dx and why does she have this?
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Cervical Intrapeithelial neoplasia III because of the full thickness of the cervical epithelium. More common in patients whove had early sexual intercourse, multiple sexual partners, male partner with muliple partners. HPV 16 adn 18. Diethylstilbrestrol DES exposure in utero is strongly associated with clear cell adenocarcinomas of vagina and cervix. Estrogen theray does not increase risk for CIN
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62 year old obese, nulliparous woman, w episode of vaginal bleeding. Scant blood. PE shows no uterine enlargement. Cervix normal. Pap shows cells consistent wtih adenocarcinoma. Which of the following contributed to this? Endometrial hyperplasia, Chronic endometriosis, oral contraceptives, HPV, Adenomyosis
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She has Endometrial carcinoma. Causes: Estrogenic stimulation from anovulatory cycles, nulliparity, obesity and exogenous estrogens (in higher amounts than found in birth control pills) leads to endometrial carcinoma in 25% cases. Chronic endometritis doesnt lead to cancer. Adenomyosis and HPV dont cause it.
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36 year old primigavida wtih peripheral edema in late second trimester. BP 155/95. Usinalysis shoes no blood, glucose or ketones but 2+ proteinuria. Delivers a normal viable but low birth-wt babyat 36 weeks. Symptoms abate. Exam of the placenta will reveal: Chronic villitis, partial mole, hydrops, multiple infarcts, choriocarcinoma?
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Toxemia of pregnancy. Pre-eclampsia based on hypertension, proteinuria and edema but no seizures. Exam will reveal placental infarcts. Plaenta is small due to reduced maternal blood flow w uteroplacental insufficiency. Infarctions and retroplacental hemorrhages can occur. A chronic villitis is characteristic of congential infections such as CMV. A fetus isnt present with choriocarcinoma.
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D and C revealed uterinetissue with "snowstorm" appearance. What hormone would be elevated? AFP, HCG, lactate, thyroxine,
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This is a hyatidiform mole - a complete mole with grapelike villi that form the mass in the endometrial cavity. These trophoblastic tumors secrete hCG. Molar pregnancies result from abnormal fertilization. In a complete mole, only paternal chromosomes are pressent. AFP is the marker for some germ cell tumors wtih yold sac elements. Thyroxine could be produced by a rare struma ovarii, a teratoma of thyroid tissue.
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A total abdominal hysterectomy is performed in a 46 year old postmenopausal female with metrorrhagia. Image shows a uterus wtih two well-circumscribed gray white masses in myometrium and microscopically: spindle shaped cells in whorled bundles, no mitotic figures, Image shows a uterus wtih two well-circumscribed gray white masses in myometrium and microscopically: spindle shaped cells in whorled bundles, no mitotic figures, The gross and microscopic features are likely to be: Leiomyoma, leimyosarcoma, endometrial polyp, adenomyosis, invasive mole
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Benign neoplasm -- Leiomyoma. This is not a leiomyosarcoma,which are not well demarcateed and look heterogeneous with microscopic features of pleomorphic spindle cells and numerous mitoses.
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On 2 occasions this month, a 62 year old childless woman noticed blood tinged vaginal discharge. Binmanual exam reveals a normal-sized uterus with no palpable adnexal masses. No cervial erosions or masses. ROS shows HTN and DM Type I. Endometrial biopsy is likely to show: Adenomyosis, mixed malignant mullerian tumor, leiomyosarcoma, adenocarcinoma, squamous cell carcinoma, choriocarcinoma.
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Post menopausal bleeding is a red flag for endometrial carcinoma. These arise in setting of endometrial hyperplasia. Increased estrogenic stimulation. Risk factors are obesity, nulliparity, htn, Dm, infertility. Adenomyosis causes symmteric enlargement, leiomyosarcoma yields giant assymetric enlargment. Leiomyosarcomas would cause bleeding though, as would MMMullerian tumors. Squamous carcinomas of endometrium are too rare adn choriocarcinomas are gestational in origin.
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What is the karyotype of Klienfelters
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47XXY
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What is the most common type of familial ovarian cancer and what is the mutation.
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Serous cystadenocarcinoma. BRCA1. This tumor suppressor gene playes a role in familial breast cancers. c-erb B2 may be overexpressed in ovarian cancers. Rb1 is in famililal retinoblastoma and osteosarcoma.
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What is an uncommon vaginal tumor found in kids under 5. It forms polypoid, grapelike masses, sometimes called sarcoma botryoides. Small round, blue cell tumor wit hskeletal muscle differentiation, attested to by presence of muscle protein desmin.
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Embryonal rhabdomyosarcoma.
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Where do neuroblastomas form?
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Adrenals or extra adrenal sympathetic chain.
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A 50 year old woman undergoes total abdominal hysterectomy for dx endometrial adenocarcinoma. The uterus reveals a single 1.5 cm firm tan-white circumscribed subserosal nodule. This is most likely a what?
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Leiomyoma. aka Fibroids. Enlarge during reproductive years, then stop or involute dueing menopause. Common finding
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How is eclampsia linked to DIC
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Untreated pre-eclampsia and eclampsia are characterized by inadequate maternal blood flow to placenta. There can be microscopic or macroscopic clotting. This can trigger a clotting cascade leading to DIC. Otherwise, it's the gram negative bacteria that cause DIC.
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Why do ovarian tumors lead to endometrial hyperplasia?
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Most granulosa-theca cell tumors are hormonally active and make estrogens that act on the endometrium.
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A 28-year old female with fever, pelvic pain, feeling of heaviness for a week. Pelvic exam reveals a palpable left adnexal mass. Laproscopy reveals an indistinct fallopian tube, that is part of a circumscribed, 5-cm, red-tan mass. The microbiologic agent most likely responsible is: HPV, M. Tb, Treponema, Neisseria, Candida
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Neisseria.
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A 20-year old female has bloody, brownish discharge for a day. She now has SOB. CXR shows numerous 2-5 cm nodules on both lungs. A red brown mass is on the lateral wall of vagina, and a biopsy shows malignant syncytiotrophoblastic cells. What hormone is elevated?
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This patient has choriocarcinoma, an aggressive malignant, trophoblastic tumor. Metastases to vaginal wall and lungs, along wti hhemorrhagic appearance is common. Syncytiotrohphoblastic cells make HCG
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Atypical ductal hyperplasia
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A cellular proliferation resembling ductal carcinoma in situ but lacking sufficient features for dx as carcinoma. Realtively monomorphic cells, regularly spaced, it is distinguished from DCIS because it only partially fillls ducts and is limited in extent.
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Give a name to the spectrum of benign changes. Includes microcysts, fibrosis of stroma, adenosis (increased number of acini), epithelial hyperplasia
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Fibrocystic change. Sometimes cysts develop (drainable by biopsy, may have "milk of calcium") or there is apocrine metaplasia, which is a transformation of ductal cells to apocrine type
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Her2/Nu
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TK receptor. Cancer may overexpress this TK and it is more aggressive type of cancer. Treatable w Trastuzumab.
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Infiltrating ductal carcinoma
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Most common type of invasive breast cancer
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Infiltrating lobular carcinoma
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Less common type. Single-file arrangement of cells. Usually bilateral and often multicentric, meaning women often have to have double mastectomies. No calcifications.
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Describe a Fibroadenoma and whether they put a woman at increased risk for cancer
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Solid. Feels like marble. Mobile. Well circumscribed. No increased risk of carcinoma. Increased fibrous tissue and compressed ducts.
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Where are stem cells in breast?
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Terminal ductal lobules. These cells give rise to myoepithelial cells which eject milk and lobular luminal cells which make the milk.
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The presence of calcium on a mammogram can be ___ (malignant) or ____ (benign)
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malignant: Ductal carcinoma in situ benign: Apocrine cysts can have a little calcium too
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Describe the progression of Breast cancer
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Normal duct with uniform cell layer and flat cells, myoepithelial cells, intact BM, round structure. First change: Proliferative change. Increase in growth (hyperplasia) and loss of apoptosis. genome instability. Second change: Apical hyperplasia. Cells have differences in architecture. cells look weird. Third change: Carcinoma in situ. THis is also called malignancy. The cells are still confined to BM, but they have acquired malignant transformation. Calcification may be present on mammography. Biopsy is needed or excision. Fourth change: Invasive carcinoma.
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Ductal carcinoma in situ
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Strong risk of progression to invasive cancer. Treat aggressively. Grade from high to low risk. On H&E the lobules look DARKER. This is due to hyperplasia. It's more dense. Too cellular.
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Name the pathology: Duct within a duct pattern. Nuclei look bigger. "Cribriform pattern"
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Ductal carcinoma in situ
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What is the comedo type of DCIS
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Coarse "casting" calcification. Can be extensive. High nuclear grade. Increased recurrence and invasion. H&E shows big globules of pink with dense purple inside and blue purple surrounding on outside. The dense cells are outside, while the pink inner layer is necrosis w calcium in middle
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Which is worse: Non-comedo type or comedo type of DCIS?
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Comedo type. Non comedo type is usually not invasive and has a low nuclear grade
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Which have an increased risk for CA?: fibrosis, cysts, adenosis, mild epithelial hyperplasia, Atypical ductal hyperplasia, DCIS,
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The last two: Atypical ductal hyperplasia and DCIS
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What is infiltrating (mammary) carcinoma?
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Malignant cells invade beyond ducts into breast tissue with desmoplastic stroma, meaning there is increased angiogenesis, scarring with collagen and activated fibroblasts. There is access to lymphatics. Two main types of infiltrating carcinoma: infiltrating ductal carcinoma and infiltrating lobular carcinoma. These look on mammography like hyperlucencies within the gray with feathered margins.
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Is lobular carcinoma unilateral or bilateral?
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Usually bilateral and often multicentric, meaning women often have to have double mastectomies.
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Does lobular carcinoma have calcifications adn what does it mean for detection?
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No calcifications, meaning it is less obvious on mammography and may be caught much later than DCIS
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What is te classic pattern of infiltrating lobular carcinoma?
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Single-file arrangement of small cells in densely sclerotic stroma
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What is lobular neoplasia (carcinoma) and what does it mean for a pt?
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Encompasses LCIS and Atypical Lobular hyperplasia. The risk of developing invasive cancer is much less than DCIS or ADH, more similar to florid proliferative fibrocystic change. The point is that later on she is at higher risk for invasive carcinoma may be ductal or lobular and in either breast.
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Are fibrocystic changes considered non-proliferative or proliferative?
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Non-proliferative. meaning no increased risk for BC
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Name the pathology: Presence of solid sheets of pleomorphic cells with 'high grade" hyperchromatic nuclei and areas of central necrosis. Necrotic cell membranes commonly calcify.
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Comedocarcinoma, a form of DCIS
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Name the Pathology: Rare manifestation of BC w a unilateral erythematous eruption w scale crust. Pruritis is common and the lesion may be mistaken for eczema. Malignant cells extend from DCIS into nipple. Usually there is a palpaable mass
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Paget's disease of the breast. All these women have invasive carcinoma if you can palpate a mass. if not, if you just see the skin eruption, it is likely DCIS
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Name teh pathology associated wtih each phrase: 1. Benign process of the breat with multiple histologic features, including cysts, fibrosis, adenosis 2. Most common breast change under 30
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1. Fibrocystic changes (non-proliferative, no risk of CA) 2. Fibroadenoma
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Which is the most common type of ovarian tumor?
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Surface epithelial tumors
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What 3 cell types are seen in surface epithelial tumors of teh ovaries?
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Serous, mucinous, endometrioid. Cells differentiate along one of these 3 pathways
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The 6 yaer survival for borederlineserous tumors confined to ovary is ____
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100%. Borderline serous tumors are analogous to carcinoma in situ so they do extremely well
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The most common germ cell tumor of the ovary is ____
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Teratoma
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Which of the following tissues are not seen in a benign cystic teratoma? Sheets of pleomorphic cells w frequent mitoses, hair follicles, skin w sebaceous glands, cartilage, thyroid
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sheets of pleomorphic cells
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A 25 year old woman presents with acute torsion of R ovary. Specimen is a hemorrhagic mass w hair and skin. The dx is?
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Benign cystic teratoma. This is a common presentation. The large size means it can cut off its own blood supply
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A 45 year old woman has no complaints but ultrasound reveals a 5 cm cystic mass. Smooth, filled w serous fluid. Dx is?
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Papillary serous adenoma. This is a benign cyst .They can get very large. You must sample the lining and if it's grossly smooth with one layer of uniform cells you have the dx
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A 70 year old woman has ascites and weight loss. Paracentesis show malignant cells with mucin in abdomen. What is dx?
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Mucinous adenocarcinoma. The mucin gives it away
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Risk for ovarian carcinoma include all of teh following except: Nulliparity, Multiparity, Gonadal dysgenesis, BRCA1, FH
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Multiparity.
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I am a smooth, unilocular cyst of teh ovary wtih low Ca-125, clear fluid. What am I?
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serous cystadenoma (benign - NOT CYSTADENOCARCINOMA, which is more common in ovary). Benign tumors have no (or very few) pappilary projections. Borderline tumors have more.
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I am a tumor of the ovary that appears externally smooth, but I am internally complex, with papillary projections and Ca-125 variability.
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Serous borderline tumor. (NO INVASION into cyst wall)
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Are serous bordeline tumors unilateral or bilateral usually?
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Bilateral. They have 100 percent survival if confined to ovary. But if they develop metastasis involving omentum, peritoneum, typically indolent course w 90% 5YS
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I am a large bulky tumor of the ovary w solid areas and invasion of cyst wall. i have complex papillary structures, elevated Ca-125, ascites, metastasis to omentum, peritoneum.
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Serous cystadenocarcinoma of ovary. 70% 5YS if confined to ovary but only 25% if metastatic
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If embroynal carcinoma, endodermal sinus tumor (yolk sac tumor), choriocarcinoma and teratoma are all derived from differentiated tissue of germ cell, then what tumor is from a germ cell in a woman that has not differentiatED?
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Dysgerminoma (ovarian seminoma)
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I am also known as a dermoid cyst?
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Teratoma
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What is a teratoma of mature thyroid tissue/
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Struma ovarii. They can cause hyperthyroidism
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What is the most common germ cell tumor of ovary, 1% of which are malignant, most are benign
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Teratoma. Grossly cystic w calcification. Visible teeth and hair
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What tissues are in a teratoma?
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May contain all embryonic cell lines Ecto Endo Meso, although ecto often predominates w squamous elements. Squamous cell CA is most common CA of teratomas, even though it is rare in general
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What are the three types of serous epithelial tumors of the ovary?
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Benign, borderline and malignant
