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HRM Exam 3 > Witrak Part 1: OBGYN Pathology > Flashcards

Witrak Part 1: OBGYN Pathology Flashcards

1
Q

What are some causes of abnormal vaginal bleeding?

A

Endometrial atrophy (post-menopausal), endometrial hyperplasia/carcinoma, structural disorders of endometrium/myometrium: endometrial polyps, abnormal gestation

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2
Q

what are the most malignant primary ovarian neoplasms?

A

epithelial: serous vs. mucinous

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3
Q

are germ cell tumors in men benign or malignant? what about women?

A

malignant for men. benign for women.

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4
Q

adnexal mass in post-menopausal female = ______ until proven otherwise?

A

CANCER

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5
Q

what is an early trimester gestational disorder example

?

A

miscarriage, ectopic gestation

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6
Q

post-menopausal vaginal bleeding is _____ until proven otherwise?

A

cancer

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7
Q

almost all of the infections of the vulva and vagina are _____________, except ____.

A

largely sexually transmitted, except candidiasis and post-partum types.

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8
Q

infections with clinical manifestations typically limited to _______ genital tract

A

lower (vulva, vagina, cervix).

candidiasis, trichomonas, gardnerella (bacterial
vaginosis), HSV, HPV, molluscum, and tropical
STDs (lymphogranuloma venereum, granuloma
inguinale, chancroid)

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9
Q

what two bugs can progress to Pelvic Inflammatory Disease (asymptomatic usually) and what does it put the female at risk for?

A

Chlamydia and gonococcus. Ectopic pregnancy and infertility.

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10
Q

What infectious agents are potentially fatal sequelae?

A

HIV, Syphillis, viral hepatitis.

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11
Q

What STDs are notable for risk to fetus/newborn?

A

HSV, Chlamydia, gonorrhea, syphilis, HIV,

hepatitis B and C

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12
Q

what is a common complication leading to obstetrical infection in the third world? from what organism?

A

retained placenta doesnt allow uterus to contract. Group B strep.

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13
Q

Classically, but can be subclinical: Sexually active female with lower abdominal pain, purulent endocervical discharge, chandelier sign (pain with movement of cervix). Name that disorder!

A

PID. subclinical could be first evidence of tubal infertility.

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14
Q

Dx is largely a clinical one:
one recommendation: sexually active young women with lower abdominal, adnexal, and cervical motion tenderness – should receive WHAT?

A

receive empiric antibiotic RX.

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15
Q

what is the commonest cause of vaginal discharge (40-50%) in reproductive age women?

A

Bacterial vaginosis- results from disturbed vaginal flora (Gardnerella vaginalis)

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16
Q

How does Gardnerella vaginalis present? Inflammation?

A

malodorous (fishy), gray-white discharge usually WITHOUT signs of INFLAMMATION. Clue CELLS

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17
Q

What is the commonest curable STD in the world?

A

Trichomoniasis due to flagellated protozoan T. vaginalis

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18
Q

Are Candida albicans usually sexually transmitted?

A

NO. often normally present as a commensal in small numbers, due to IMMUNOSUPPRESSION (antibiotics, HIV)

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19
Q

Sexually active female presents with multiple, shallow, painful genital ulcers (preceding vesicles), inguinal adenopathy. What is this infection?

A

HSV-2

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20
Q

T or F: HSV is sexually transmitted and may occur during asymptomatic/sub-clinical viral shedding (even without genital lesions)

A

True!

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21
Q

HSV-2 is the most common cause of sporadic _______

A

MENINGITIS!!!

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22
Q

Tzanck smear is used to see what infectious agent? what would you see?

A

HSV. multinucleated giant cells, intranuclear inclusions.

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23
Q

what do you see on a histologic slide for HPV?

A

papillomatous proliferation w/ koilocytotic atypia/mild dysplasia (low grade squamous intraepithelial lesion).

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24
Q

what type of cervical cancer, due to HPV, is the most common?

A

Squamous cell carcinoma! Adenocarcinoma is the next (if it infects endocervical glandular mucosa).

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25
Q

______ disease usually presents with non-specific pruritus, soreness, or dyspareunia

A

non-neoplastic

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26
Q

what is the commonest tumefaction of vulva (either infection with abscess or inflammatory duct obstruction with cyst formation)?

A

Bartholin gland disease

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27
Q

90% of vulvar malignancies are ________

A

squamous carcinoma

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28
Q

what is the principal cause of vulvar carcinoma in older/post-menopausal women?

A

‘differentiated type’: typically seen arising in relation to LICHEN SCLEROSUS or LICHEN SIMPLEX CHRONICUS

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29
Q

what can present as abnormal coloration: usually white but also may be red or dark/pigmented. symptomatically: vulvar itch, burning, pain

A

Squamous vulvar neoplasia

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30
Q

what does the whiteness of the vulvar skin represent?

A
  • lichen simplex chronicus – chronically irritated/hyperplastic skin.
  • lichen sclerosus et atrophicus = atrophic epidermis with subepidermal edema

OR Pre-invasive cancer. -> NEED BIOPSY TO TELL THE DIFFERENCE

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31
Q

what benign lesion is associated with the ‘milk line’ and a lump of the vulva?

A

Papillary hidradenoma. benign labial neoplasm which may ulcerate- hypothesized as originating from ectopic-breast tissue (axilla to groin = milk line)

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32
Q

can have cancer have condyloma like features?

A

YES. biopsy to make sure. 90% benign condylomatous disease

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33
Q

a post-menopausal white woman has a non-squamous malignancy on her clitoris, what type of cancer is it?

A

melanoma (5-10%). HIGH mortality rate if > 1 mm thickness. favors clitoris and labia minora

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34
Q

what vulvar carcinoma presents as a ‘rodent’ ulceration, usually non-metastasizing?

A

Basal Cell Carinoma (2% of vulvar CA)

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35
Q

____ _____: locally aggressive/non-metastasizing neoplasm relatively unique to vulva/perineum/female pelvis

A

Deep angiomyxoma

36
Q

in adults, commonest malignancies involving the vagina come from where?

A

direct extension from cervical, vulvar or endometrial CANCER or hematogenous spread from breast, ovary, kidney

37
Q

Vagina CA symptom?

A

bleeding or discharge

38
Q

who does largerly aggressive embryonal rhabdomyosarcoma effect?

A

infants/young children

39
Q

______ from HPV is the commonest cancer worldwide of female genital tract

A

invasive cervical carcinoma

40
Q

_____ is more vulnerable to HPV infection than any other genital tract site.

A

Cervix.

41
Q

Which area of the cervix does carinoma usually develop?

A

transformation zone (ecto-cervix squamous -> endo-columnar)

42
Q

what are the 3 early symptoms of Cervical CA?

A

irregular or heavy vaginal bleeding, post-coital bleeding (after sex), or non-bloody vaginal discharge

43
Q

what are 3 late symptoms of cervical cancer?

A

invasion of parametrium (pain), direct invasion of vagina with secondary malignant fistulas into bladder or rectum

44
Q

how do most women die of cervical cancer?

A

NOT GETTING SCREENED IN TIME!

45
Q

why do we NOT screen most individuals before age 21?

A

low risk dysplasia that will go away! regresses

46
Q

what are two paramount concerns with abnormal uterine bleeding?

A
  1. chronic or acute hemorrhage sufficient to cause anemia

2. is endometrial cancer present

47
Q

what are indications for endometrial biopsy?

A
  1. age > 45 yrs 2. younger than 45yrs: history of unopposed estrogen exposure (obesity, chronic anovulation), tamoxifen, Lynch
48
Q

what is a syndrome of anovulation that is characterized by oligomenorrhea, hyperandrogenism, obesity and insulin resistance?

A

Polycystic ovary syndrome.

49
Q

what are the two chief causes of vaginal bleeding in postmenopausal women?

A

endometrial atrophy (59%) & endometrial polyps (12%). hyperplasia (10%), carcinoma (10%)

50
Q

what type of cancer is the commonest GYN cancer in developed world? average age of diagnosis?

A

Endometrial carcinoma. 61 yrs. 25% cases in pre-menopausal women.

51
Q

what do you give obese women with complex atypical hyperplasia and want to remain fertile?

A

give progestational agents! reversible if remains superficial in patient, but still varies on success.

52
Q

major risk factor for endometrial carcinoma?

A

CHRONIC UNOPPOSED ESTROGEN STATES: obesity, chronic anovulation, nulliparity (sad), tamoxifen (antagonist in BREAST, agonist in endometrium)

53
Q

What tends to be higher stage, poor prognosis tumor and can be a serous carcinoma?

A

type 2 endometrial CA

54
Q

_____ = ectopic endometrial glands and stroma (outside of uterine cavity)

A

endometriosis

55
Q

what does endometriosis present as on a histological section?

A

ovaries may be markedly enlarged and cystic (CHOCOLATE CYST)

56
Q

what are specific types of disorders in myometrial pathology?

A

***LEIOMYOMAS, * adenomyosis, leiomyosarcoma

57
Q

what is the commonest visceral tumor in women (15-20%)?

A

Uterine leiomyomas (fibroid tumors)

58
Q

Main Sx in reproductive age women: pelvic pressure/pain, urinary frequency, difficult defecation, abnormal uterine bleeding with dysmenorrhea, impaired fertility, or adverse pregnancy outcomes.
Name that type of tumor!

A

Uterine leiomyomas

59
Q

who is uterine leiomyomas most common in

A

african-american women. Think- Lions (leio) live in Africa

60
Q

on a pathology report, what presents as a circumscribed white/rubbery nodules with bland smooth muscle proliferation?

A

Leiomyomas

61
Q

what cancer usually presents as typically large tumors with soft/fleshy cut surfaces showing hemorrhage and necrosis?

A

Uterine leiomyosarcoma. RARE. Distorted uterus.

62
Q

what pathologies are associated with fallopian tubes?

A

endometriosis, tubal infertility, ectopic pregnancy.

63
Q

what percent of women have PCOS?

A

6-8%*

64
Q

what is the most FEARED cancer of the female genital tract?

A

ovarian cancer

65
Q

what is the MOST common ovarian neoplasia?

A

epithelial (mullerian) tumors: 67% of all primary ovarian neoplasia, 95% of ovarian CA

66
Q

epithelial ovarian tumors: serous are most often ____ (unilateral, bilateral), mucinous ____ (unilateral, bilateral)

A

bilateral. unilateral.

67
Q

USA: what is the second most common GYN malignancy but commonest cause of GYN cancer death?

A

Ovarian carcinoma. majority of patients: diagnosed at advanced stage and are high grade serous type.

68
Q

what do you use the CA-125 marker for?

A

NOT used for screening. used to follow for tumor recurrence if initially elevated

69
Q

what are the mass majority of ovarian germ cell tumors?

A

Mature cystic teratoma- dermoid cyst- skin, hair, bone, etc. benign!!!

70
Q

where are the major areas that metastasize to ovary?

A

non-OBGYN: *colorectum, appendix, stomach, breast.

71
Q

what is the most common pathology you see in a first trimester woman?

A

spontaneous abortion with symptoms of abdominal pain, amenorrhea, vaginal bleeding. pregnancy loss < 20 wks

72
Q

what is the major risk for retaining a dead fetus over 4wks?

A

the mother Disseminated Intravascular Coagulation. can be completely calcified.

73
Q

what does HELLP syndrome stand for?

A

hemolysis, elevated liver enzymes, low platelets (usually associated with severe preeclampsia)

74
Q

____ = presence of placental tissue extending over or just proximal from the internal cervical os

A

placenta previa

75
Q

when would you suspect placenta previa?

A

in patients > 20wks gestation with painless vaginal bleeding

76
Q

_____= morbidly adherent/suck placenta

A

placenta accreta. due to defective/thin decidual layer at implantation site

77
Q

what can an ascending infection (from vagina/cervix)?

A

premature membrane rupture (PROM). usually polymicrobial

78
Q

what is the most common cause of life-threatening newborn infection?

A

GROUP B STREPTOCOCCUS

79
Q

what will be elevated in HYDATIDIFORM MOLE?

A

increase serum HCG

80
Q

______ ____: fertilization of an empty ovum by either a single sperm which duplicates or two separate sperm= 46 XX or XY (DIPLOID)

A

Complete MOLE

81
Q

___ ___: fertilization of ordinary ovum (23X) by two separate sperm= 69 XXX, XXY, XYY (TRIPLOID)

A

PARTIAL mole

82
Q

____ ___ = diffuse vesicular enlargement of villi (gross vesicles) without fetal sac/fetus

A

COMPLETE mole

83
Q

___ __ = variable vesicular enlargement of villi w/ fetal sac/fetus

A

PARTIAL mole

84
Q

____ ___= neoplasitc villi penetrate myometrium

A

invasive mole

85
Q

why is HCG associated with hyperthyroidism

A

some thyroid stimulating properties

86
Q

_____ = hemorrhagic/necrotic tumor w/ mixtures of syncytiotrophoblastic and cytotrophoblastic cells (w/o villus formation)

A

choriocarcinoma

87
Q

____ = ‘intermediate’ cytotrophoblastic cells (w/o villi) diffusely infiltrating myometrium

A

PSTT

HRM Exam 3 (16 decks)

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