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Pathoma - 13 (Female GU)

mlinnie's version from 2018-11-12 00:00

Section 1

Question Answer
What causes condyloma acuminata?HPV 6,11
what causes condyloma lata?secondary syphillis
koilocytesHPV infected cells
where are 3 areas that HPV can infect?vulva, vaginal canal, cervix
thinning of epidermis and fibrosis of dermis of VULVAlichen sclerosis = paper skin
pt presents with leukoplakia with parchment-like (paper thin) VULVAR skin?lichen sclerosis
which vulvar disorder is has an increased risk for vulvar squamous cell carcinoma?lichen sclerosis (but NOT lichen simplex chronicus)
hyperplasia of vulvar squamous epitheliumlichen simplex chronicus
pt presents with leukoplakia and thick leathery vulvar skinlichen simplex chronicus (looks like what i have on my ankle!)
what epithelium lines the vulvasquamous epithelium
what are 2 causes of vulva carcinoma?HPV 16, 18 or long standing lichen sclerosis
what is extramammary pagets disease of the vulva?malignant epithelial cells in the epidermis of the vulva
how can you tell the difference btw extramammary pagets disease vs. melanoma of vulva?Pagets disease: PAS+, keratin+, S100-.
Melanoma: PAS-, Keratin-, S100+

Section 2

Question Answer
what is vaginal adenosis?persistence of columnar epithelium in upper 2/3 of vagina (instead of squamous epithelium)
what is the upper 2/3 of the vagina derived from? lower 1/3?upper 2/3: mullerian duct with COLUMNAR epithelium.
lower 1/3: urogenital sinus with SQUAMOUS epithelium
whats a risk factor for teh development of vaginal adenosis?DES in utero
DES-induced adenosis increases the risk for which cancer?vaginal clear cell adenocarcinoma
malignant mesenchymal proliferation of immature skeletal muscle of vagina or penisembryonal rhabdomyosarcoma = sarcoma botryoides
kid presents with grape-like mass protruding from vagina or penisembryonal rhabdomyosarcoma = sarcoma botryoides

Section 3

Question Answer
HPV: what does E6 destruct?E6 destructs p53
HPV: what does E7 destruct?E7 destructs Rb
is carcinoma in situ reversible or irreversible?IRREVERSIBLE!
whats a HY risk factor for cervical carcinoma?immunodeficiency = cervical carcinoma is an AIDS-defining illness
what are the 2 subtypes of cervical carcinoma?squamous cell carcinoma and cervical adenocarcinoma = BOTH RELATED HPV!
where does cervical carcinoma like to spread to?invades thru uterine wall into bladder, blocking the ureters --> causing hydronephrosis with postrenal failure

Section 4

Question Answer
what is Asherman syndrome?secondary amenorrhea due to loss of basalis (regenerative layer of endometrium) and scarring
what causes acute endometritis?retained products of conception (piece of placenta) after delivery or miscarriage
female pt presents with fever, uterine pain and pelvic pain...diagnosis?acute endometritis
what cell characterizes CHRONIC endometritis?lymphocytes and PLASMA CELLS! (plasma cells are crucial for diagnosis of chronic endometritis)
pt presents with hyperplastic protrusion of endometrium causing abnormal bleedingendometrial polyp
what cause endometrial polypsside effect of tamoxifen (estrogen agonist at endometrium)
what is endometriosis?endometrial glands and stroma outside the uterine endometrium
wheres the most common site of endometriosis?ovary = chocolate cyst
what is adenomyosis?endometriosis in the uterine myometrium
what characterizes endometrial hyperplasia?hyperplasia of endometrial GLANDS relative to stroma due to uncontrolled Estrogen
malignant proliferation of endometrial glandsendometrial carcinoma
what 2 pathways lead to endometrial carcinoma?1) hyperplasia due to estrogen exposure (endometroid)
2) sporadic pathway - driven by p53 mutation --> papillary serous with psamommas bodies
benign proliferation of smooth muscle arising from myometriumleiomyoma = uterine fibroids
multiple, well-defined white whorled masses on uterusleiomyoma = uterine fibroid --> pt presents with abnormal uterine bleeding, infertility and pelvic mass
malignant proliferation of smooth muscle arising from myometriumleiomyosarcoma = arises DE NOVO = single lesion with areas of necrosis and hemorrhage

Section 5

Question Answer
what 3 things make up the ovarian follicle? oocyte surrounded by granulosa cells and theca cells
which cell does LH act on?LH acts on theca INTERNA cell to induce ANDROGEN production
which cell does FSH act on?FSH acts on granulosa cell to convert androgens to estradiol via aromatase
PCOS: what are the levels of LH and FSH?increased LH and low FSH (LH:FSH >2)
which ovarian cell produces androgens?theca INTERNA cell
which ovarian cell converts androgens to estradiol?granulosa cell
pts with PCOS are at increased risk for which cancer?endometrial carcinoma = since they have high levels of estrone
explain the pathogenesis of PCOSincrease LH induces excess androgen production from theca cells resulting in hirsutism. Androgen is converted to estrone in adpiose tisse --> estrone feedback decreases FSH resulting in cystic degernation of follicles

Section 6

Question Answer
what 3 cell types make up the ovaries?surface epithelium, germ cells, sex-cord stroma
whats the most common type of ovarian tumor?surface epithelial tumors
what are surface epithelial tumors derived from?coelomic epithelium that lines the ovaries
what are the 4 subtypes of surface epithelial tumors?serous and mucinous (which can be benign, borderline or malignant) and less commonly endometroid and brenner tumors
which mutation is a/w increaser risk for serous carcinoma of ovary and fallopian tube?BRCA1
what carcinoma is a/w BRCA1serous carcinoma of ovary and fallopian tube
ovarian tumor that is composed of bladder-like epithelium (urothelium)?brenner tumor (surface epithelial tumor) = "brenner has to pee"
CA-125ovarian carcinoma (surface epithelial tumors)
whats the most common ovarian germ cell tumor in women?cystic teratoma
what is struma ovarii?cystic teratoma composed mainly of THYROID TISSUE --> causes hyperthyroidism
pt presents with hyperthyroidism and mass in ovary...diagnosis?teratoma composed of thyroid tissue = struma ovarii
whats the most malignant germ cell tumor?dysgerminoma = large cells with clear cytoplasm and central nuclei
germ cell tumor with increased LDHdysgerminoma (marker for dysgerminoma = PLAP = placental alkaline phosphatase)
which cell layer of the villi produces b-HCG?syncytotrophoblasts
how does choriocarcinoma respond to chemo?POOR RESPONSE if germ cell tumor. if from complete mole, its okay
name 3 sex-cord stromal tumors in femalesgranulosa-theca cell tumor, sertoli-leydig cell tumor, FIBROMA
what do ovarian granulosa-theca cell tumors mainly produce?ESTROGEN!! causes precuocious puberty, menorrhagia, or endometrial hyperplasia in post-menopausal women
reinkes crystalssertoli-leydig cell tumor (sertoli cell form tubules and leydigs are btw tubules)
whats the triad of meigs syndrome?OVARIAN fibroma, ascities, pleural effusion
what causes Krukenberg tumor (mucinous tumor involving both ovaries)metastatic gastric carcinoma - DIFFUSE TYPE
how can you tell the difference btw metastases vs. primary mucinous carcinoma of ovary?bilateral involvement of ovaries = metastasis!!
what causes pseudomyxoma peritonei (jelly belly)?mucinous tumor of APPENDIX!

Section 7

Question Answer
what is placenta previa?implantation of placenta in lower uterine segment = placenta overlies cervical os
what is placental abruption?separation of placenta from decidua (uterine wall) prior to delivery
whats a common cause of stillbirth?placenta abruption
what 2 conditions present with third-trimester bleeding?placenta previa and placental abruption
whats is placenta accreta?implantation of placenta into MYOMETRIUM with no intervening decidua (endometrium under effect of progesterone)
teratogenic effect of phenytoin?digit hypoplasia and cleft lip
whats the triad of preeclampsia?HTN, proteinuria, edema
what causes preeclampsia?placental ischemia! abnormality in maternal-fetal vascular interface in placenta
what type of necrosis do you see in placenta?FIBRINOID necrosis
whats the functional unit of the placenta?villi
what is a hydatidiform mole?abnormal conception characterized by swollen and edematous villi with proliferation of trophoblasts
pregnant pt shows that her uterus is much larger and b-HCG is much higher than expected...diagnosis?hyatidiform mole
pt in her second trimester presents with grape-like masses thru the vaginal canalhyaditiform mole
snowstorm appearance on UShyaditiform mole
whats the tx of hyaditiform mole?dilatation and curettage
choriocarcinomas can arise from?complications of 1) spontaneous abortions 2) normal prenancy 3) hyaditiform moles 4) germ cell tumor
whats the difference btw choroicarciomas that arise from gestational pathways (spontaneous abortion, normal pregnancy, mole) vs. germ cell pathway?choriocarcinoma from gestational pathway = respond well to chemo!! germ cell tumor choriocarinoma do NOT!!

Section 8

Question Answer
which mole: 69 chromosomes = normal ovum fertilized by 2 spermpartial mole
which mole: 69 chromosomes, fetal tissue present, some villi are hydropic, FOCAL proliferation around hydropic villi, NO risk for choriocarcinomapartial mole
which mole: 46 chromosomes (empty ovum fertilized by 2 sperms)complete mole
which mole: 46 chromosomes, NO fetal tissue, most villi are hydropic, diffuse/circumferential trophoblastic proliferation, risk for choriocarcinomacomplete mole
which mole has an increased risk for choriocarcinoma?complete mole