Term
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Definition
- Anatomically includes the skin and mucosa of the female genitalia external to the hymen (labia majora, labia minora, mons pubis, and vestibule)
- Lined by squamous epithelium
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Term
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Definition
- Cystic dilation of the bartholin gland
- One bartholin gland that is present on each side of the vaginal canal and produces mucus-like fluid that drains via ducts into the lower vestibule
- Arises due to inflammation and obstruction of gland
- Usually occurs in women of reproductive age
- Presents as a unilateral, painful cystic lesion at the lower vestibule adjacent to the vaginal canal
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Term
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Definition
- Warty neoplasm of vulvar skin, often large
- most commonly due to HPV types 6 or 11 (condyloma acuminatum)
- secondary syphilis (condyloma latum) is a less common cause
- both are STD
- Histologically, HPV associated condylomaas are char. by koilocytes (hallmark of HPV invected cells)
- Condylomas rarely progress to carcinoma
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Term
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Definition
- Char. by thinning of epidermis and fibrosis (sclerosis) of the dermis
- presents as a white patch (leukoplakia) with parchment-like vulvar skin
- Most commonly seen in postmenopausal women; possible autoimmune etiology
- Benign, but associated with a sclightly ncreased risk for squamous cell carcinoma
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Term
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Definition
- Char. by hyperplasia of the vulvar squamous epithelium
- presents as leukoplakia w/ thick, leathery vulvar skin
- associated w/ chronic irritation and scratching
- Benign; no increased risk of squamous cell carcinoma
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Term
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Definition
- Carcinoma arising from squamous epithelium lining the vulva
- Relatively rare, accounting for only a small percentage of femal genital cancers
- Presents as leukoplakia; biopsy may be required to dist. carcinoma form other causes of leukoplakia
- Etiology may be HPV related or non-HPV related
- HPV-related vulvar carcinoma is due to high-risk HPV types 16 and 18
- Risk factors are related to HPV exposure and include multiple partners and early first age of intercourse; generally occurs in women of reproductive age
- Arises from vulvar intraepithelial neoplasia (VIN), a dysplastic precursor lesion char. by koilocyte change, disordered cellular maturation, nuclear atypia, and increased mitotic activity
- Non-HPV related vulvar carcinoma arises, most often, from long-standing lichen sclerosis
- Chronic inflammation and irritation eventually lead to carcinoma
- Gen. seen in elderly women (avg age is >70 years)
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Term
| Extramammary Paget disease |
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Definition
- Char. by malignant epithelial cells in the epidermis of the vulva
- Presents as erythematous, pruritic, ulcerated vulvar skin
- Represnts carcinoma in situ, usually w/ no underlying carcinoma
- Paget disease of the nipple is also char. by malignant epithelial cells in the epidermis of the nipple, but it is almost always associated w/ an underlying carcinoma
- Must be dist. from melanoma, which rarely can occur on the vulva
- Paget cells are PAD+, keratin +, and S100-
- Melanoa is PAS-, keratin-, adn S100+
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Term
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Definition
- Canal leading to the cervix
- mucosa is lined by nonkeratinizing squamous epithelium
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Term
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Definition
- Focal persistence of columnar epithelium in teh upper 1/3 of the vagina
- during dev. squamous dpithelium from the lower 2/3 of the vagina (derived from the urogenital sinus) grows upward to replace the columnar epithelium lining of the upper 1/3 of the vagina (derived from teh Mullerian ducts)
- Increased incidence in females who were exposed to diethylstilbesterol (DES) in utero
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Term
| Clear Cell Adenocarcinoma |
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Definition
- Malignant proliferation of glands with clear cytoplasm
- Rare, but feared complication of DES-associated vaginal adenosis
- Discovery of this complication (along w/ other DES-induced abn. of the gynecologic tract such as abnormal shape of the uterus) led to cessation of DES useage
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Term
| Embryonal Rhabdomyosarcoma |
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Definition
- Malignant mesenchymal proliferation of immature skeletal muscle; rare
- Presents as bleeding and a grape-like mass protruding from the vagina or penis of child (usually <5 yrs of age) also known as sarcoma botryoides
- Rhabdomyoblast, the char. cell, exhibits cytoplasmic cross-striations and positive immunohistochemical staining fro desmin adn myogenin
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Term
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Definition
- Carcinoma arising from squamous epithelium lining the vaginal mucosa
- Usually related to high-risk HPV
- Precursor lesion is vaginal intraepithelial neoplasia (VAIN)
- When spread to regional lymph node occurs, cancer from the lower 2/3 of vagina goes to inguinal nodes, and cancer from the upper 1/3 goes to regional iliac nodes
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Term
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Definition
- Anatomically, comprises the "neck" of teh uterus
- Divided into the exocervix (visible on vaginal exam) and endocervix
- exocervix is lined by non-keratinizing squamous epithelium
- Endocervix is lined by a single layer of columnar cells
- Junction between the exocervix and endocervix is called the transformation zone
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Term
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Definition
- Sexually transmitted DNA virus taht infects teh lower genital tract, especially the cervix in the transformation zone
- Infection is usually eradicated by acute inflammation; persistent infection leads to an increased risk for cervical dysplasia (cervical intraepithelia neoplasia, CIN)
- Risk of CIN depends on HPV type, which is det. by DNA sequencing
- High-risk- HPV types 16, 18, 31, and 33
- Low-risk- HPV types 6 and 11
- High risk HPV produce E6 and E7 proteins which result in increased destruction of p53 and Rb, respectively. Loss of these tumor suppressor proteins increases the risk for CIN
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Term
| Cervical Intraepithelial Neoplasia |
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Definition
- Char. by koilocytic change, disordered cellular maturation, nuclear atypia, and increased mitotic activity w/i the cervical epithelium
- Divided into grades based on the extent of epithelial involvement by immature dysplastic cells
- CIN involves <1/3 of the thickness fo the epithelium
- CIN II involves 2/3 of the thickness of the epithelium
- CIN III involves slighly less that the entire thickness of the epithelium
- Carcinoma in situ (CIS) involves teh entire thickness of the epithelium
- CIN classically progresses in a stepwise fashion though CIN I, CIN II, CIN III, ANd CIS to become invasive squamous cell carcinoma
- Progresion is not inevitable (CIN I often regresses)
- The higher the grade of dysplasia, the more likely it is to progress to carcinoma and the less likely it is to regress to normal
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Term
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Definition
- Invasive carcinoma that arises from the cervical epithelium
- Most commonly seen in middle-aged women (avg age 40-50)
- Presents as vaginal bleeding, especially postcoital bleeding, or cervical discharge
- Key risk factor is high-risk HPV infection; secondary risk factors include smoking and immunodeficiency (ex cervical carcinoma is an AIDS-defining illness).
- MOst common subtypes of cervical carcinoma are squamous cell carcinoma (80% of cases) and adenocarcinoma (15% of cases). Both types are related to HPV infection
- Advanced tumors often invade through the anterior uterine wall into the bladder, blocking the ureters. Hydronephrosis with postrenal failure is a common cause of death in advanced cervical carcinoma
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Term
| Screening and Prevential of Cervical Carcinoma |
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Definition
- The goal of screening is to catch dysplasia (CIN) before it develops into carcinoma
- Progression from CIN to carcinoma on avg, takes 10-20 years
- screening begins at age 21 and is initially perforemed yearly
- Pap smear is the gold standard for screening
- Cells are scraped from teh transformation zone using a brush and analyzed under a microscope
- dysplastic cells are classified as low grade (CIN I) or high grade (CIN II and III)
- High-grade dysplasia is char. by cells with hyperchromatic (dark) nuclei and high nuclear to cytoplasmic ratios
- Pap smear is the most successful screening test dev. to date
- It is resp. for a sig. reduction in the morbidity and mortality of cervical carcinoma (cervical carcinoma went from being the most common to one of teh least common types of gynecologic carcinoma in the US)
- Women who develop invasive cervical carcinoma usually have not undergone screening
- An abnormal pap smear is followed by confirmatory colposcopy (visualization of cervix with a magnifying glass) and biopsy
- Limitations of the pap smear include inadequate sampling of the transformation zone (false negative screening) and limited efficacy in screening for adenocarcinoma.
- Despite Pap smear screening, the incidence of adenocarcinoma has not decreased significantly
- Immunization is effective in preventing HPV infections
- The quadrivalent vaccine covers HPV types 6, 11, 16, and 18
- Antibodies generated against types 6, and 11 protect against condylomas
- Antibodies generated against types 16 and 18 protect against CIN and carcinoma
- Protection lasts for 5 years
- Pap smears are still necessary due to the limited number of HPV types covered by the vaccine
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Term
| Endometrium and Myometrium |
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Definition
- Endometrium is the mucosal lining of the uterine cavity
- Myometrium is the smooth muscle wall underlying the endometrium
- Endometrium is hormonally sensitive
- Growth of the endometrium is estrogen driven (proliferative phase)
- Preparation of the endometrium for implantation is progesterone driven (secretory phase)
- Shedding occurs with loss of progesterone support (menstrual phase)
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Term
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Definition
- secondary amenorrhea due to loss of the basalis and scarring
- result of overaggressive dilation and curettage (D&C)
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Term
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Definition
- Lack of ovulation
- Results in an estrogen-driven proliferative phase w/o a subsequent progesterone-driven secretory phase
- Prliferative glands break down and shed resulting in uterine bleeding
- Represents a common cause of dysfunctional uterine bleeding, especially during menarche and menopause
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Term
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Definition
- Bacterial infection of the endometrium
- Usually due to retained products of conception (eg after delivery or miscarriage)
- ; retained products act as a nidus for infection
- Prevents as fever, abnormal uterine bleeding, and pelvic pain
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Term
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Definition
- Chrnoic Inflammation of the endometrium
- Char. by lymphoctyes and plasma cells
- Plasma cells are necessary for the diagnosis of chronic endometritis given that lymphocytes are normally found in the endometrium
- causes include retained products of conception, chronic pelvic inflammatory disease (ex Chlamydia), IUD, and TB
- Presents as abnormal uterine bleeding, pain, and infertility
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Term
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Definition
- Hyperplastic protrusion of endometrium
- Presents as abnormal uterine bleeding
- Can arise as a side effect of tamoxifen, which has anti-estrogenic effects on the breast but weak pro-estrogenic effects on the endometrium
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Term
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Definition
- Endometrial glands and stroma outside of the uterine endometrial lining
- most likely due to retrograde menstruation with implantation at an ectopic site
- Presents as dysmenorrhea (pain during menstruation) and pelvic pain; may cause infertility
- endometriosis cycles just like normal endometrium
- Most common site of involvement is the ovary, which classically results in formation of a "chocolate" cyst
- Other sites of involvement include the uterine ligaments (pelvic pain), pouch of Douglas (pain with defecation), bladder wall (pain w/ urination), bowel serosa (abdominal pain and adhesions) ,and fallopian tube mucosa (scarring increases risk for ectopic tubal pregnancy); implants classically appear as yellow-brown 'gun-powder' nodules
- Involvement of the uterine myometrium is called adenomyosis
- There is an increased risk of carcinoma at the site of endometriosis, especially in the ovary
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Term
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Definition
- Hyperplasia of endometrial glands relative to stroma
- Occurs as a consequence of unopposed estrogen (ex obesity, polycystic ovary syndrome, and estrogen replacement)
- Classically presents as postmenopausal bleeding
- Classified histologically based on architectural growth pattern (simple or complex) and the presence or absence of cellular atypia
- Most important predictor for progression to carcinoma (major complication) is the presnce of cellular atypia; simple hyperplasia with atypia often progresses to cancer (30%); whereas, complex hyperplasia w/o atypia rarely does (<5%)
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Term
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Definition
- Malignant proliferation of endometrial glands
- Most common invasive carcinoma of teh femal genital tract
- presents as postmenopausal bleeding
- Arises via two distinct pathways; hyperplasia and sporadic
- In the hyperplasia pathway (75% of cases), carcinoma arises from endometrial hyperplasia
- Risk factors are related to estrogen exposure and include early menarche/late menopause, nulliparity, infertility w/ anovulatory cycles, adn obesity.
- Average age of presentation is 60 years
- Histology is endometrioid( ie normal endometrium-like)
- In the sporadic pathway (25% of cases), carcinoma arises in an atrophic endometrium with no evident precursor lesion
- Average ge at presentation is 70 years
- Histology is usually serous and is char. by papillary structures w/ psammoma body formation; p53 mutation is common, and the tumor exhibits aggressive behavior
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Term
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Definition
- Benign neoplastic proliferation of smooth muscle arising from myometrium; most common tumor in females
- Related to estrogen exposure
- Common in premenopausal women
- Often multiple
- Enlarge during pregnancy; shrink after menopause
- Gross exam shows multipl, well-defined, white, whorled masses that may distort the uterus and impinge on pelvic structures
- usually asymptomatic; when present, symptoms include abnormal uterine bleeding, infertility, and a pelvic mass
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Term
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Definition
- Malignant proliferation of smooth muscle arising from the myometrium
- Arises de novo; leimyosarcomas do not arise from leiomyomas
- usually seen in postmenoupausal women
- Gross exam often shows a single lesion w/ areas of necrosis and hemorrhage; istological features include necrosis, mitotic activity, and cellular atypia
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Term
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Definition
- The functional unit of the ovary is the follicle
- A follicle consists of an oocyte surrounded by granulosa and theca cells
- LH acts on theca cells to induce androgen production
- FSH stimulates granulosa cells to convert androgen to estradiol (drives the proliferative phase of the endometrial cycle)
- Estradiol surge induces an LH surge, which leads to ovulation (marking the beginning of the secretory phase of the endometrial cycle)
- After ovulation, the residual follicle becomes a corpus luteum, which primarily secretes progesterone (drives the secretory phase which prepares thes endometrium for a possible pregnancy)
- Hemorrhage into a corpus luteum can result in a hemorrhagic corpus luteal cyst, especially during early pregnancy
- Degeneration of follicles results in follicular cysts. Small numbers of follicular cysts are common in women and have no clinical significance
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Term
| Polycystic Ovarian Disease (PCOD) |
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Definition
- Multiple ovarian follicular cysts due to hormone imbalance
- Affects 5% of women of reproductive age
- Char. by increased LH and low FSH (LJ:FSH>2)
- Increased LH induces excess androgen production (from theca cells) resulting in hirsutism (excess hair in a male distribution)
- Androgen is converted to estron in adipose tissue
- Estrone feedback decreases FSH resulting in cystic degeneration of follicles
- High levels of circulating estrone increase resk for endometrial carcinoma
- Classic presentation is an obese young woman with infertility, oligomenorrhea, and hirsutism; some patients have insulin resistance and may develop type 2 diabetes mellitus 10-15 years later
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Term
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Definition
- Ovary is composed fo 3 cycle types; surface epithelium, germ cells, and sex cord-stroma
- Tumor can arise from any of these cell types or from metastases
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Term
| Surface Epithelial Tumors of Ovary |
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Definition
- Most common type of ovarian tumor (70%) of cases
- Derived from coelomic epithelium that lines the ovary; coelomic epithelium embryologically produces the epithelial lining of the fallopian tube (serous cells), endometrium, and endocervix (mucinous cells)
- The two most common subtypes of surface epithelial tumors are serous and mucinous; both are usually cystic
- Serous tumors are full of watery fluid
- Mucinous tumors are full of mucus-like fluid
- Mucinous and serous tumors can be benign, borderline, or malignant
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Term
- Benign tumors (cystadenomas)
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Definition
| are composed of a single cyst w/ a simple, flat lining; most commonly arise in premenopausal women (30-40 years old |
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Term
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Definition
- Malignant tumors
- composed of complex cysts with a thick, shaggy lining; most commonly arise in postmenopausal women (60-70 years old)
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Term
| Borderline ovarian tumors |
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Definition
- have features in between benign and malignant tumors
- better prognosis than clearly malignant tumors, but still carry metastatic potential
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Term
| Mutation that has an increased risk for serous carcinoma of the ovary and fallopian tube |
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Definition
- BRCA1 mutation carriers
- often elective to have a prophylactic salpingo-oophorectomy (along w/ prophylactic mastectomy due to the increased risk for breast cancer)
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Term
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Definition
- Composed of endometrial-like glands and are usually malignant
- may arise from endometriosis
- 15% of endometroid carcinomas of the ovary are associated w/ an independent endometrial carcinoma (endometrioid type)
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Term
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Definition
- Composed of bladder-like epithelium and are usually benign
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Term
| Surface tumors of ovarian tumors |
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Definition
- Surface tumors clinically present late w/ vague abdominal symptoms (pain and fullness) or signs of compression (urinary frequency)
- Prognosis is generally poor for surface epithelial carcinoma (worst prognosis of female genital tract cancers)
- Epithelial carcinomas tend to spread locally, especially to the peritoneum
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Term
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Definition
| a useful serum marker to monitor treatment response and screen for recurrence |
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Term
| Female Germ Cell Tumors of Ovary |
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Definition
- 2nd most common type of ovarian tumor (15% of cases)
- Usually occur in women of reproductive age
- Tumor subtypes mimic tissues normally produced by germ cells
- Fetal tissues-cystic teratoma and embryonal carcinoma
- Oocytes- dysgerminoma
- Yolk sac- endodermal sinus tumor
- Placental Tissue- choriocarcinoma
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Term
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Definition
- Cystic Tumor composed of fetal tissue derived from two or three embryologic layers (ex skin, hair, bone, cartilage, gut, and thyroid)
- Mostt common germ cell tumor in females; bilateral in 10% of cases
- Benign, but presence of immature tissue (usually neural) or somatic malignancy (usually squamous cell carcinoma of skin) indicates malignant potential
- Struma ovarii is a teratoma composed primarily of thyroid tissue
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Term
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Definition
- Tumor composed of large cells with clear cytoplasm and central nuclei (resemble oocytes) most common malignant germ cell tumor
- Testicular counterpart is called seminoma, which is relatively common germ cell tumor in males
- Good prognosis; responds to radiotherapy
- Serum LDH may be elevated
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Term
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Definition
- Malignant tumor that mimics the yolk sac; most common germ cell tumor in children
- Serum AFP is often elevated
- Schiller-Duval bodies (glomerulus-like structures) are classically seen on histology
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Term
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Definition
- Malignant tumor composed of trophoblasts and syncytiotrophoblasts; mimics placental tissue, but villi are absent
- Small, hemorrhageic tumor w/ early hematogenous spread
- High beta-hCG is char. (prod by syncytiotrophoblasts); may lead to thecal cysts in the ovary
- Poor response to chemotherapy
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Term
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Definition
- Malignant tumor composed of large primitive cells
- aggressive with early metastasis
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Term
| Ovary Sex cord-stromal tumors |
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Definition
| Tumors that resemble sex cord-stromal tissues of the ovary |
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Term
| Granulosa-thea cell tumor |
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Definition
- Neoplastic proliferation of granulos and theca cells
- Often produces estrogen; presents with signs of estrogen excess
- Prior to puberty-precocious puberty
- reproductive age-menorrhagia or metrorrhagia
- Postmenopause (most common setting for granulosa-theca cell tumors)-endometrial hyperplasia with postmenopausal uterine bleeding
- Malignant but minimal risk for metastasis
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Term
| Sertoli-Leydig Cell tumor of Ovary |
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Definition
- Composed of sertoli cells that form tubules and Leydig cells (between tubules) with char. Reinke crystals
- May produce androgen; associated w/ hirsutism and virilization
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Term
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Definition
- benign tumor of fibroblasts
- Associated with pleural effusions and ascites (Meigs syndrome); syndrome resolves with removal of tumor
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Term
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Definition
- A metastatic mucinous tumor that involves both ovaries; most commonly due to metastatic gastric carcinoma (diffuse type)
- Bilaterally helps distinguish metastases from primary mucious carcinoma of the ovary, which is usually unilateral
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Term
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Definition
- Massive amounts of mucus in the peritoneum
- due to mucinous tumor of the appendix, usually with metastasis to the ovary
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Term
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Definition
- Implantation of fertilized ovum at a site other that the uterine wall; most common site is the lumen of the fallopian gube
- Key risk factor is scarring (eg secondary to PID or endometriosis)
- [image]
- Classic presentation is lower quadrant abdominal pain a few weeks after a missed period
- Surgical emergency;major complications are bleeding into fallopian tube (hematosalpinx) and rupture
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Term
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Definition
- Miscarriage of fetus occuring before 20 weeks gestation (usually during 1st trimester)
- common; occurs in up to 1/4 of recognizable pregnancies
- Presents as vaginal bleeding, cramp-like pain, and passage of fetal tissues
- Most often due to chromosomal abn. (esp. trisomy 16); other causes include hypercoagulable states (eg antiphospholipid syndrome), congenital infection, and exposure to teratogens (especially during the first 2 weeks of embryongenesis)
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Term
| Effects of teratogens depends on... |
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Definition
- Dose, agent, and time of exposure
- First 2 weeks of gestation- spon. abortion
- weeks 3-8- risk of organ malformation
- Months 3-9 risk of organ hypoplasia
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Term
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Definition
- Implantation of the placenta in the lower uterine segment; placenta overlies cervical os (opening)
- Presents as 3rd trimester bleeding
- often requires delivery of fetus by caesarian section
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Term
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Definition
- Separation of placenta from the decidua prior to delivery of the fetus
- common cause of still birth
- presents with third-trimester bleeding and fetal insufficiency
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Term
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Definition
- Improper implantation of placenta into the myometrium with little or no intervening decidua
- presents with difficult delivery of the placenta and postpartum bleeding
- Often requires hysterectomy
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Term
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Definition
| most common cause of mental retardation; also leads to facial abnormalities and microcephaly |
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Term
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Definition
| intrauterine growth retardation and placental abrubtion |
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Term
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Definition
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Term
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Definition
| intrauterine growth retardation |
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Term
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Definition
| spon. abortion, hearing and visual impairment |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| Digit hypoplasia and cleft lip/palate |
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Term
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Definition
- Pregnancy-induced HTN, proteinuria, and edema, usually arising in the 3rd trimester; seen in aprox 5% of pregnancies
- HTN may be severe, leading to headaches and visual abnormalities
- due to abnormality of the maternal-fetal vascular interface in the placenta; resolves with delivery
- Current theory has to do with a toxin from the placenta crossing into the maternal bloodstream, it destroys the vasculature ? (If anyone remembers exactly what this was please let me know, and I'll edit this card.)
- Eclampsia is preeclampsia with seizures
- HEELP is preeclampsia with thrombotic microangiopathy involving the liver; char. by hemolysis, elevated liver enzymes, and low Platelets
- both eclampsia and HEELP usually warrant immediate delivery
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Term
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Definition
- Death of a health infant (1 month to 1 year old) without obvious cause
- Infants usually expire during sleep
- Risk factors include sleeping on stomach, exposure to cigarette smoke, and prematurity
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Term
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Definition
- Abnormal conception char. by swollen and edematous villi with proliferation of trophoblasts.
- Uterus expands as if a normal pregnancy is present, but the uterus is much larger and beta-hCG much higher than expected for date of gestation
- Classically presents in the second trimester as passage of grape-like masses through the vaginal canal
- with prenatal care, moles are diagnosed by routine ultrasound in the early first trimester. Fetal heart sounds are absent, and a 'snowstorm' appearance is classically seen on ultrasound
- Classified as complete or partial
- Treatment is dilatation and curettage
- subsequent Beta-hCG monitoring is important to ensure adequate mole removal and to screen for the dev. of choriocarcinoma
- Choriocarcinoma may arise as a complication of gestation (spon. abortion, normal pregnancy, or hyatidiform mole) or as a spon. germ cell tumor
- Choriocarcinomas that arise from the gestational pathway respond well to chemotherapy; those that arise from the germ cell pathway do not
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Term
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Definition
- Normal ovum fertilized by two sperm (or one sperm that duplicates chromosomes); 69 chromosomes
- fetal tissue is present
- some villi are hydropic, and some are normal
- Trophoblastic proliferation=focal proliferation present around hydropic villi
- Minimal risk for choriocarcinoma
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Term
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Definition
- Empty Ovum fertilized by two sperm (or one sperm that duplicates chromosomes); 46 chromosomes
- absent fetal tissue
- Most villi are hydropic
- Trophoblastic proliferation: diffuse circumferential proliferation around hydropic villi
- 2-3% risk for choriocarcinoma
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