Term
| 3 vulvar lesions that can present w/ leukoplakia? |
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Definition
1) Lichen sclerosis (thin; rarely transforms to HPV-negative cancer)
2) Lichen Simplex Chronicus (leathery; from chronic irritation/rubbing; no risk for cancer)
3) Vulvar Carcinoma |
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Term
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Definition
Low: 6,11
High: 16,18,31,33 |
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Term
| Where are the vestibular glands (Bartholin) located anatomically. |
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Definition
bottom of vestibule.
Bartholin cysts result from inflammation & obstruction of gland (usually infection) |
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Term
| Histologically, what type of cancer can Paget disease of breast/vulva look like? How do you differentiate them? |
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Definition
Melanoma. Differentiate these 2 by stains:
- Paget = PAS+, Keratin+, S100-
- Melanoma = PAS-, Keratin-, S100+ |
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Term
Embryologically, the lower 2/3 of the vagina are derived from ___ and are composed of ___ type of epithelium.
The upper 1/3 is derived from ___ and is initially composed of ____ epithelium, but gets replaced by ____ from the lower 2/3 |
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Definition
lower2/3 = UG sinus; non-keratinized squamous cell epithelium
Upper 1/3 = Mullerian ducts; columnar epithelium; gets replaced by squamous epithelium of lower 2/3; failure of this replacement results in vaginal adenosis |
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Term
| DES increases risk for what? |
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Definition
| Vaginal adenosis --> may develop into Clear Cell Adenocarcinoma |
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Term
| Bleeding, protruding, grape-like mass from penis or vagina that has cytoplasmic cross-striations & is desmin positive |
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Definition
| Embryonal Rhabdomyosarcoma (sarcoma botryoides) |
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Term
1) Risk factor for vaginal carcinoma? what type of carcinoma is it?
2) If in lower 2/3, what lymph node does it spread to?
3) If it's in upper 1/3 what nodes? |
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Definition
1) High-risk HPV (16,18,31,33); squamous cell;
2) lower 2/3 = inguinal nodes (derived from UG sinus)
3) upper 1/3 = iliac nodes (derived from Mullerian ducts) |
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Term
Name cancers that smoking increases the risk for:
HINT: 6 are things that are directly exposed to the smoke & its metabolites
2 are not |
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Definition
6: Oropharyngeal, esophageal, & laryngeal (all 3 synergistic w/ EtOH); Lung, Kidney (RCC), & uroepithelial
2: Pancreatic adenocarcinoma; Cervical cancer |
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Term
| Is carcinoma in situ reversible? |
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Definition
no
- CIN-I (lower 1/3 of cervical epithelium) is reversible 66% of the time
- CIN-II (lower 2/3 of epithelium) is reversible 33% of the time
- CIN-III (Whole epithelium except top layer) is rarely reversible
CIS has dysplastic cells that comprise the entire epithelial thickness |
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Term
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Definition
E6 --> inactivate p53
E7 --> inactivate Rb
ASIDE: p53 identifies DNA damage & calls in repair enzymes; if damage is too extensive --> signals BAX, which degrades Bcl2
Rb binds E2F & prevents G1->S transition; When Rb is phosphorylated by CyclinD, it releases E2F |
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Term
| Is squamous carcinoma, adenocarcinoma, or both of the cervix related to HPV infection? |
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Definition
Both are (80% of lesions are Squamous)
remember, the screening methods available (i.e. PAP smear) are only effective at picking up squamous cell carcinoma. However, the HPV vaccine is effective at preventing BOTH squamous & adenocarcinomas |
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Term
| middle aged women (40-50) presenting with post-coital bleeding, cervical discharge. PMH of smoking/immunodeficiency/multiple sexual partners. She presents w/ hydronephrosis & post-renal failure. Diagnosis? |
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Definition
Invasive cervical cancer.
NOTE: this question has all the major risk factors & epidemiology. HPV, smoking, & immunosuppression are major risk factors. Cervical cancer, for whatever reason, is locally invasive & usually presents with signs of bladder/ureter invasion instead of metastases. |
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Term
| Is cervical carcinoma an AIDS defining illness? |
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Definition
| yes. Remember, one of the risk factors is immunosuppression |
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Term
| How often do you have to get an HPV vaccine booster? |
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Definition
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Term
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Definition
Secondary amenorrhea caused by uterine adhesions, obliterating lumen
Usually caused by loss of basalis, usually from repeated/aggressive D&C's
ASIDE: Basalis holds the endometrial stem cells --> replaces functionalis every menstrual cycle |
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Term
| Why is there no progesterone produced in an anovulatory cycle? |
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Definition
| Egg doesn't ovulate --> corpus luteum isn't formed --> no estrogen |
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Term
| What type of cell needs to be seen in order to diagnose chronic endometritis? |
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Definition
| Plasma cells (Lymphocytes are normally seen in endometrium) |
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Term
| What type of tissue is endometrial tissue of endometriosis made of? |
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Definition
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Term
| Pt taking tamoxifen has abnormal uterine bleeding. Imaging shows a protruberant mass in the endometrium. |
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Definition
Endometrial polyp
Tamoxifen has antiestrogenic effects on breast, but partial agonist effects on the endometrium & bone |
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Term
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Definition
endometriosis involvement of the ovary (most common side of involvement)
Other sites include:
- Pouch of Douglas (pain w/ defecation)
- Bladder (dysuria)
- Bowel (abdominal pain & adhesions)
- Fallopian tube mucosa (potential scarring->ectopic tubal preg)
Implants in soft tissues present as tan-brown "gun powder" nodules (in contrast to the "chocolate cyst" of the ovary |
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Term
| Endometriosis cancer risk? |
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Definition
| yes. increased risk for cancer at site, especially if on ovary (?cause of endometrioid ovarian cancer?) |
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Term
| Is endometrial hyperplasia estrogen dependent? |
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Definition
yes
Risk factors include:
- PCOS
- Obesity
- Estrogen replacement |
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Term
What is the prognostic criteria for endometrial hyperplasia?
HINT: remember complex/simple & atypia |
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Definition
Complex + atypia > Simple + atypia >> complex - atypia > Simple - atypia
Atypia is the single most important risk factor for development into endometrial carcinoma |
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Term
| What is the most common invasive cancer of the female genital tract? |
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Definition
endometrial carcinoma
Derived from either the hyperplasia --> carcinoma pathway (75%) OR sporadic pathway (usually "serous" w/ psammoma bodies & driven by p53 mutations) |
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Term
| name cancers w/ psammoma bodies? |
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Definition
1) Papillary cancer of thyroid
2) Serous carcinoma of ovary or endometrium
3) Meningioma
4) Mesothelioma |
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Term
| Is nulliparity a risk factor for endometrial carcinoma? |
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Definition
YES
additionally: early menarche, late menopause, infertility w/ anovulatory cycles (e.g. PCOS), obesity |
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Term
Asymptomayic, multiple, well-defined, white, whoreled masses in the endometrium.
Are these related to estrogen exposure? |
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Definition
Yes (these are fibroids, i.e. leiomyoma)
They are common in premenopausal women; are often multiple; and enlarge during pregnancy & shrink during menopause
NOTE: contrast this to leiomyosarcoma, which are not related to estrogen exposure |
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Term
| Endometriosis that has implanted in endometrial smooth muscle layer? |
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Definition
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Term
| Which cells in the ovary produce Androgens? Which cells aromatize them? |
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Definition
Theca produces androgens under the control of LH
Granulosa aromatizes these androgens under the control of FSH in order to feed the growing oocyte in the follicle during proliferative phase |
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Term
| Start from increased LH and describe PCOS |
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Definition
increased LH --> Increased androgen production by theca --> hirsutism, etc --> adipose aromatizes androgens --> estrogens feed back onto pituitary to decrease FSH release
Overall, High LH & low FSH create PCOS in a self-renewing cycle |
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Term
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Definition
endometrial
some pts have insulin resistance & may develop type2 diabetes |
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Term
Name tumors that derive from each layer of the ovary:
1) Surface (4)
2) Germ Cell (5)
3) Stroma (3) |
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Definition
1) Serous(BRCA), mucinous, endometrioid (associated w/ endometrial cancer), Brenner (bladder)
{remember Ca-125}
2) Dysgerminoma(LDH), Teratoma(struma ovarii), Embryonal(aggressive), Choriocarcinoma(hCG), Yolk sac(AFP)
3) Granulosa-theca (estrogens); Sertoli-leydig(androgens); fibroma(meigs) |
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Term
| How do you differentiate a signet-ring carcinoma of the ovary from a signet-ring metastasis to the ovary? |
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Definition
| the mets are bilateral (usually from diffuse-type of gastric adenocarcinoma) |
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