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Pathology(Female Reproductive)*


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Rare malignant tumor of the vagina w/c inc. in incidence in daughters of women who receive Diethylstilbestrol(DES)therapy during therapy;may also occur in the cervix;vaginal adenosis(mucosal columnar epithelial-lined crypts in areas normally lined by str
Clear Cell Adenocarcinoma
Neoplasm of the vagina occuring in children <5yrs;rare variant of rhabdomyosarcoma;presents as multiple polypoid masses resembling "bunch of grapes"projecting into the vagina protruding from the vulva
Sarcoma Botryoides
Maternal exposure to DES(diethylstilbestrol)
Clear cell carcinoma of the vagina in daughters
Predisposes to male germ cell tumors even if surgically corrected
Cryptorchidism(undescended testes)
Toxemia w/ CNS involvement, including convulsions & coma in a pregnant woman
Most common cause of hematosalpinx
Ectopic Pregnancy
-chronic pelvic inflammatory dse. may predispose to ectopic pregnancy
Leukorrhea & irregular bleeding in a postmenopausal woman
Endometrial Carcinoma
-risk factors include obesity, diabetes, hypertention, infertility, & endometrial hyperplasia
Leading cause of infertility, w/ menstrual irregularities, severe dysmenorrhea, & intrapelvic bleeding in a young woman
-"Chocolate Cysts" or blood- and debris-filled cysts in ovaries may develop
Discrete, rubbery, movable mass in the inner lower quadrant of the breast of a young female
-most common benign tumor of the female breast
Blue-domed cysts & dense fibrosis that produce palpable lumps & mammographic densities
Fibrocystic change of the breast
-epithelial cell lining around cysts shows apocrine metaplasia
Bleeding w/ passage of grape-like structures, increased hCG, & rapid incr. in uterine size
Hydatidiform Mole
-similar presentation w/o uterine enlargement=choriocarcinoma
Most common cause of scrotal enlargement
-clear, serous fluid can be seen upon transillumination of scrotal sac
Tumor w/ tendency to affect both breast
Infiltrating lobular carcinoma
Nodule of rock hard consistency in the upper outer quadrant of the breast of a postmenopausal woman
Invasive(infiltrating)carcinoma of the breast
-histologically charact. by nests of tumor cells in a scirrhous, or scar-like, dense, hard stroma
Most common benign tumor in females
-benign tumor of the smooth muscle of the uterus
Germ cell tumor that may contain, teeth, cartilage, &/or glands
Mature Cystic Teratoma(dermoid cyst)
-tumor is derived from all three germ cell layers
Presents as urinary urgency, frequency, & nocturia in anolder male
Nodular hyperplasia of the prostate(benign prostatic hyperplasia)
-commonly arises in the periurethral & transition zones of the prostate causing compression of the urethra
Eczematoid lesion of the nipple, often w/ underlying ductal carcinoma
Paget dse. of the breast
Psammona bodies
Papillary serous cystadenocarcinoma of the ovary
-also in papillary carcinoma of the thyroid & meningioma
Young female w/ amenorrhea, infertility, obesity, & hirsutism
Polcystic ovary(Stein-Leventhal)Synd.
-may be caused by excess secretion of luteinizing hormone
Insidious onset of hypertension, edema, proteinuria, & headache after the 32nd week of pregnancy
Extragenital infections due to gonorrhea
Pharyngitis(orogenital sexual contact), Proctitis(anal intercourse),Purulent arthritis(monoarticular involving large joints),Ophthalmia neonatorum(acquired at delivery)
Neoplasm of the vulva w/c accounts for 10% of malignant tumors of the vulva
Malignant Melanoma
Chlamydial infection causing the most common sexually transmitted dse.;common cause of PID;often asymptomatic;caused by Chlamydia trachomatis
Chlamydial Cervicitis
Chlamydial infection caused by C.trachomatis(L1,L2,or L3 serotypes); manifest as a small papule or ulcer~ superficial ulcers,lymphnode enlargement;lead to rectal stricture due infl.rxn. & scarring
Lymphogranuloma venereum
Neoplasm of the vulva similar to Pagets dse. of the breast;assoc. w/ underlying adenocarcinoma of the apocrine glands
Pagets disease of the vulva
Neoplasm of the vagina due to extension of squamous cell carcinoma of the cervix
Squamous Cell Carcinoma
Disorder charact. by severe HPN occuring de novo during pregnancy(during 3rd trimester often in 1st pregnancy)or complicates pre-existing hypertensive dse. affecting the kidneys,liver & CNS
Toxemia of Pregnancy
-occurs in 2 forms:preeclampsia(mild form,HPN,albuninuria,edema)& eclampsia(severe form,HPN,albuminuria,edema, convulsions,DIC;fatal)
STD producing small vesicles & shallow ulcers that involve the cervix,vagina, clitoris,vulva,urethra,& perianal skin; presence of multinucleated giant cells w/ viral inclusions in cytologic smears
Herpes Simplex Virus(HSV)infection
-HSV type 2 accounts for genital herpes
STD caused by Treponema pallidum presenting as a firm,painless ulcer(chancre) or as condyloma lata(gray,flattened wart-like lesions);may cause fetal malformation during pregnancy
STD caused by Haemophelus ducreyi charact. by soft,painful ulcerated lesions(in contrast to syphilis w/c have firm painless ulcers);common in tropical areas
STD caused by Calymmatobacterium(Donovania)granulomatis charact. by Donovan bodies(organism filling histiocytes)appearing as papules~ ulcerate~progress by adjacent lesions~large genital or inguinal ulerations w/ lymphatic obstruction or genital distortio
Granuloma Inguinale
Most common benign tumor of the vulva w/c originates from the apocrine sweat glands presenting as labial nodule~ulcerate~bleed;cured by exicision
Papillary Hidradenoma
Benign squamous cell carcinoma caused by HPV(types 6&11)presenting as multiple wart-like lesions(venereal warts)in the vulvovaginal,perianal & cervical regions charact. hitologically by koilocytes(expanded epithelial cells w/perinuclear clearing
Condyloma Acuminatum
Most common malignant tumor of the vulva occuring often in older women; assoc. w/ HPV type 16,18,31,33(also assoc. w/ squamous cell carcinoma of the vagina & cervix);preceded by vulvar dystrophy
Squamous Cell Carcinoma
-preceded by premalignant changes graded as vulvar intraepithelial neoplasia(VIN)1-3
Most common form of vaginitis;caused by Candida albicans(normal flora of vagina);charact. by white,patch-like mucosal lesions,a thick white discharge,& vulvovaginal pruritus
-assoc. w/ DM,pregnancy,broad spectrum antibiotic therapy,oral contraceptive use,& immunosuppresion
Infectious disorder of the vagina transmitted by sexual contact w/ charact. "clue cells"(epithelial cells containing dot-like organisms in Papanicolaou smear);classified as nonspecific vaginitis
Gardnerella Vaginitis
-caused by Gardnerella vaginitis
Infect. disorder of the vagina assoc. w/ use of highly absorbent tampons; caused by Staphylococcus aureus(grows in the tampon);charact. by rash(folowed by desquamation),fever,vomiting,& diarrhea~renal failure,shock
Toxic Shock Synd.
PID transmitted sexually;can be asymptomatic but infectious;charact. by purulent acute inflammation of the urethra,paraurethral & Bartholin glands,& Skene ducts;may ascend to infect the endocervix,uterine canal & fallopian tubes
-caused by N.gonorrhea
Results from an obstruction of the Bartholin ducts;can be infected by Neisseria gonnorrhoeae or staphylococcus
Bartholin Cyst
Group of disorders of epithelial growth presenting w/ pruritus & leukoplakia w/c may have no malignant potential(Lichen sclerosus,hyperplastic dystrophy)or premalignant lesion(atypical hyperplastic dystrophy)
Vulvular Dystrophy
-should be evaluated by biopsy
Second most common type of vaginitis; caused by Trichomonas vaginitis; transmitted by sexual contact
Non-neoplastic disorder of the uterine cervix charact. by columnar epith. replacing squamous epith.;may be a manifestation by chronic cervicitis
Non-neoplastic disorder affecting the endocervix caused by staphylococci, enterococci,Gardenella vaginalis, Trichomonas vaginalis,Candida albicans,Chlamydia trachomatis manifested by cervical discharge;often asymptomatic
General charact.,cause,& classification of dysplasia & carcinoma in situ in the uterine cervix
Charact. by disordered epithelial growth often in the squamocolumnar junct. beginning at the basal layer extending outward;assoc. w/ HPV(type 16,18,31,33)infxn.;dysplasia~carcinoma in situ;classified as cervical intraepithelial neoplasia(CIN)1-3
Malignant disorder in the uterine cervix affecting middle-age groups;often squamous cell carcinoma; arises from pre-existing CIN at the squamocolumnar junction;evovles from dysplasia~carcinoma in situ~invasive carcinoma;dec. mortality w/ Papanicolaou cyt
Invasive Carcinoma
Epidemiologic factors & role of HPV in invasive carcinoma
Inc. incidence w/ history of early sexual activity,multiple sexual partners,economically deprived & cigarette smoking;HPV types 16,18,31,33 are most common cause(>90%) of malignant genital squamous cell tumors;dysplastic cells demonstrate koilocytosis
Assoc. w/ intrauterine trauma from instrumentaion,intrauterine contraceptive devices,complications of pregnancy(postpartum retention of placental fragments;caused by Staphylococcus aureus or Streptococcus species
Acute Endometritis
Charact. by presence & proliferation of ectopic endometrial tissue;most common in the pelvic area(ovary most common, next uterine ligaments,rectovaginal septum);clinically manifest w/ severe mentrual-related pain;results in infertility
-non-neoplastic;responsive to hormonal variations of the menstrual cycle; charact. by bleeding into ectopic endometrium~blood filled"chocolate cysts"
Caused by retrograde dissemination of endometrial fragments through the fallopian tubes during menstruation w/ implantation on the ovary,peritoneal structures,or blood borne or lymphatic borne dissemination of endometrial fragments
Charact. by islands of endometrium w/in the myometrium
Abno┬░ proliferation of the endometrial glands caused by excess estrogen stimulation~anovulatory cycles, polycystic ovary dse.,estrogen secreting ovarian tumors,estrogen therapy;manifest as postmenopausal bleeding
Endometrial Hyperplasia
-may be a precursor for endometrial carcinoma depending on the degree of cellular atypia
Benign lesion occuring in women >40yr w/c may result in uterine bleeding
Endometrial Polyp
Most common uterine tumor & most common tumor in women;benign;estrogen sensitive in w/c it inc. in size during pregnancy & dec. during following menopause;manifest as menorrhagia(if subendometrial)
-may be in the myometrium(intramural), subendometrial(submucous),subperitoneal(subserous)
A malignant tumor of the uterus that occurs infrequently;arises de novo & is almost never caused by a malignant transformation by leiomyoma
Most common gynecologic malignancy;peak incidence in older age group;often presents as postmenopausal bleeding; preceded by endometrial hyperplasia; predisposed by prolonged estrogen stimulation(estrogen therapy,estrogen producing tumors)
Endometrial Carcinoma
-predisposed by obesity,diabetes,HPN; assoc. w/nulliparity
PID of the fallopian tubes assoc. w/ infl. of the ovaries & other adjacent tissues due to N.gonnorrhea,anaerobic bact., C.trachomatis,streptococci; results in pyosalpinx(tube filled w/ puss),hydrosalpinx(tube filled w/ watery fluid),& tubo-ovaria
Bleeding into the fallopian tube caused by ectopic pregnancy
Most frequent benign tumor of the fallopian tube
Adenomatoid Tumor
Ovarian cyst due to distention of the unruptured graafian follicle;assoc. w/ hyperestrinsm & endometrial hyperplasia
Follicular Cyst
Ovarian cyst due to bleeding into a persistent mature corpus luteum w/c presents w/ mentrual irregularity & intraperitoneal hemorrhage
Corpus luteum cyst
Ovarian cyst due to gonadotropin stimulation;assoc. w/ choriocarcinoma & hydatidiform mole;multiple & bilateral; lined by luteinized theca cells
Theca-lutein Cyst
A bloody-containing cyst resulting from ovarian endometriosis w/ hemorrhage; ovary is most common site
Chocolate Cyst
Ovarian cyst in young women charact. by amenorrhea,infertility,obesity,& hirsutism due to excess LH & androgens; morphologically charact. by thickened ovarian capsule,multiple small follicular cyst & cortical stromal fibrosis
Polycystic Ovary(Stein-Leventhal)synd.
-assoc. w/ insulin resistance(DM, hyperinsulinemia)~inc. ovarian androgen prod.~inc. LH
Malignant tumor of the ovary w/c accounts for 50% of ovarian carcinomas; often bilateral
Serous Cystadenocarcinoma
-serous tumor
Benign cystic tumor of the ovary lined by cells similar to fallopian tube epithelium;accounts for 20% of all ovarian tumors;bilateral
Serous Cystadenoma
Benign mucinous tumor of the ovaries charact. by multilocular cyst lined by mucus-secreting columnar epith. & filled w/ mucinous material
Mucinous Cystadenoma
Malignant mucinous tumor of the ovaries due to rupture or metastasis in pseudomyxoma peritonei w/ multiple peritoneal tumor implants producing intraperitoneal mucinous material
Mucinous Cystadenocarcinoma
Malignant tumor of the ovaries resembling the endometrium
Endometrioid Tumor
Rare malignant tumor of the ovaries
Clear Cell Tumor
Rare benign tumor of the ovaries charact. by small islands of epithelial cells resembling bladder transitional epithelium interspersed w/in a fibrous stroma
Brenner Tumor
Tumors of surface cell origin w/c make up almost 3/4 of ovarian tumors;occurs in women >20yrs
Serous(cystadenoma,cystadenocarcinoma), Mucinous(cystadenoma, cystadenocarcinoma),Endometrial,Clear cell,& Brenner tumor
Tumors of germ cell origin w/c make up 1/4 of ovarian tumors & account for most ovarian tumors occuring in women <20yrs
Dysgerminoma,Endodermal sinus(yolk sac)tumor,Teratomas(immature,dermoid cyst or mature teratoma,monodermal teratoma),Ovarian choriocarcinoma
An attachment of the placenta to the lower uterine segment w/c may completely or partially cover the cervical os resulting in bleeding;may coexist w/ placenta accreta
Placenta Previa
Pregnancy occuring in the fallopian tubes(most common),ovary,abdominal cavity,cervix;predisposed by chronic salpingitis(often gonorrheal), endometriosis,postoperative adhesions~ hematosalpinx & tubal rupture
Ectopic Pregnancy
-most common cause of hematosalpinx
Ovarian tumor of sex cord-stromal origin w/c secretes androgen;assoc. w/ virilism(masculinization)
Sertoli-Leydig Cell Tumor(androblastoma,arrhenoblastoma)
Metastatic tumors to the ovaries w/c are GIT,breast,& endometrial in origin;bilaterally replace the ovaries w/ mucin secreting "signet-ring cells"
Krukenburg Tumors
-stomach is common site of origin
A premature separation of the placenta causing antepartum bleeding & fetal death;assoc. w/ disseminated intravascular coagulation(DIC)
Abruptio Placentae(placental abruption)
An attachment of the placenta directly on the myometrium of the uterus in presence of a defective decidual layer due to endometrial infl. & old scars from past cesareans w/c manifest as impaired placental separation after delivery assoc. w/ massive h
Placenta Accreta
Malignant germ cell tumor of the ovaries w/c is homologous to testicular seminoma
Ovarian tumor of germ cell origin w/c produces alpha-fetoprotein;homologous to endodermal sinus tumor of the testis
Endodermal sinus(yolk sac)tumor
Ovarian tumor of germ cell origin derived from 2-3 embryonic layers & have 3 distinct forms(immature,mature, monodermal)
-immature(aggressive malignant),mature(dermoid cyst;most frequent benign ovarian tumor;lined by skin,hair follicles,bone,tooth,cart.,etc.), monodermal(contains 1 tissue elements; most common,struma ovarii)
Ovarian tumor of germ cell origin w/c secretes human chorionic gonadotropin(hCG);aggressive malignant tumor
Monodermal teratoma
Ovarian tumors of ovarian sex cord-stromal origin w/c affects all age groups;accounts a small % of ovarian neoplasms
Thecoma-fibroma(Fibroma,Thecoma), Granulosa Cell tumor,Sertoli-Leydig cell tumor(andronblastoma, arrhenoblastoma)
Solid ovarian tumor of sex cord-stromal origin consisting of spindle-shaped fibroblast assoc. w/ Meig's synd(ovarian fibroma,ascites,& hydrothorax)
Ovarian tumor of sex cord-stromal origin w/c secerets estrogen & demonstrates round lipid-containing cells in addition to fibroblast
Estrogen secreting ovarian tumor of sex cord-stromal assoc. w/ endometrial hyperplasia or endometrial carcinoma & charact. by Call-Exner bodies(small follicles filled w/ eosinophilic secretion)causing precocious puberty
Granulosa Cell Tumor
Peripartal complication of pregnancy caused by a tear in the placenta memb. & rupture of maternal veins charact. by sudden peripartal respiratory difficulty~shock~death & masses of debris of epithelial squamous cells in the maternal pulmonary mic
Amniotic Fluid Embolism
-causes DIC;should not be confused w/ amniotic fluid aspiration synd.
Peripartal complications of pregnancy w/c is consequence of severe hypotension(blood lost most common);insidious onset over weeks-months following delivery;of ant. pituitary hypofunction
Postpartum Ant. Pituitary Necrosis(Sheehan Synd.)
Peripartal complication of pregnancy w/c follows premature rupture of membranes due to ascending infection from the vagina or cervix
A degenerative or neoplastic change of trophoblastic tissue manifested by enlarged,edematous placental villi in a loose stroma resembling bunch of grapes;marked by inc. in hCG(also occurs in normal or ectopic pregnancy, gestational choriocarcinoma,germ c
Hydatidiform Mole
-charact. by vaginal bleeding & rapid inc. in uterine size;can be mistaken for normal pregnancy;results in choriocarcinoma(2-3% of cases)
2 variants of hydatidiform mole
Complete hydatidiform mole(no embryo present;46,XX karyotype(paternal derivation-androgenesis); Partial hydatidiform mole(embryo present;due to fertilization of the ovum by 2 or more spermatozoa~69 chromosomes derived from 2 paternal & 1 maternal haploid set
An aggressive malignant neoplasm charact. by inc. hCG(important diagnostic sign),early hematogenous spread to lungs;preceded by hydatidiform mole(50%),abortion of ectopic pregnancy(20%),& normal-term pregnancy(20-30%)
Gestational Choriocarcinoma
-more common than ovarian choriocarcinoma;responsive to chemotherapy
Most common disorder of the breast affecting women ages 25-50yrs charact. as a palpable breast mass w/ midcycle tenderness due to inc. activity or sensitivity to estrogen or dec. progesterone activity;bilateral
Fibrocystic Dse.
-nonproliferative forms(stromal fibrosis & cyst form.):no risk of breast cancer;Epithelial hyperplasia w/ atypia or sclerosing adenosis(inc. risk of cancer w/ hyperplastic epthelial atypia)
Morphological charact. of fibrocystic dse.,the most common disorder of the breast
Fibrosis,cyst(may be filled w/ fluid & appear blue through the cyst wall "blue dome cyst"),epithelial changes(flattened,apocrine metaplasia, hyperplastic w/ atypia),adenosis(proliferation of ducts & myoepithelial cells),sclerosing adenosis(adenosis w/ fibrosis)
Most common breast tumor in women <25yrs old;benign;presents as a firm, rubbery,painless,well-circumscribed lesion;well demarcated from adjacent breast tissue
-subclassified into:Intracanalicular(stroma compresses & distorts glands into slitlike spaces)& Pericanalicular(glands retain round shape)
A large,bulky mass on the breast of variable malignancy w/ ulceration of overlying skin charact. by cystic spaces containing leaf-like projections from the cyst walls & myxoid contents
Phyllodes Tumor
Tumor of the breast presenting w/ serous of bloody discharge & a palpable mass;mistaken for malignancy
Adenoma of the nipple
A benign tumor of the major lactiferous ducts presenting as serous or bloody discharge;must be distinguished from carcinoma
Intraductal papilloma
2nd most common malignancy of women(carcinoma of lungs is 1st);most common cause of breast mass in postmenopausal women;occurs most often in upper outer quadrant~metastasize to axillary lymph nodes,lung,liver & bone;has several histologic types(invas
Carcinoma of the breast
-demonstrates estrogen & progesterone receptors in some tumors
Tumor of the breast w/c may demonstrate estrogen & progesterone receptors; presence correlates good prognosis & is a predictor of efficacy of antiestrogen therapy;not predisposed by oral contraceptive regiments
Carcinoma of the breast
-other prognostic factors(type & size of the tumor,extent of lymphnode involvement,DNA ploidy);hyperexpression of c-erbB2(HER-2/neu)is assoc. w/ poorer prognosis
Factors w/c inc. the risk of carcinoma of the breast
Age(inc. w/ inc. age),(+)family history,history of breast cancer in one breast,early menarche & late menapause(due to inc. duration of reproductive life & hormonal activity),obesity, nulliparity,1st pregnancy after age 30,high animal fat diet,proliferative fibrocystic dse. w/ atypical epthelial hyperplasia
Carcinoma of the breast w/ lymphatic involvement involvement of skin causing red,swollen,hot skin resembling an inflammatory process;poor prognosis
Inflammatory Carcinoma
Carcinoma of the breast hitologically charact. by pools of extracellular mucus surrounding clusters of tumor cells;gelatinous consistency;better prognosis than invasive ductal carcinoma
Carcinoma of the breast histologically charact. by cellular w/ scant stroma; soft,fleshy consistency;lymphocytic infiltrate;better prognosis than invasive ductal carcinoma
Medullary Carcinoma
Carcinoma of the breast histologically charact. by eczematoid lesion of the nipple or areola charact. by large cells surrounded by a clear halo-like area,invade the epidermis;usually accompanied by ductal carcinoma
Paget Dse. of the breast
Carcinoma of the breast charact. by ducts filled w/ tumor cells~tumor cell necosis~cheesy like consistency
Intraductal Carcinoma in situ(comedocarcinoma)
Most common carcinoma of the breast charact. by tumor cells arranged in cords,islands,& glands embedded in a dense fibrous stroma;fibrous tissue results in firm consistency
Invasive Ductal Carcinoma(scirrhous carcinoma)

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