Comprehensive Pathology Flashcards

Flashcards covering the key concepts and Q&A from the lecture notes on the pathology of neoplastic uterine corpus, placenta, gestational trophoblastic disease, ovary, fallopian tubes, and cervical cancer screening, Pap smear, and HPV.

What is endometrial hyperplasia?

Abnormal proliferation of endometrial glands due to excessive estrogen without enough progesterone.

What are the main causes of endometrial hyperplasia?

Anovulatory cycles (e.g., perimenopause), Polycystic ovarian syndrome (PCOS), Estrogen-secreting tumors (e.g., granulosa cell tumors), Prolonged estrogen therapy (no progesterone opposition)

How does WHO classify endometrial hyperplasia?

Hyperplasia without atypia (low cancer risk, ~1-3%) Managed with progestins. Atypical hyperplasia / EIN (high cancer risk, ~30-40%) Hysterectomy (or progestins if fertility desired).

What is the gland-to-stroma ratio in hyperplasia?

Normally 1:1, but hyperplasia shows ≥2:1 or 3:1 (more glands than stroma).

What are the two main types of endometrial cancer?

Type 1 (Endometrioid): Estrogen-driven, good prognosis, PTEN mutations. Type 2 (Serous): Not estrogen-linked, aggressive, p53 mutations.

How does Type 1 differ from Type 2 in terms of prognosis?

Type 1: Favorable (slow-growing). Type 2: Poor prognosis (rapid spread).

What is the FIGO staging for endometrial carcinoma?

Stage I: Confined to uterus (Ia: superficial myometrium, Ib: deep invasion). Stage II: Involves cervix. Stage III: Spread to pelvis (e.g., lymph nodes). Stage IV: Distant metastases (e.g., lungs).

What is the most common symptom of endometrial cancer?

Postmenopausal bleeding (or irregular bleeding in premenopausal women).

What is a leiomyoma?

A benign smooth muscle tumor (fibroid), estrogen-sensitive, often asymptomatic.

How can leiomyomas present clinically?

Abnormal uterine bleeding. Pelvic pain/pressure. Infertility or bladder compression.

What features suggest a leiomyosarcoma?

Necrosis, high mitotic activity. Bulky, fleshy mass (malignant, poor prognosis).

What are the types of endometrial stromal tumors?

Stromal nodule (benign), Low-grade stromal sarcoma (indolent), High-grade stromal sarcoma (aggressive).

What is carcinosarcoma?

A biphasic malignant tumor with both adenocarcinoma (epithelial) and sarcoma (mesenchymal) components.

Why is carcinosarcoma high-risk?

Extremely aggressive, poor survival rates.

Where does fertilization occur, and what structure does the zygote form?

Fertilization occurs in the fallopian tube, and the zygote develops into a blastocyst.

What is the role of trophoblasts in implantation?

Trophoblasts are the outer cell layer of the blastocyst that attach to the endometrium, penetrate the uterine lining, and form chorionic villi.

What are the two main types of trophoblasts, and how do they differ?

Cytotrophoblasts are germinative, mitotically active, have single nuclei and clear cytoplasm, and proliferate to form new cells. Syncytiotrophoblasts are terminally differentiated, multinucleated, have a brush border, and produce hormones like hCG and hPL.

What are the three layers of the decidua, and where are they located?

Decidua basalis is beneath the placenta, decidua capsularis surrounds the embryo, and decidua parietalis lines the rest of the uterus.

What are the two major categories of causes for spontaneous abortion?

Fetal causes (50% chromosomal abnormalities) and maternal causes (uterine abnormalities, infections, trauma).

Where do 90% of ectopic pregnancies occur? What are key clinical signs?

90% occur in the fallopian tubes. Signs include hematosalpinx (blood in tube) and rupture leading to acute abdomen or shock.

Compare placenta accreta, increta, and percreta.

Accreta adheres to myometrium and causes postpartum bleeding. Increta invades the myometrium and is associated with placenta previa. Percreta penetrates the uterus and often requires hysterectomy.

What is the triad of preeclampsia? What happens in the placenta?

The triad is hypertension, proteinuria, and edema (with seizures in eclampsia). Placental findings include infarcts, fibrinoid necrosis, and lipid-laden vessels.

What’s the difference between chorioamnionitis and funisitis?

Chorioamnionitis is infection of fetal membranes with PMN infiltration. Funisitis is infection of the umbilical cord.

How do pathogens usually reach the placenta?

Ascending route (most common, bacterial) and hematogenous route (e.g., TORCH infections).

How do complete and partial hydatidiform moles differ genetically?

Complete mole is 46XX, all paternal DNA, with no fetal parts. Partial mole is triploid (69XXX), with fetal parts.

Why is choriocarcinoma uniquely treatable despite being aggressive?

It is highly sensitive to chemotherapy, even in the presence of metastases.

What’s a key marker for placental site trophoblastic tumor (PSTT)?

PSTT produces human placental lactogen (hPL), not hCG.

What are the three types of functional ovarian cysts?

Follicle cysts (from unruptured Graafian follicles, lined by granulosa cells), corpus luteum cysts (hemorrhagic, from ruptured follicles), cortical inclusion cysts (entrapped surface epithelium)

Why are these cysts considered functional?

They arise from normal ovarian processes and often resolve spontaneously.

What hormonal abnormalities define PCOS?

High LH, low FSH leading to anovulation, hyperandrogenism (hirsutism, acne), insulin resistance causing obesity

How do PCOS ovaries appear histologically?

Multiple subcortical cysts, thickened fibrotic capsule, cysts lined by granulosa cells and hyperplastic luteinized theca interna

Name 3 clinical features of PCOS.

Infertility, oligomenorrhea, obesity

Define endometriosis.

Presence of endometrial glands and stroma outside the uterus

What is the retrograde menstruation theory?

Endometrial tissue flows backward through fallopian tubes and implants in the pelvis

Why do endometriosis patients have chocolate cysts?

Cyclic bleeding in ectopic endometrial tissue causes hemorrhagic chocolate-colored cysts

List 3 symptoms of endometriosis.

Dysmenorrhea, dyspareunia, chronic pelvic pain

Which is the most common ovarian tumor type?

Serous tumors

How do benign, borderline, and malignant serous tumors differ?

Benign tumors have non-stratified epithelium, borderline tumors show stratification with mild atypia, malignant tumors show low-grade (KRAS/BRAF, psammoma bodies) or high-grade (TP53 mutations, solid architecture)

What unique feature links endometrioid and clear cell tumors?

Both are associated with endometriosis

What is a mature cystic teratoma?

Dermoid cyst with mature tissues from two or more germ layers; may contain hair, teeth, sebum

How does immature teratoma differ?

Contains malignant immature tissue, especially primitive neuroectoderm

What is the prognosis for dysgerminoma?

Excellent, highly chemo-sensitive

What hormone does granulosa cell tumor secrete? Name 2 histologic features.

Estrogen; Call-Exner bodies and coffee-bean nuclei

What is a Krukenberg tumor?

Metastatic signet-ring cell carcinoma, usually from the stomach

Which ovarian cancer often originates in the fallopian tube?

High-grade serous carcinoma with TP53 mutations

Why is ovarian cancer often diagnosed late?

No screening test and nonspecific symptoms

What is the most common ovarian tumor in reproductive-age women?

Mature cystic teratoma

Why is cervical cancer considered one of the most preventable cancers?

Because it has a long precancerous phase (10–20 years) due to slow HPV-driven progression, allowing early detection via screening (Pap/HPV tests) and treatment of precancerous lesions before they become invasive.

How much did cervical cancer deaths drop in the U.S. between 1941 and 2015?

From 26,000 to fewer than 5,000 deaths, thanks to widespread Pap smear screening.

What are the two main categories of HPV, and what do they cause?

High-risk HPV (e.g., types 16, 18, 31, 33) cause cervical cancer. Low-risk HPV (e.g., types 6, 11) cause genital warts (not cancer).

Name three high-risk HPV types most associated with cervical cancer.

HPV 16, 18, and 45

Why is HPV testing combined with Pap smear (“co-testing”) in women aged 30–65?

Because persistent high-risk HPV infection is the root cause of cervical cancer. Co-testing improves detection sensitivity compared to Pap alone.

What are the two methods of collecting cells for a Pap smear?

Conventional Pap (cells scraped and smeared directly on a slide) and Liquid-Based Cytology (cells suspended in liquid for better preservation)

What are the advantages of a Pap smear?

Simple, rapid, inexpensive, and no risk to the patient

What is the main limitation of a Pap smear?

It’s a screening test, not a definitive diagnosis (requires biopsy for confirmation)

What does ASC-US stand for, and how is it managed?

Atypical Squamous Cells of Undetermined Significance. If HPV positive, do colposcopy. If HPV negative, repeat co-test in 3 years.

What is koilocytosis, and what does it indicate?

Cytopathic effect of HPV: nuclear enlargement, hyperchromasia, and perinuclear halos. Pathognomonic for HPV infection, seen in LSIL.

How do LSIL and HSIL differ cytologically?

LSIL: Mild atypia, abundant cytoplasm, low or high-risk HPV, CIN 1 HSIL: Severe atypia, high nuclear to cytoplasmic ratio, high-risk HPV, CIN 2/3

When should cervical cancer screening begin, and how often is it done for women aged 21–29?

Start at age 21. Pap smear every 3 years. HPV testing not recommended in this age group.

What is the preferred screening strategy for women aged 30–65?

Co-testing (Pap + HPV) every 5 years or Pap alone every 3 years if co-testing unavailable

When can screening be discontinued?

After age 65 if prior screenings were normal and no high-risk history

A patient has HSIL on Pap smear. What’s the next step?

Colposcopy with biopsy. If confirmed, excision (LEEP or conization) may be needed.

What does ASC-H mean, and how is it managed?

Atypical Squamous Cells, cannot exclude HSIL. Always requires colposcopy.

What is a Krukenberg tumor, and what primary cancer causes it?

Metastatic signet-ring cell carcinoma, usually from stomach or colon. Mimics ovarian fibroma on imaging.

Name two infections that can cause salpingitis.

Gonococcus (Neisseria gonorrhoeae) and Mycobacterium tuberculosis (TB salpingitis)