Female Genital System and Gestational Pathology (Pathoma Chapter 13)

Question-and-Answer flashcards covering key pathology concepts of the vulva, vagina, cervix, endometrium, myometrium, ovary, and gestational complications from Pathoma Chapter 13.

Which structures make up the vulva?

Labia majora, labia minora, mons pubis, and vestibule (skin external to the hymen).

What type of epithelium lines the vulvar skin and mucosa?

Squamous epithelium.

What is a Bartholin cyst?

Cystic dilation of the Bartholin gland caused by inflammation and duct obstruction.

Typical demographic for Bartholin cysts?

Women of reproductive age.

Clinical presentation of a Bartholin cyst?

Unilateral, painful cystic lesion in the lower vestibule adjacent to the vaginal canal.

Define vulvar condyloma.

A warty (papillary) neoplasm of vulvar skin, often large.

Most common infectious cause of condyloma acuminatum?

HPV types 6 or 11 (low-risk).

Less common infectious cause of a vulvar condyloma (condyloma latum)?

Secondary syphilis.

Histologic hallmark of HPV-associated condyloma?

Koilocytosis.

Do HPV-6 and HPV-11 condylomas often progress to carcinoma?

Rarely, because they are low-risk HPV types.

Key pathologic features of lichen sclerosus?

Thinning of epidermis and dermal fibrosis (sclerosis).

Typical presentation of lichen sclerosus?

White parchment-like vulvar patches (leukoplakia) in postmenopausal women.

Cancer risk associated with lichen sclerosus?

Slightly increased risk of vulvar squamous cell carcinoma.

Pathologic features of lichen simplex chronicus?

Hyperplasia of vulvar squamous epithelium → thick, leathery leukoplakia.

Is lichen simplex chronicus premalignant?

No; there is no increased risk of squamous cell carcinoma.

Most important clinical sign of vulvar carcinoma?

Leukoplakia requiring biopsy to distinguish from benign causes.

High-risk HPV types linked to HPV-related vulvar carcinoma?

HPV 16 and 18.

Precursor lesion for HPV-related vulvar carcinoma?

Vulvar intraepithelial neoplasia (VIN).

Non-HPV vulvar carcinoma usually arises in the setting of what chronic disorder?

Long-standing lichen sclerosus.

Average age group for non-HPV vulvar carcinoma?

70 years

What is extramammary Paget disease of the vulva?

Malignant epithelial cells in vulvar epidermis presenting as erythematous, pruritic, ulcerated skin; carcinoma in situ with usually no underlying mass.

Key immunostains distinguishing Paget disease from melanoma?

Paget: PAS+, keratin+, S-100−; Melanoma: PAS−, keratin−, S-100+.

Upper vagina embryologic origin?

Müllerian (paramesonephric) ducts and columnar epithelium.

Lower vagina embryologic origin?

Urogenital sinus and squamous epithelium.

What is vaginal adenosis?

Focal persistence of columnar epithelium in the upper vagina.

Prenatal exposure that increases risk of vaginal adenosis?

Diethylstilbestrol (DES).

Rare but feared cancer following DES-associated adenosis?

Clear cell adenocarcinoma of the vagina.

Classic presentation of embryonal rhabdomyosarcoma (sarcoma botryoides)?

Bleeding and grape-like mass protruding from vagina or penis of child <5 years.

Characteristic cell markers of rhabdomyoblast?

Cross-striations, desmin+, myogenin+.

High-risk HPV types most linked to vaginal carcinoma?

Types 16, 18, 31, 33.

Lymphatic spread pattern of vaginal carcinoma in lower 1/3?

Inguinal lymph nodes.

Lymphatic spread pattern of vaginal carcinoma in upper 2/3?

Iliac lymph nodes.

Name the junction between exocervix and endocervix.

Transformation zone.

High-risk HPV oncoproteins and targets?

E6 (destroys p53) and E7 (destroys Rb).

List four high-risk HPV types.

HPV 16, 18, 31, 33.

Define CIN I.

Koilocytic dysplasia involving <1/3 of epithelial thickness.

Define CIN II.

Dysplasia involving <2/3 of epithelial thickness.

Define CIN III.

Dysplasia involving almost full epithelial thickness but not entire layer.

Define carcinoma in situ (CIS) of cervix.

Full-thickness epithelial dysplasia without invasion.

Most common histologic subtype of invasive cervical carcinoma?

Squamous cell carcinoma (≈80%).

Classic presenting symptom of cervical carcinoma?

Postcoital vaginal bleeding.

Major late mortality mechanism in advanced cervical carcinoma?

Hydronephrosis and post-renal failure due to ureteral obstruction.

Purpose and starting age of Pap smear screening?

Detect CIN before carcinoma; start at age 21.

High-grade dysplasia cytologic features on Pap smear?

Hyperchromatic nuclei and high nuclear-to-cytoplasmic ratio.

Main limitation of Pap smear screening?

Less effective for detecting adenocarcinoma and may miss transformation zone.

HPV vaccine types covered by quadrivalent formulation?

6, 11, 16, 18.

Do women vaccinated for HPV still need Pap smears?

Yes, because vaccine covers only some HPV types.

Which hormone drives proliferative phase of endometrium?

Estrogen.

Which hormone drives secretory phase of endometrium?

Progesterone.

What is Asherman syndrome?

Secondary amenorrhea due to loss of basalis and scarring after aggressive D&C.

Anovulatory cycle increases risk of what clinical problem?

Dysfunctional uterine bleeding.

Common cause of acute endometritis?

Retained products of conception leading to bacterial infection.

Histologic requirement for diagnosing chronic endometritis?

Presence of plasma cells in endometrial stroma.

Endometrial polyp may arise as side effect of which drug?

Tamoxifen.

Define endometriosis.

Presence of endometrial glands and stroma outside uterine cavity.

Most common site of endometriosis?

Ovary (chocolate cyst).

Appearance of peritoneal endometriotic implants?

Yellow-brown ‘gun-powder’ nodules.

What is adenomyosis?

Endometriosis involving the uterine myometrium.

Endometriosis increases risk of carcinoma in which location particularly?

Ovary.

Pathologic definition of endometrial hyperplasia.

Hyperplasia of endometrial glands relative to stroma from unopposed estrogen.

Most important predictor of progression from endometrial hyperplasia to carcinoma?

Presence of cellular atypia.

Most common invasive gynecologic cancer in females?

Endometrial carcinoma.

Age and histology associated with hyperplasia-pathway endometrial carcinoma?

≈60 years; endometrioid histology.

Age and histology associated with sporadic (non-hyperplasia) endometrial carcinoma?

≈70 years; serous papillary histology with psammoma bodies and p53 mutation.

Leiomyoma dependence on hormones?

Growth stimulated by estrogen; enlarge in pregnancy, shrink post-menopause.

Gross appearance of leiomyoma (fibroid)?

Multiple, well-defined white whorled masses in myometrium.

Symptomatic triad sometimes seen with leiomyomas?

Abnormal bleeding, infertility, pelvic mass.

Key difference between leiomyoma and leiomyosarcoma in origin?

Leiomyosarcoma arises de novo, not from a leiomyoma.

What is the functional unit of the ovary?

The follicle (oocyte + granulosa + theca cells).

LH stimulates which ovarian cell type and to do what?

Theca cells to produce androgens.

FSH stimulates which ovarian cell type and to do what?

Granulosa cells to convert androgens to estradiol.

Hormonal pattern in polycystic ovarian disease (PCOD)?

↑LH, ↓FSH (LH:FSH >2).

Three classic clinical features of PCOD?

Obesity, oligomenorrhea/infertility, hirsutism.

Long-term metabolic risk in PCOD patients?

Type 2 diabetes mellitus (due to insulin resistance).

Most common category of ovarian tumors?

Surface epithelial tumors (~70%).

Two main cystic surface epithelial tumor subtypes?

Serous (watery) and mucinous (mucus).

Define cystadenoma.

Benign serous/mucinous surface tumor with single cyst and flat lining; premenopausal.

Define cystadenocarcinoma.

Malignant serous/mucinous tumor with complex cysts and shaggy lining; postmenopausal.

BRCA1 mutation increases risk for which ovarian malignancy?

Serous carcinoma of ovary and fallopian tube.

Which ovarian surface tumor subtype mimics endometrium and is often malignant?

Endometrioid carcinoma.

Brenner tumor histology resembles what tissue?

Urothelium (bladder-like epithelium).

Useful serum marker for monitoring epithelial ovarian carcinoma?

CA-125.

Most common ovarian germ-cell tumor in females?

Cystic teratoma.

Definition of struma ovarii.

Ovarian teratoma composed predominantly of thyroid tissue.

Histologic hallmark of dysgerminoma?

Large clear cells with central nuclei; elevated LDH.

Most common ovarian germ-cell tumor in children and its marker?

Endodermal sinus (yolk sac) tumor; ↑AFP; Schiller-Duval bodies.

Ovarian germ-cell tumor with high β-hCG and poor chemo response?

Choriocarcinoma of germ-cell origin.

Sex-cord tumor that secretes estrogen and causes precocious puberty or bleeding?

Granulosa-theca cell tumor.

Sex-cord tumor that may secrete androgen causing virilization?

Sertoli-Leydig cell tumor (with Reinke crystals).

What is Meigs syndrome?

Ovarian fibroma with ascites and pleural effusion.

Define Krukenberg tumor.

Bilateral ovarian metastases of mucinous signet-ring carcinoma, usually gastric.

What is pseudomyxoma peritonei?

Massive mucinous ascites from appendiceal mucinous tumor with ovarian spread.

Most common site for ectopic pregnancy?

Lumen of fallopian tube.

Key risk factor for ectopic pregnancy?

Tubal scarring (PID or endometriosis).

Classic presentation of ectopic pregnancy rupture?

Lower quadrant abdominal pain weeks after missed period, possible hematosalpinx.

Define spontaneous abortion.

Loss of fetus before 20 weeks gestation.

Most common chromosomal abnormality causing spontaneous abortion?

Trisomy 16.

Placenta previa definition and symptom?

Placental implantation over cervical os; presents with third-trimester bleeding.

Placental abruption definition and consequence?

Premature separation of placenta from decidua → stillbirth & painful bleeding.

Placenta accreta definition and complication?

Placenta attaches to myometrium without decidua → postpartum hemorrhage, often needs hysterectomy.