ERM2 - Female Repro Path

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Author:
jknell
ID:
184314
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ERM2 - Female Repro Path
Updated:
2012-11-19 01:02:52
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Endocrine Reproductive Pathology
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Endocrine and Reproductive Pathology
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  1. Differential Diagnosis of ovarian cysts and masses
    • 1. Functional
    •      -Follicular cysts
    •      -Luteal cysts
    •      -PCOS

    • 2. Inflammatory
    •      -Salpingo-oophoritis
    •      -Pyogenic oophoritis
    •      -granulomatous oophoritis

    • 3. Metaplastic
    •      -endometriosis

    4. Neoplastic
  2. Diagnosis of Ovarian Masses
    • -sx or PEx --> imaging
    • -Pelvic U/S
    • -Indications for surgery (high risk of malignancy, >4cm)

    DO NOT BX (seeding)
  3. Risk of malignancy
    • -age (postmenopause has greatest risk)
    • -U/S features:
    •      -multiloculated
    •      -solid areas
    •      -bilaterally
    •      ->10cm
    •      -ascites
  4. Follicular Cysts
    • -very common
    • -usually small
    • -physiologic: unruptured Graafian follicles
    • -large cysts may become symptomatic
    • -rupture can cause intra-abdominal hemorrhage
  5. Luteal Cysts
    • -rupture and release ovum
    • -physiologic
    • -can persist and become hemorrhagic
    • -thick, yellow wall (lots of glycogen)
  6. PCOS: symptoms
    • -multiple ovarian cysts
    • -obesity (40%)
    • -hirsutism (50%)

    • -follicular cysts do not release ova --> persistant anovulation
    • -cells produce excess androgen
  7. Endometriosis: Epidemiology
    -10-15% of reproductive age women
  8. Endometriosis: Description
    • -endometrial tissue outside of the endo and myometrium
    • -common sites: ovaries, broad ligaments, clu de sac
    • -usually multifocal
  9. Endometriosis: Symptoms
    • -dysmenorrhea
    • -irregular bleeding
    • -lower abd, pelvic, back pain
    • -infertility
  10. Endometriosis Ovarian cyst
    • -chocolate cysts
    • -normally benign
  11. Ovarian Neoplastic Tumors
    • 6% of cancers in women
    • often detected late (advanced and fatal)
    • 80% are benign (mostly younger women)

    • Risk Factors
    • -nulliparity
    • -family history
    • -BRCA1 and 2 mutations
  12. Ovarian Neoplastic Tumors: Symptoms
    • -pain
    • -distention
    • -urinary/GI
    • -bleeding

    -may be asymptomatic
  13. Surface Epithelial Ovarian Neoplasm
    • -70%
    • -90% are malignant
    • -Types:
    •      -Serous Tumor
    •      -Mucinous Tumor
    •      -Endometrial Tumor
    •      -Clear-cell Tumor
    •      -Brenner Tumor
  14. Serous Ovarian Tumors
    • -can be benign, borderline or malignant
    • -most common malignant tumor of ovary
    • -carcinomas grow fast
    • -5YS: borderline (~100%), carcinoma (25-70%)

    • Histology
    • -Benign: smooth surface, lined with ciliated columnar epithelium
    • -Malignant: not smooth, invades into cyst wall

    -mutations in Kras and BRAF

    -Psammomabodies
  15. Mucinous Ovarian Tumors
    • -like serous (different histology)
    • -10% of ovarian cancers
    • -can become very enlarged (30cm)
    • -less likely to be malignant

    • Histology:
    • -mucinous columnar lining
  16. Mucinous Ascites
    • -pseudomyxoma peritonei
    • -rupture of mucinous tumor
    • -can lead to intestinal obstruction and death

    **usually due to appendix malignancy ("jelly belly")
  17. Endometriod Ovarian Tumors
    • -usually malignant
    • -30% are bilateral
    • -associated with mutation in PTEN
  18. Clear Cell Ovarian Tumor
    • -high grade carcinoma
    • -ALWAYS malignant
    • -poop prognosis
    • -older age
    • -usually presents with mets and ascites
    • -25% associated with endometriosis
  19. Germ Cell Tumors
    • 1. Teratomas
    • 2. Dysgerminoma  (~ nonseminoma in males)
    • 3. Yolk Sac Tumor
    • 4. Choriocarcinoma
  20. Sex Cord Stromal Tumors
    • -4% of all ovarian tumors
    • -BENIGN-fibroma most common (Meigs Syndrome)
    • -thecomas rare
    • -Granulosa cell tumor (secrete estrogen)
    • -Sertoli-Leydig Cell Tumor (secrete testosterone)
  21. Granulosa Cell Tumor
    • -considered low grade malignant tumors
    • -Cell-Exner bodies
    • -coffee bean shaped nucle
    • -produce estrogen
  22. Tumors Metastatic to Ovary
    • -most primaries from genital tract
    • -Krukenberg tumor: bilateral mets, signet ring cells
  23. Benign Breast Lesions
    • 1. Galactocoele
    • 2. Fibrocystic Changes
    • 3. Inflammatory Benign Lesions
    • 4. Fibroepithelial Tumor
  24. Galactocoele
    • -cystic dilation of an obstructed duct during lactation
    • -painful mass
  25. Fibrocystic Changes
    • -very common (60% of patients)
    • -incidence increases with age (reproductive)
    • -benign
    • -OCPs decrease incidence
    • -Two groups:
    •      1. Non-proliferative (60-80%)
    •      2. Proliferative
  26. Non-proliferative Fibrocystic Changes
    • -cysts and fibrosis without proliferation
    • -cysts 1-5cm
    • -calcification
    • -no increased risk of malignancy
  27. Proliferative Fibrocystic Changes
    • -epithelial proliferation (ductules and lobules)
    • -Florid hyperplasia (severe, slight increase risk of carcinoma)
    • -Apical ductal hyperplasia (significant risk of carcinoma)
  28. Inflammatory Benign Breast Lesions
    • 1. Acute Mastitis (staph infection)
    • 2. Fat Necrosis (trauma)
    • 3. Mammary duct ectasia
    •      -40-50yrs old
    •      -indurated breast with skin and nipple retraction
    •      -microscopy: dilated ducts filled with secretion, surrounded by lymphocytes
    •      -NOT malignant
  29. Fibroepithelial Tumor
    • -usually benign
    • -proliferation of stroma and epithelial components
    • -Two types:
    •      1. Fibroadenoma
    •      2. Phyllodes tumor
  30. Fibroadenoma
    • -defined borders, white rubbery nodules
    • -calcified
    • -always benign
    • -reproductive age women
    • -Biphasic (stroma and epithelium)
  31. Phyllodes tumor
    • -Leaf like tumor
    • -less common
    • -usually benign but may be malignant
    • -can eventually become a sarcoma
    • -usually in older women
    • -recur and metastasize
  32. Malignant Breast Tumors
    • 1. Pre-Invasive Carcinoma (99% survival)
    • 2. Invasive Carcinoma (65% survival)
    • 3. Inflammatory Breast Cancer
  33. Breast Carcinoma
    • -arise from duct epithelial cells
    • -1/8 women
    • -13% lifetime risk
  34. Breast Carcinoma on Mammography
    • -densities of various shapes and sizes
    • -calcifications
    • -changes over time
  35. Inflammatory Breast Carcinoma
    • -skin erythema
    • -induration (edema)
    • -Orange peel skin
    • -lymphatics plugged by tumor cells
  36. Normal Adult Cervix
    • -endocerivcal cells (red: closer to blood vessels)
    • -uinversal cervical inflammation common
    •      -glycogen is a substrate for bacteria
  37. Endocervical polyps
    • -benign and inflammatory
    • -tx: curettage or excision
  38. Chronic Active Cervicitis
    • -common
    • -mucopurulent discharge

    • Causes:
    • -chlamydia/gonorrhea
    • -ureaplasma urealyticum
    • -Candida
    • -Trich
    • -HSVII
    • -HPV
  39. Risk Factors for Cervical Neoplasia
    • -early age at first intercourse
    • -multiple sexual partners
    • -high risk HPV infection
  40. Koilocytosis
    • -nuclear enlargement
    • -irrecgular nuclear membrane
    • -hyperchromasia
    • -perinuclear halo
    • -characteristic of ASC-US
    • -LSIL
  41. Treatment of Cervical Dysplasia
    • -CIN1: observe
    • -CIN2-3: surveillance in young women, ablation or excision
  42. Lichen Simplex Chronicus
    • -chronic itching
    • -end stage of inflammatory deramtoses
    • -epithelial thickening
    • -significant parakeratosis
    • -band-like inflammatory cells
  43. Lichen Scerlosus et Atrophicus
    • -common, esp after menopause
    • -skin and mucosa pale grey
    • -labia atrophied and vaginal orifice narrowed
    • -small percent develop cancer
  44. Vulvar Intraepithelial Lesion
    • -low grade VIN/Condyloma (HPV 6 and 11)
    • -high grade VIN (younger patients associated with HPV, older patients hx of LSA and LSC)
  45. Condyloma Acuminata
    • -benign veneral warts
    • -caused by HPV 6 and 11
    • -usually regress spontaneously
    • -VIN low grade
  46. Invasive Squamous Carcinoma of vulva
    • -most common vulvar neoplasm
    • -mostly in older women
    • -intially white or pigmented plaques
    • -90% HPV associated
  47. Extramammary Paget's Disease
    • -similar to VIN
    • -vulva and perianal regions
    • -pruritic, red, crusted, irregular, map-like
    • -persists for many years
    • -prone to recurrance
    • -non underlying carcinoma

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