Study 20 flashcards on Flashcards: Female Reproductive Pathology — 20 Must-Know Flashcards with OmpathStudy. Quick, focused revision for Kenyan medical and h...
Q1. What are the two HPV oncoproteins and their targets?
Answer: E6 inactivates p53; E7 inactivates Rb — together promoting uncontrolled cell growth and carcinogenesis.
Q2. What is the key histologic difference between lichen sclerosus and lichen simplex chronicus?
Answer: Lichen sclerosus causes epidermal thinning; lichen simplex chronicus causes epidermal thickening. Neither shows atypia.
Q3. What distinguishes vulvar Paget disease from breast Paget disease?
Answer: Vulvar Paget disease usually has no underlying tumour; breast Paget disease is almost always associated with underlying carcinoma.
Q4. What is the transformation zone and why does it matter?
Answer: Region where columnar endocervical epithelium undergoes squamous metaplasia. HPV preferentially infects here — origin of most cervical carcinomas.
Q5. What is the two-tiered classification of CIN and its management?
Answer: LSIL (CIN I) — conservative observation; HSIL (CIN II and III) — surgical excision by cone biopsy with lifelong follow-up.
Q6. What are the three diagnostic features required for endometriosis and how many are needed?
Answer: Endometrial glands, endometrial stroma, and haemosiderin pigment — at least two of three must be present.
Q7. How does adenomyosis differ from endometriosis regarding cyclic bleeding?
Answer: Adenomyosis derives from stratum basalis and does NOT bleed cyclically. Endometriosis contains functioning endometrium that DOES bleed cyclically.
Q8. What is the cancer risk of complex endometrial hyperplasia with atypia?
Answer: 20–50% risk of progression to endometrial carcinoma. Requires serial endometrial biopsies and evaluation for concurrent cancer.
Q9. What are the key differences between endometrioid and serous endometrial carcinoma?
Answer: Endometrioid — oestrogen-related, PTEN mutations, perimenopausal, better prognosis. Serous — atrophy background, TP53 mutations, older women, aggressive.
Q10. What are the three diagnostic criteria for leiomyosarcoma and what borderline entity exists?
Answer: Tumour necrosis, cytologic atypia, and mitotic activity — all three needed. Borderline cases are called smooth muscle tumours of uncertain malignant potential.
Q11. What are the key biochemical abnormalities in PCOS and what is absent on histology?
Answer: Excess androgens, high LH, low FSH. Corpora lutea are conspicuously absent on histology reflecting failure of ovulation.
Q12. What are the two types of serous ovarian carcinoma and their key mutations?
Answer: Low-grade — KRAS, BRAF, or ERBB2 mutations, slow progression. High-grade — TP53 mutations in 96%, develops rapidly.
Q13. What is pseudomyxoma peritonei and what is its most common cause?
Answer: Peritoneal implantation of mucinous cells producing copious mucin. Most commonly caused by metastasis from the appendix, not a primary ovarian tumour.
Q14. What is the complete mole karyotype and how does it arise?
Answer: Diploid (46,XX or 46,XY) with all paternal chromosomes — arises when two spermatozoa or a diploid sperm fertilise an empty egg.
Q15. Why does gestational choriocarcinoma respond better to chemotherapy than gonadal choriocarcinoma?
Answer: Placental choriocarcinoma carries paternal antigens triggering a maternal immune response that acts as an adjunct to chemotherapy.
Q16. What is the core pathophysiologic defect in preeclampsia and what syndrome can result?
Answer: Inadequate spiral artery remodelling causes placental hypoxia. Severe cases develop HELLP syndrome — Haemolysis, Elevated Liver enzymes, Low Platelets.
Q17. What is the precursor lesion of clear cell adenocarcinoma of the vagina and its cause?
Answer: Vaginal adenosis caused by in utero DES exposure. Persistence of glandular epithelium in the vagina undergoes malignant transformation.
Q18. What is the hallmark histologic feature of sarcoma botryoides and who does it affect?
Answer: Cambium layer — dense subepithelial condensation of rhabdomyoblasts. Affects girls under 5 years presenting as grape-like vaginal masses.
Q19. What is the key difference between DCIS and LCIS regarding cancer risk?
Answer: DCIS is a direct precursor to ipsilateral invasive carcinoma. LCIS is a bilateral risk marker — increases risk in both breasts and is associated with loss of E-cadherin.
Q20. What is the single most important prognostic factor in invasive breast carcinoma?
Answer: Axillary lymph node status. Node-positive disease significantly worsens prognosis regardless of tumour size, grade, or receptor status.