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Robbins et al. > 22 Female Genital Tract > Flashcards

22 Female Genital Tract Flashcards

1
Q

What forms the urogenital sinus?

A

The cloaca after formation of the urorectal septum

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2
Q

What forms the paramesonephric or lateral Mullerian ducts?

A

Invagination of coelomic epithelium

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3
Q

What is the final organ(s) formed by the urogenital sinus?

A

Lower vagina and vestibule

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4
Q

What does the unfused portion of the lateral Mullerian ducts form in the adult female?

A

Fallopian tube

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5
Q

What do the fused portions of the lateral Mullerian duct form in the adult female?

A

The uterus and upper vagina

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6
Q

Where do Gardner duct cyst originate?

A

Remnants of mesonephric duct in cervix and vagina

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7
Q

What factors may lead to HSV reactivation

A

Stress, UV radiation, hormonal changes, immunosuppression, trauma

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8
Q

What increases vertical transmission of HSV?

A

Active infection and initial maternal infection

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9
Q

What are some methods of testing for HSV?

A

Tissue viral culture, PCR, direct immunofluorescent antibody tests on lesional secretions

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10
Q

Which subtype of molluscum contagiosum is most often sexually transmitted?

A

MCV-2; MCV-1 is most prevalent and can be seen in children who are infected by shared fomites

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11
Q

What are three main causes of PID?

A

Neisseria gonorrhea, Chlamydia trachomatis and peurperal infections (polymicrobial)

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12
Q

What infection gives the gross appearance of ‘strawberry cervix’?

A

Trichomonas

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13
Q

What are the local manifestations or complications of gonococcal disease in PID other than acute cervicitis or vaginitis?

A 
acute suppurative salpingitis
salpingo-oophritis
tubo-ovarian abscess
pyosalpinx
chronic follicular salpingitis
hydrosalpinx
Infertility
ectopic pregnancy
pelvic pain
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14
Q

What are some complications of PID outside of the genital tract?

A

After bacteremia, infection can spread to cause:
peritonitis
endocarditis
meningitis
suppurative arthritis
intestinal obstruction from pelvic adhesions

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15
Q

What are the differences in etiology of basaloid and warty carcinomas as opposed to keratinising squamous carcinoma of the vulva?

A

Warty and basaloid carcinomas are HPV-related while keratinising squamous cell carcinomas are not. Instead the latter is often associated with chronic lichen sclerosis/

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16
Q

What are the precursors for basaloid and warty carcinomas as opposed to keratinising squamous carcinoma of the vulva?

A

Warty and basaloid carcinoma - classic VIN

Keratinising squamous cell carcinoma - differentiated VIN

17
Q

What are the risks factors for progression of VIN to invasive carcinoma?

A

Age over 45, extent, and immunosuppression

18
Q

What etiologies cause vaginal anomalies?

A

Genetic syndromes
in utero exposure to diethylstilbestrol
Abnormalities in reciprocal epithelial-stromal signalling

19
Q

Where does one find Gartner duct cysts?

A

Lateral wall of the vagina in the submucosa location.

20
Q

What two chemical entities does lactobacilli secrete to deter cervicitis?

A

lactic acid

hydrogen peroxide

21
Q

What are causes of alkaline pH in the vagina?

A

bleeding
sexual intercourse
vaginal douching
antibiotic treatment

22
Q

What are the risk factors for cervical cancer? Name at least 8.

A

HPV exposure: multiple sexual partners, male partner with multiple sexual partners, young age at first intercourse, high parity, use of oral contraceptives
Viral oncogenicity: persistent infection
Inefficiency of immune response: immunosuppression, certain HLA subtypes, use of nicotine

23
Q

What are the approximate rates of clearance of HPV at 8 months and 2 years?

A

8 months - 50% cleared

2 years - 90% cleared

24
Q

What accounts for the difference in epithelial susceptibility to HPV infection at different sites?

A

HPV infection requires access to the basal cells, either at sites of trauma or to metaplastic squamous epithelium. Sites such as the cervix and the squamocolumnar junction of the anus have large areas of metaplasia.

25
Q

What enables HPV to replicate in mature squamous cells?

A

Viral proteins E6 and E7 induce the mitotic cycle. E7 binds Rb and upregulates cyclin E. E6 binds p53, interrupts apoptotic pathways and upregulates telomerase. Both E6 and E7 work together to induce centrosome duplication and genomic instability.

26
Q

How does the physical state of HPV DNA differ between disease entities?

A

Integrated viral DNA into host DNA in carcinoma but usually free or episomal viral DNA is found in precancerous lesions and condylomata.

27
Q

What percentage of LSIL regresses, persists and progresses (to HSIL) after 2 years?

A

Regress - 60%
Persist - 30%
Progress to HSIL - 10%

28
Q

What percentage of HSIL regresses, persists and progresses (to carcinoma) after 2 years?

A

Regress - 30%
Persist - 60%
Progress - 10%

29
Q

What are the histological subtypes of lobular carcinoma?

A 
Classic
Pleomorphic
Alveolar
Solid
Tubulo-lobular
Mixed
Histiocytoid
Signet ring cell
30
Q

What defines T4 stage in cervical carcinomas?

A

Beyond true pelvis or involvement of mucsoa of the bladder or rectum.

31
Q

What is the size criteria for microinvasive carcinoma of the cervix?

A

Stage IA - invasion < 5 mm with horizontal spread not exceeding 7 mm

32
Q

What determines prognosis and survival for invasive cervical carcinomas?

A

Stage and cell type

-neuroendocrine tumours have very poor prognosis

33
Q

Due to what cause do most patients with Stage IV cervical carcinoma perish?

A

local extension of tumour leading to any of the following:

-ureteral obstruction, pyelonephritis and uremia

34
Q

What are the layers of the endometrium?

A

Basalis-

Functionalis - Shed in menses; divided into the spongiosum and compactum

Robbins et al. (4 decks)

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