24. FR pathology Flashcards
Infection of female reproductive tract
2 type
upper
lower
Internal oc of cervix is the demarcation
infection of lower mostly
viral
fungi
bacterial
protozoal
infection of upper mostly
pelvic inflammatoty disease
pelvic tb
Fungal infection
by
C.albicans (normal flora of the vagina) cause vulvovaginal candidiasis.
fungal infection causes symptoms in women with
3
DM, Pregnancy , immunodeficiency.
symptoms of fungal infection
Symptoms include pruritus , erythema, curd like vaginal discharge.
candidiasis is not considered a sexually transmitted disease.
Bacteria infection by
Gardnerela vaginalis Gram-variable coccobacilli
causes bacterial vaginosis
Patients typically present with-
bact. infection
thin, green-gray, malodorous (fishy) vaginal discharge.
is it sexually transmitted BV
no
clue cell
Epithelial cells covered with bacteria
Protozoa infection by
Trichomonas vaginalis is a large, flagellated ovoid protozoan.
causes- prot. infection
Cause vaginitis, cervicitis and urethritis.
clinical symptoms
yellow, frothy vaginal discharge , vulvovaginal discomfort , dysuria , and dyspareunia.
Vaginal and cervical mucosa typically has a fiery-red Appearance ……………..
“Strawberry cervix”.
genital ulcers
Pelvic inflammatory diseases(PID)Two setting
STI or puerperal infection
Following STI
by
N. gonorrhoeae and C. trachomatis
Ascending infection
Following puerperal infection
Occurs after abortion, delivery
Polymicrobial (staphylococci, streptococci, or enteric bacteria)
Hematogenous and lymphatic invasion
These infections tend to produce more inflammation within the deeper layers of the organs
Clinical presentation of PID
classic triad
lower abdominal pain, cervical motion tenderness, and bilateral adnexal tenderness.
others - supporting criteria’s
Fever, purulent cervical or vaginal discharge.
2 complications
Acute complication
Chronic complication
Acute complication
Chronic complication
Acute complication: peritonitis, tubo-ovarian abscess, bacteremia, sepsis.
Chronic complication: infertility, ectopic pregnancy, Fitz-Hugh-Curtis syndrome and intestinal obstruction.
in physical examination they show what sigh
chandelier sign
Fitz – Hugh – Curtis syndrome
what
presents with
seen as …on laproscopy
condition characterized by inflammation of the liver capsule and surrounding tissues, known as perihepatitis
Presented with RUQ abdominal pain
Has violin - string adhesions on laparoscopy
Pelvic tb
Can be hamtogenous disseminated from lung
Or acquired through direct extension from instestinal and peritoneum by m. Bovis
Common site is
The fallopian tube
Complication include
Infertile due to tubal occlusion and asherman syndrome is formation of scar tissue which causes the wall of the uterus to stick together
And
Ectopic pregnancy
Disease of vulva
include
imperforate hymen
Bartholin cyst
Leukoplakia
Imperforate hymen
present with
and it causes
Usually present at puberty with amenorrhea, hematocolpos and hematometra
May cause infertility due to endometriosis
Bartholin cyst
Cystic dilation of the Bartholin gland. Arises due to inflammation (gonococcal) and obstruction of gland
Usually occurs in reproductive age
Bartholin cyst presents with
Presents as a unilateral, painful cystic lesion at the lower vestibule adjacent to the vaginal canal
Bartholin cyst histologically the lining of cyst
transitional epithelium
Leukoplakia
plus type
Plaque like thickening noticed on naked-eye examination.
non neoplastic neoplastic
non neoplastic leukoplakia list
lichen sclerosus
Squamous hyperplasia
neoplastic leukoplakia list
Vulvar intraepithelial neoplasia (VIN) and Vulvar carcinoma
Extramammary Paget
lichen sclerosus
seen as
common in
cause
histology
Presents as a white patch with parchment (ብራና) like vulvar skin.
Most commonly in postmenopausal women.
Probably autoimmune disorder.
Thinning of the epidermis and fibrosis (sclerosis) of the dermis
lichen sclerosus associated with
and risk of cancer
Associated with a slightly increased risk for squamous cell carcinoma
Squamous hyperplasia
AKA
present with
lichen simplex chronicus
Hyperplasia of the vulvar squamous epithelium.
Presents as leukoplakia with thick, leathery vulvar skin
lichen simplex chronicus associated with
and risk of cancer
Associated with chronic irritation and scratching.
Vulvar intraepithelial neoplasia (VIN) and Vulvar carcinoma
Vulvar carcinoma constitutes 3% of female genital tract cancers.
~2/3 occur in women older than 60 years.
………….. is the most common histologic type of VIN
Squamous cell carcinoma
VIN Divided into two groups:
Basaloid and warty carcinomas
Keratinizing squamous cell carcinomas
Basaloid and warty carcinomas
no. of cases
develop from
peak age
HPV relation
30% of cases
Develop from vulvar intraepithelial neoplasia (VIN).
Peak age is in the 6th decade.
Related to high risk HPVs
Bowen disease
carcinoma in situ non invasive
Keratinizing squamous cell carcinomas
no. of cases
develop from
peak age
HPV relation
70% of cases
Develop in long-standing lichen sclerosus and is not related to HPV.
The peak occurrence is in the 8th decade
Extramammary Paget disease
presents as
usually on
Presents as a pruritic, red, crusted, maplike area, usually on the labia majora.
pagets disease association with cancer
Typically not associated with underlying cancer and is confined to the epidermis of vulvar skin
to distinguish pagets disease from melanoma
Paget cells are PAS+, keratin+, and S100-/+.
disease of vagina include 7
Vaginal adenosis
Vaginal septum
Vaginal agenesis
Gartner duact cyst
Primary squamous Cell Carcinoma of vagina
Clear cell adenocarcinoma
Embryonal Rhabdomyosarcoma
Vaginal adenosis
and associated with
Focal persistence of columnar epithelium in the upper 1/3 of the vagina.
Associated with diethylstilbestrol (DES) exposure in utero(1/3 of the DES-daughters)
Vaginal septum
plus types plus how they are formed
Can be vertical or transvers.
Transverse result from faulty fusion or canalization of the urogenital sinus and müllerian ducts.
longitudinal vaginal septum forms when the distal ends of the müllerian ducts fail to fuse properly.
Vaginal agenesis
types
plus describe the types
Mullerian dysgenesis an isolated vaginal agenesis due to incomplete caudal development and fusion of the lower part of the mullerian ducts.
Mullerian agenesis(Mayer–Rokitansky–Kuster–Hauser syndrome) vaginal, uterus and fallopian tubes agenesis.
Gartner duact cyst
location anatomical and histological
Relatively common lesions found along the lateral walls of the vagina and are derived from wolffian (mesonephric) duct remnant.
They are 1- to 2-cm fluid-filled cysts that occur in the submucosal location.
histologically the cysts of gartner duct
simple cuboidal to low columnar
Primary squamous Cell Carcinoma of vagina
precursor lesion?
1% of female genital tract malignancy.
Vaginal intraepithelial neoplasia (VAIN) is precursor lesion.
High risk HPV is an important risk factor.
The most common malignant tumor to involve the vagina is ……………………………………., followed by ………………………
carcinoma spreading from the cervix
primary squamous cell carcinoma of the vagina
metastasis of primary SCC of vagina
lower 2/3 vagina lesions metastasize to the inguinal nodes, whereas upper vagina lesions spread to regional iliac nodes.
Clear cell adenocarcinoma
plus
association
age
Malignant proliferation of glands with clear cytoplasm.
no glands in vagina
Rare, but feared, complication of DES-associated vaginal adenosis.
Mean age is 22 years with DES exposure and 55 years women with out DES esposure.
Embryonal Rhabdomyosarcoma
aka
age
= sarcoma botryoides
Malignant mesenchymal proliferation of immature skeletal muscle.
~ 90% of cases are diagnosed before 5 years of age.
This is a rare tumor of unknown etiology and pathogenesis.
Disease the uterine cervix
Transformation zone
Neoplastic disease of the cervix
Neoplastic disease of the cervix
include
Benign diseases include cervical polyps.
Premalignant and malignant diseases include CIN and invasive carcinoma.
Risk factor for precancerous and cancerous lesion of the cervix
HPV infection
Young age at first intercourse
Multiple sexual partners or a male partner with multiple sexual partners
Oral contraceptives
Cigarette smoking
High parity (multiparous)
Family history
Associated genital infections
Lack of circumcision in male sexual partner
Cervical intraepithelial neoplasia
types
course
type of dysplasia
CIN 1 2 3
Carcinoma in situ the invasive carcinoma
Invasive cervical carcinoma
and major type
3rd common female genital tract cancer in both incidence and mortality.
About 85% are Squamous cell carcinoma,10% Adenocarcinoma and 5% Adenosquamous , neuroendocrine and undifferentiated.
Occurs when CIN break the basement membrane and involve the cervical stroma.
Microinvasive tumor not extend beyond 5mm from nearest basement membrane.
Invasion of stroma and nesting of malignant cell in stroma there is also lymphocytic response.
Can be fungating , ulcerative or infiltrative
Clinical presentation
of invasive cervical carcinoma
Post coital vaginal bleeding
Leukorrhea
Dyspareunia
Pelvic pain
Sign and symptom of anemia
Sign and symptom of renal failure and dysuria
………………………. is common cause of death and why
Obstructive renal failure
Direct extension to adjacent structures and to pelvic lymph nodes.
Screening
types for ICC
pap smear
visual inspection with acetic acid
visial inspection with Lugols iodine
Visual inspection with acetic acid(VIA)
If the cervical epithelium contains an abnormal load of cellular proteins, the acetic acid coagulates the proteins conferring an opaque and white aspect of the concerned area. A precancerous lesion has higher protein content when compared to normal epithelium. As a consequence it becomes white (acetowhite) and is considered to be “VIA positive”.
Visual inspection with lugol’s iodine (VILI)
Lugol’s iodine, a compound that reacts with glycogen resulting in a brown or black coloration. Normal mature squamous epithelium contains glycogen. When in contact with Lugol’s iodine it becomes black, whereas precancerous lesions and cancer contain little or no glycogen thus turning yellow after Lugol application.
Vaccine
Gardasil = Quadrivalent ( HPV 6/11/16/18) virus like particle vaccine.
Best given before onset of sexual intercourse
Screening is still not stopped
