Chapter 13: Female Genital System and Gestational Pathology

Question 1

What is a unilateral, painful, cystic lesion present at the lower vestibule adjacent to the vaginal canal?

Answer 1

Bartholin cyst

Question 2

Condyoma most commonly results from what types of HPV?

Answer 2

HPV types 6, or 11

Question 3

What are the histological hallmarks of an HPV-associated condyloma?

Answer 3

Koilocytes

Question 4

Post-menopausal women presents with a benign white patch (leukoplakia) with parchment-like vulvar skin [thinning of the epidermis and fibrosis (sclerosis) of the dermis. What is it?

Answer 4

Lichen Sclerosis

Question 5

Patient presents with leukoplakia with thick, leathery vulvar skin - hyperplasia of the vulvar squamous epithelium associated with chornic irritation and scratching. What is it?

Answer 5

Lichen Simplex Chronicus

Question 6

What are the risk factors for Vulvar Carcinoma?

Answer 6

HPV exposure, multiple partners, early first age of intercourse.

Question 7

What do Vulvar Carcinoma’s arise from?

Answer 7

Vulvar intraepithelial neoplasia (VIN) - dysplastic precursor lesion characterized by koilocytic change, disordered cellular maturation, nuclear atypia, and increased mitotic activity

Question 8

Women presents with erythematous, pruritic, ulcerated vulvar skin. This disease is characterized by malignant epithelial cells in the epidermis of the vulva. What is it?

Answer 8

Extramammary paget disease

Question 9

Distinguish between paget disease of the nipple and paget disease of the vulva.

Answer 9

Paget disease of the vulva = NO UNDERLYING CARCINOMA

Paget Disease of the nipple: ALMOST ALWAYS ASSOCIATED WITH AN UNDERLYING CARCINOM

Question 10

Distinguish between Paget cells and Melanma

Answer 10

Paget: PAS +, Keratin +, S100 -
Melanoma: PAS -, Keratin -, S100+

Question 11

Describe the embryologic origin of the Vagina

Answer 11

Upper 2/3: Mullerian duct (columnar)

Lower 1/3: urogenital sinus (stratified squamous)

Question 12

Described as a focal persistence of columnar epithelium in the upper 1/3 of vagina. Has an increased incidence in females who were exposed to diethylstilbestrol (DES) in utero

Answer 12

Adenosis

Question 13

A rare, but feared, complication of DES -associated vaginal adenosis. Is a malignant proliferation of glands with clear cytoplasm.

Answer 13

Clear cell adenocarcinoma

Question 14

A child presents with bleeding and a grape-like mass protruding from the vagina (or penis). It is shown to be a malignant mesenchymal proliferation of immature skeletal muscle. What is it?

Answer 14

Embryonal Rhabdomyosarcoma.

Question 15

Describe the characteristic cell in embryonal rhabdomyosarcoma

Answer 15

Rhabdomyoblast: exhibits cytoplasmic cross-striations and positive immunohistochemical staining for desmin (intermediate filament present in muscle cells) and myogenin (nuclear transcription factor present in immature skeletal muscle)

Question 16

Describe vaginal carcinoma and where it will spread based on location

Answer 16

Cancer from lower 1/3 of vagina goes to inguinal nodes, cancer from upper 2/3 goes to regional iliac nodes

Question 17

What is the precursor lesion for vaginal carcinoma?

Answer 17

Vaginal intraepithelial neoplasia (VAIN) - usually associated with high-risk HPV

Question 18

Where does HPV usually target?

Answer 18

Infects the lower genital tract (vulvar, vaginal canal, cervix), especially the cervix in the transformation zone

Question 19

Persistent HPV infection leads to an increased risk for _____

Answer 19

cervical dysplasia (cervical intraepithelial neoplasia, CIN)

Question 20

What are the high/low risk types of HPV

Answer 20

High: 16,18 (also 31,33) –> dysplasia –>carcinoma
Low: 6,11 –> condyloma

Question 21

What makes high risk HPV high risk?

Answer 21

Produces E6 (destroy p53) and E7 (destroy Rb). Loss of these tumor suppressor proteins increases the risk for CIN

Question 22

What is characterized by koilocytic change, disordered cellular maturation, nuclear atypia, and increased mitotic activity within the cervical epithelium?

Answer 22

Cervical Intraepithelial neoplasia (CIN)

Question 23

What are the different grades of CIN?

Answer 23

CIN I: <2/3 of the thickness
CIN III: Slightly less than entire thickness
Carcinoma in situ (CIS): irreversible - involves the entire thickness

Question 24

What will CIS progress to?

Answer 24

Cervical Carcinoma

Question 25

What are the key risk factors for cervical carcinoma?

Answer 25

Key = high risk HPV infection

secondary risk factor: smoking, and immunodeficiency

Question 26

What happens with advanced tumors in cervical carcinoma?

Answer 26

Invade through the anterior uterine wall into the bladder, blocking the uterus.
Hydronephrosis with postrenal failure is a common cause of death in advanced cervical carcinoma

Question 27

What (and when) is the gold standard for Cervical Carcinoma screening?

Answer 27

Pap smear beginning at age 21

Question 28

A high grade dysplasia (CIN II and III) is characterized by what type of cells on pap smear?

Answer 28

Hyperchromatic nuclei and high nuclear to cytoplasmic ratios

Question 29

What happens if you find an abnormal Pap?

Answer 29

followed by confirmatory colposcopy and biopsy

Question 30

What are you protected against with the quadrivalent vaccine for cervical carcinoma?

Answer 30

HPV types 6,11,16,18