Chapter 13: Female Genital System and Gestational Pathology Flashcards
Start again at Endometrium and Myometrium
What is a unilateral, painful, cystic lesion present at the lower vestibule adjacent to the vaginal canal?
Bartholin cyst
Condyoma most commonly results from what types of HPV?
HPV types 6, or 11
What are the histological hallmarks of an HPV-associated condyloma?
Koilocytes
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?
Lichen Sclerosis
Patient presents with leukoplakia with thick, leathery vulvar skin - hyperplasia of the vulvar squamous epithelium associated with chornic irritation and scratching. What is it?
Lichen Simplex Chronicus
What are the risk factors for Vulvar Carcinoma?
HPV exposure, multiple partners, early first age of intercourse.
What do Vulvar Carcinoma’s arise from?
Vulvar intraepithelial neoplasia (VIN) - dysplastic precursor lesion characterized by koilocytic change, disordered cellular maturation, nuclear atypia, and increased mitotic activity
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?
Extramammary paget disease
Distinguish between paget disease of the nipple and paget disease of the vulva.
Paget disease of the vulva = NO UNDERLYING CARCINOMA
Paget Disease of the nipple: ALMOST ALWAYS ASSOCIATED WITH AN UNDERLYING CARCINOM
Distinguish between Paget cells and Melanma
Paget: PAS +, Keratin +, S100 -
Melanoma: PAS -, Keratin -, S100+
Describe the embryologic origin of the Vagina
Upper 2/3: Mullerian duct (columnar)
Lower 1/3: urogenital sinus (stratified squamous)
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
Adenosis
A rare, but feared, complication of DES -associated vaginal adenosis. Is a malignant proliferation of glands with clear cytoplasm.
Clear cell adenocarcinoma
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?
Embryonal Rhabdomyosarcoma.
Describe the characteristic cell in embryonal rhabdomyosarcoma
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)
Describe vaginal carcinoma and where it will spread based on location
Cancer from lower 1/3 of vagina goes to inguinal nodes, cancer from upper 2/3 goes to regional iliac nodes
What is the precursor lesion for vaginal carcinoma?
Vaginal intraepithelial neoplasia (VAIN) - usually associated with high-risk HPV
Where does HPV usually target?
Infects the lower genital tract (vulvar, vaginal canal, cervix), especially the cervix in the transformation zone
Persistent HPV infection leads to an increased risk for _____
cervical dysplasia (cervical intraepithelial neoplasia, CIN)
What are the high/low risk types of HPV
High: 16,18 (also 31,33) –> dysplasia –>carcinoma
Low: 6,11 –> condyloma
What makes high risk HPV high risk?
Produces E6 (destroy p53) and E7 (destroy Rb). Loss of these tumor suppressor proteins increases the risk for CIN
What is characterized by koilocytic change, disordered cellular maturation, nuclear atypia, and increased mitotic activity within the cervical epithelium?
Cervical Intraepithelial neoplasia (CIN)
What are the different grades of CIN?
CIN I: <2/3 of the thickness
CIN III: Slightly less than entire thickness
Carcinoma in situ (CIS): irreversible - involves the entire thickness
What will CIS progress to?
Cervical Carcinoma
What are the key risk factors for cervical carcinoma?
Key = high risk HPV infection
secondary risk factor: smoking, and immunodeficiency
What happens with advanced tumors in cervical carcinoma?
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
What (and when) is the gold standard for Cervical Carcinoma screening?
Pap smear beginning at age 21
A high grade dysplasia (CIN II and III) is characterized by what type of cells on pap smear?
Hyperchromatic nuclei and high nuclear to cytoplasmic ratios
What happens if you find an abnormal Pap?
followed by confirmatory colposcopy and biopsy
What are you protected against with the quadrivalent vaccine for cervical carcinoma?
HPV types 6,11,16,18
