Chapter 18 Flashcards
What is the most common condition in the Vulva?
Inflammation
Is neoplasia common or rare in the vulva?
Rare
What type of vulvitis is assorted with erythema, itching, oozing, and are caused by soaps lotions, detergents?
Allergic contact dermatitis
What are causes of infectious vulvitis?
Condylomata acuminata, HSV, preponema pallidum, N. Gonorrhoeae, C. Albicans
What condition associated with the vulva is an obstruction/dilation of the Bartholin gland?
Bartholin cyst
Is a Bartholin cyst painful or painless and how long does it take to develop?
Can be painless or painful, develops in days.
What condition of the vulva may possibly have a co-infection which my lead to an abscess?
Bartholin cyst
What condition is associated with epidermal thinning, with smooth white lesions near labia minor?
Lichen sclerosus
What is the cause of lichen sclerosus?
Idiopathic/autoimmune
Who is most common affected by lichen sclerosus and what is a risk factor?
Bimodal (old and young) cancer Risk (5% –>SCC)
What condition is associated epithelial hyperplasia and hyperkeratosis?
Lichen simplex chronicus
Does lichen sclerosus or lichen simplex chronicus has a cancer risk?
Lichen sclerosus
Is lichen simplex chronicus a thickening or thinning of epidermis ??
Thickening
What condyloma is associated with secondary syphilis and are flat, moist, painless?
Condylomata Alta
Are vulvar carcinomas rare or common?
Rare
In what age group are vulvar carcinomas most commonly seen?
> 60 (late mets)
What is the most common vulvar carcinoma?
Non-HPV-related SCC
What vulvar carcinoma is associated with vulvar intraepithelial neoplasia?
HPV-Related Squamous cell carcinoma (SCC)
Who as at risk for a HPV related (vulvar carcinoma) squamous cell carcinoma?
Middle aged, smokers, immunodeficiency
Who is at risk for a non-HPV-related (vulvar carcinoma) squamous cell carcinoma. ?
Older woman, isolated, lichen sclerosus.
What causes a white vaginal infection?
C. Albicans
What causes a green vaginal discharge in the vagina?
Trichomonoas vaginalis
What are risks for infections in the vagina?
Diabetes, immunodeficiency, antibiotics
Are congenital malformations of the vagina common or rare?
Rare
Leukorrhea (discharge), pain, and itching, that is most common benign and transient is associated with what condition?
Vaginitis
What form of vaginal cancer is most commonly seen in elderly (>60) ?
Squamous cell carcinoma
What form of vaginal cancer has a risk factor of HPV (early intercourse, multiple partners) and informs from a precancerous vaginal intraepithelial neoplasia.?
Squamous cell carcinoma
What form of vaginal cancer is usually seen in children less than 5 years old?
Sarcoma Botryoides
What vaginal cancer is from an ADR because their mothers took Diethylsthilbestrol (DES) ?
Clear cell adenocarcinoma
What form of vaginal cancer is is rare with red/granular forci?
Clear cell adenocarcinoma
Mothers who took DES this increases their child’s chances by________%of getting what form of vaginal cancer?
Clear cell adenocarcinoma
Embryonal Rhabdomyosacrcoma is associated with what vaginal cancer?
Sarcoma Botryoides
Where in the body is rhabdomyosarcoma commonly seen?
Areas with little skeletal muscle (head neck 40%, genitourinary 25%, extremities 20%, truck 7%)
What is the most common pediatric soft tissue sarcoma ?
Rhabdomyosarcoma
What percent of patients with rhabdomyosarcoma are cured?
2/3
Is cervicitis most commonly benign or malignant ?
Benign
What is the most common causes of infectious cervicitis ?
Chlamydia ( 40% of cases
What is the causes of acute non infections cervicitis?
Postpartum
What is the cause of chronic non infectious cervicitis?
Estrogen fluctuations or trauma ( reproductive aged woman)
What are 4 risk factors of neoplasia of the cervix?
Early 1st intercourse, multiple sex partners, male partner with several past partners, High risk HPV infection.
What HPV’s are involved with neoplasia of the cervix?
HPV16 and HPV18
Most HPV infections are______?
transient (months)
do most HPV infections persist to Cervical intraepithelial neoplasia?
No
what is the most common location for HPV?
transformation zone
Endocervix = what kind of epithelium ?
columnar
exocervix = what kind of epithelium?
squamous
What is eversion during puberty?
Columnar cells undergo squamous metaplasia
What is the most common pathology of the vulva?
Inflammation
What are causes of allergic vulvitis?
Contact dermatitis (eczema)
What are causes of infectious vulvitis?
HPV, HSV, preponderance pallium, gonorrheae
What is a Bartholin cyst?
Obstruction of the Bartholin gland (vulva)
Are Bartholin cysts painful?
May or may not be
What are two non neoplasticism epithelial disorders?
Lichen sclerosus, lichen simplex chronicus
What is thinning of the epidermis due to atrophy ?
Lichen sclerosus
What is a benign white lesion most common in the elderly near labia minor?
Lichen sclerosus
What is epithelial hyperplasia and hyperkeratosis?
Lichen simplex chronicus
What epithelial disorder is benign and caused by chronic irritation (leukocytes)
Lichens simplex chronicus
What is most likely though rare to have change of Turning into cancer?
Lichen sclerosus
What are 2 neoplasms of the vulva?
Condyloma, vulvar carcinoma
When do you see condylomata lata?
Secondary syphilis
When do you see condylomata culminate?>
Genital warts (HPV)
90% of vulvar carcinomas are what kind?
Squamous cell carcinoma
HPV related SCC are associated with what?
Vulvar intraepithelia neoplasia (VIN), HPV 16 and 18
What vulvar carcinoma is most common?
Non-HPV-related SCC
Non HPV related SCC are associated with what?
Older women, isolated, lichen sclerosis, NO VIN
Vaginitis is most commonly…..?
Benign and transient
What are common symptoms of vaginitis ?
Leukorrhea (discharge), pain.
Is vaginitis has a white discharge it is probably caused by what organism ?
C. Albicans
If vaginitis has a green discharge it is most commonly caused by what organism?
Trichamonas vaginalis
What vaginal cancer is most common in age 60 or older?
Squamous cell carcinoma
What are risk factors for squamous cell carcinoma?
HPV, VIN
Diethylstilbestrol (DES) is also acted with what vaginal cancer and what is the increased risk?
Clear cell adenocarcinoma, 40 times the risk
What vaginal cancer is most common in woman less that 5 years old??
Sarcoma botryoides
Sarcoma Botryoides is a type of what?
Embryonal rhabdomyosarcoma
Cervicitis is most commonly….?
Benign And has leukorrhea
What is the most common pediatric soft tissue sarcoma?
Rhabdomyosarcoma
Infectious cervicitis is most commonly caused by what?
Chlamydia
Acute (rare) Non infectious cervicitis is most common when?
Postpartum
Chronic (more common) cervicitis is most common in who? Due to?
Reproductive age woman due to estrogen fluctuations, trauma
If HPV persists what does it Turn into?
Cervical intraepithelial neoplasia (CIN)
What are high risks for cervical neoplasms?
HPV 16 and 18
Where does most of HPV take place?
Transformation zone
Eversion at puberty is what?
Changing from columnar cells to squamous metaplasia
Cervical intraepithelial neoplasia (CIN) is associated with what 2 things? ?
HPV and dysplasia
Cervical intraepithelial neoplasia (CIN) is most common in who?
30 year old, takes 15 years
With low grade CIN what happens?
Observation —60% regress, 10% progress to high grade
With high grade CIN what happens?
Excision- 30% regress, 10% get cancer
What is cellular changes from HPV?
Kilocytosis
What are characteristics of Koilocytosis ?
Enlarged nucleus, anaplaia, wrinkled boarders, dark
Is CIN asymptomatic or no?
Yes
What do we screen for CIN?
Pap smear
Invasive carcinoma or the cervix is almost always (70%) what?
Squamous cell carcinoma (SSC)
When is invasive carcinoma of the cervix diagnosed ?
Mid 40s
Where does invasive carcinomas of the cervix happen?
Transformation zone
Once invasive carcinomas get bigger than______ there is a higher likely hood of mets
Bigger than or equal to 3
What is associated with cervical cancer ? (Cause of death)
Renal failure (due to local invasion which is most common)
What kind of cells do you see in acute endometritis?
Neutrophils
What kind of cells do you see with chronic endometritis?
Plasma cells
Endomitritis is most common following what?
Pelvic inflammatory disease (from STDS, TB)
Endometritis can happen (not common) following ?
Retained products (conception, abortion, IUD)
Extrauterine endometrial tissue is associated with what?
Endometriosis
Where does endometriosis develop?
Ovaries, peritoneum, pouch of Douglass, uterine lig, Fallopian tubes, does, Hearst, lung
What is associated with 50% of all female infertility?
Endometriosis
A chocolate cyst is associated with what?
Endometriosis
What is the cause of endometrial hyperplasia ?
Increased estrogens
What is the most common female genital tract cancer?
Endometrial carcinoma?
When is someone diagnosed with endometrial carcinoma ?
55-65 years old
What type of endometrial carcinoma is most common?
Endometriod (80%)
What type of endometrial carcinoma occurs perimenopausal, causes infertility?>
Endometroid
What type of endometrial carcinoma is endometrial atrophy, that is aggressive and POST-menopausal ?
Serous
When are endometrial polyps most common?
Menopause
What is a benign smooth muscle tumor?
Leiomyoma
When are leiomyomas found?
Reproductive age
What is a malignant smooth muscle tumor ?
Leiomyosarcoma
When do we see leiomyosarcoms?
Postmenapause
Leiomyosarcoms could possible met to where?
Lung (40% 5 year survival rate)
What is inflammation of the Fallopian tubes called?
Salpingitis
Salpingitis can contribute to what?
Possible ectopic pregnancy, sterility.
What is the most common Fallopian tube carcinoma?
Adenocarcinoma
Where in the Fallopian tube do we see adenocarcinomas most?
Fimbriae
Fallopian tube adenocarcinomas are associated with what mutation
BRCA1 and BRCA2
Ovarian cysts are what size?
1-4 cm
Ovarian cysts are from what?
Graafian or ruptured follicles
In polycystic ovarian disease (PCOD), the ovaries enlarge to what side?
2x the normal size
What hormones are increased for polycystic ovarian disease?
Androgens, estrogen, LH. (FSH is decreased)
Are ovarian cysts or POCD familial?
Both are q
Talcum powder can increase you risk of ovarian cancer by what?
30%
What are risks for tumors of the ovary?
Nulliparity, BRCA1/2 gene,
Ovarian cancer is the _____mc cancer in us woman and is the _____mc cause of cancer related death?
8th, 5th
90% of ovarian cancers are what?
Surface epithelial tumors
What is the most common surface epithelial tumors ?
Serous
Are most serous epithelial tumors benign or malignant?
Benign (60%)
What is the most common malignant surface epithelial tumor?
Endometrioid
What mutation is associated with Serous Surface epithelial tumors?
TP53
______serous epithelial tumors are found in 30-40 Year olds, _______ are found in 45-65.
Benign, malignant
What surface epithelial tumor is more likely to be bilateral?
Endometrioid
Is a cystic or solid surface epithelial tumor have a higher cancer risk?
Solid
What is cancer of the GI tract that has spread to the ovaries?
Krukenberg tumors
What cells are associated with a Krukenberg tumor?
Signet-ring cells
Are most krukenberg tumors unilateral or bilateral ?
Bilateral (80%)
What is a tumor that Arises from all 3 germ layers?
Ovarian teratomas
Are most ovarian teratomas being on cancerous ?
Benign ( 90% )
When are ovarian teratomas most common?
In the first two decades
What does BEAT stand for for ovarian cancer?
Bloated, Difficulty eating, Abdominal pain, Trouble with GI.
What placental infection is most common?
Ascending
Transplacental infections are assoacited with what?
Torch (toxoplasmosis, rubella, CMV, HSV, TB syphilis, hiv
Where is the most common ectopic pregnancy?
Fallopian tube (90%)
How common is ectopic pregnancy?
1%
An acute rupture of an ectopic pregnancy happens when?
1st tri
What is associated with a rupture of and ectopic pregnancy?
Hypovolemic shock
What is a benign grape like cystic mass?
Hydatidiform mole
What is a complete hydatiform mole?
2 sperm, no fetal parts, ( risk for invasive mole)
What is a partial hydatidifrom mole?
1 egg + 2 sperm, early fetal parts
And invasive mole is from what?
Complete hydatidiform mole
Are invasive moles benign?
Yes (but locally invasive). If they rupture they’re life threatening
What are choriocarcinoma form??
Complete mole(50%) or after pregnancy
Extreme high hCG is assoacited with what?
Choriocarcinoma
What is the treatment for choriocarcinoma?
Chemotherapy (100% cured)
What most commonly when it metastasizes goes to the lung and is called a cannon ball metastasis?
Choriocarcinoma
What are the 3 things associated with preeclampsia?
HTN, proteinuria, edema in the face or periphery
When is preeclampsia diagnosed and most common?
3rd trimester, 1st pregnancy
What is maternal endothelial dysfunction assoacited with ?
Preeclampsia ( 5-10% all pregnancy)
What is eclampsia?
Seizures and coma after preeclampsia
HEELP syndrome is assoacited with what?
Eclampsia
What are symptoms of eclampsia?
Elevated BP, maternal end organ failure
What are the treatments for Eclampsia ?
Delivery >37 weeks, magnesium sulfate
What are 3 minor breast abnormalities?
Supernumerary nipple, inverted nipple (MC congenital), galactocele
When do you see galactocele?
Later stages of nursing, self limiting inflammation.
Are more break lesions benign or malignant?
Benign
Is breast cancer commonly painful?
Nooooooo
What is the number one most common female cancer? Number 2 in deaths?
Breast cancer
Most breast lumps and caused by what?
Fibrocystic changes
Fibrocystic changes occur when?
Premenopausal (reproductive age)
Where do most fibrocystic changes occur?
Superolateral quadrant
What type of fibrocystic changes are most common?
Nonproliferative
Proliferative fibrocytic changes are associated with what
An additional cellular layer
Mild proliferative fibrocytic changes =?
Orderly hyperplasia
Atypical proliferative fibrocystic changes are a risk factor for what?
Breast cancer q
What is plasma cell mastitis?
Mammary duct ectasia
What is assoacited with a non bacterial chronic inflammation of the breast, that is diagnosed around 40-60 and there may be possible nipple retraction?
Mammary duct ectasia
What is the most common benign breast lesion?
Fibroadenoma
What breast tumor is asp acted with leaf like projects and rapid rapid growth?
Phyllodes tumor
How lethal is breast cancer?
40k a year die(20%), 200k diagnosed
What is the lifetime risk for breast cancer?
1:8
Most breast cancer happens after what age?
50
In what area do most breast cancers occur on the body?
Superolateral (4% bilateral)
What breast lesion is rarely palpable, calcific, with mixed cells and has a great prognosis (97%) ?
Ducati carcinoma in Situ
What breast lesion has uniform cells, mucin vacuoles, rarely calcific. ?>
Lobular carcinoma in situ
What breast lesion adheres to pectorals, dimples the skin, nipple inversion?
Invasive carcinoma
Is DCIS or LCIS more likely to be bilateral?
LCIS (DCIS unilateral)
What invasive breast cancer makes up the majority (70-80%) of all breast cancer?
Invasive ducal carcinoma
What invasive breast cancer has aggressive growth, occult, and may met to CSF ?
Invasive lobular carcinoma
Medullary carcinoma is assoacited with what gene?
BRCA1
What invasive breast cancer is “triple negative:
Medullary carcinoma
Is invasive breast cancer mobile or fixed?
Mobile
If invasive breast cancer is lateral and central (MC) met via what?
Axillary nodes
If the invasive breast cancer is more medial it will met via what?
Internal mammary arteries
What is gene amplification that has to do with breast cancer?
HER2/neu
What receptors if both present get the best response (80%)
Estrogen (ER+) and progesterone (PR+)
Is gynecomastia unilateral or bilateral?
Bilateral
Gynecomastia is normally due to what what?
Ducati hyperplasia
Carcinoma is the male breast rapidly invades what?
The thorax (50% mets)
A button like appearance of the areola is associated with what?
Gynecomastia
What are things that give breast cancer a poor prognosis?
Anaplaia, increased size, invasion, distant mets.
What are some things that give breast cancer a better prognosis ?
Estrogen/progesterone receptors
