Diseases of the Lower Female Genital Tract Flashcards
What inflammation is the hallmark of gonorrhea infection?
Exudative purulent reaction (FACULTATIVE intracellular inside neutrophils) followed by plasma cell infiltration + granulation tissue / scarring
What are the sequellae of gonococcal cervicitis vs salpingitis?
Cervicitis - few sequelae
Salpingitis - sealing of tube with distension by pus (pyosalpinx), can form tuboovarian abscess. May subsequently scar -> infertility
What neonatal complication is associated with gonorrhea infection of the mother and how is it prevented / treated?
Neonatal ophthalmitis (neonatal conjunctivitis)
Prevent / treat with erythromycin eye ointment or silver nitrate (AgNO3)
What are the acute conditions caused by Chlamydia, how does it grow? and how is it diagnosed?
- Venereal urethritis / cervicitis which can ascend to cause PID
- Lymphogranuloma venereum
- Trachoma (follicular conjunctivitis of eye), also neonatal conjunctivitis
Grows obligate intracellularly inside mucosal cells
How is Chlamydia diagnosed?
- Giemsa stain
- Fluorescent anti-chlamydial antibodies
- PCR, nucleic acid amplification tests
What inflammation is seen in Lymphogranuloma venereum?
Vesicle at site ofinfection ulcers and has purulent exudate.
base will have granulomatous inflammation
-> both suppurative and granulomatous inflammation
Swollen inguinal, pelvic, and rectal nodes will be seen
What do herpes virus inclusions look like on histological stain and what stain do you use?
Tzank smear from bottom of ulcer
IntraNUCLEAR eosinophilic ground glass inclusions with peripheral chromatin clumping. Often have multinucleated giant cells and moulding (nuclei fit together like puzzle pieces)
Where are molluscum bodies?
These will be large, eosinophilic intraCYTOPLASMIC bodies
-> only DNA virus family to replicate in the cytoplasm
See pg 159
Does HPV cause squamous cell carcinoma or adenocarcinoma? Which strain is responsible?
HPV causes BOTH
-> adenocarcinoma mostly caused by HPV 16 & 18
What are the symptoms of trichomoniasis and how is it transmitted? How is it visualized?
It is an anerobic, flagellated protozoan which does NOT form cysts so it is sexually transmitted
Symptoms:
Pruritis with foul-smelling greenish discharge
Inflamed cervix: “Strawberry cervix”
Visualize via wet mounts.
What conditions are associated with vaginal candida infection?
Think of sketchy
Candy jar - diabetes
Pill bottle - antibiotic use
Birth control - OCP use (high estrogen levels)
What is chronic atrophic dermatitis also called and who tends to get it?
Lichen sclerosis (et atrophicus) -> commonly seen in postmenopausal women, with possible autoimmune etiology
What does Lichen sclerosis look / feel like?
Presents as a white patch (leukoplakia) in a butterfly distribution (symmetric)
-> skin surrounding vulva will be “parchment-like” -> very thin
What are the histologic features of lichen sclerosis?
Atrophy of epidermis with absence of epidermal ridges
Replacement of underlying dermis with dense fibrotic collagenous connective tissue
Dense, bandlike (lichenoid) inflammation under epidermis
What is the primary worry with lichen sclerosis?
Development of carcinoma of vulva
- > longstanding diseases can progress to non-HPV related vulvar carcinoma related to a p53 mutation
- > generally occurs in elderly women
What is VIN / what is it analogous to? What is VIN-1 and VIN-3? What is the cause usually?
Vulvar intraepithelial neoplasia, analogous to CIN (cervical)
VIN-1 = mild, dysplasia limited to lower 1/3 VIN-3 = full thickness dysplasia
Cause is usually high risk HPV strains
What is extramammary Paget disease and how does it present grossly / microscopically?
Malignant epidermal cells in the epidermis of the vulva (skin around vagina)
Presents an an erythematous, pruritic, ulcerated lesion around vulva
Microscopically - large clear tumor cells in epidermis
How is extramammary Paget disease told apart from melanoma (which can sometimes occur on vulva)?
Extramammary Paget disease: PAS+ (stains positive for mucin = carcinoma)
Keratin +, S100-
Melanoma: PAS-, keratin-, S100+ (marker for neural crest derivation)
Is there an underlying carcinoma in extramammary Paget disease?
NO -> cancer is limited to epidermis
This is in contrast to Paget disease of the nipple, in which this is a sign of underlying breast carcinoma
Where does cervical intraepithelial neoplasia tend to arise and why?
Arises in the transformation zone (zone between ectocervix (squamous epithelium) and endocervix (glandular epithelium)
Transformation zone is delicate and may have rips / tears which allow HPV to enter and infect the BASAL layer -> required for HPV replication
Why are Pap smears so effective and where should they be done?
So effective because it takes many years for CIN-1 to progress to CIN-3 and then invasive carcinoma. Typically takes 10+ years for this to arise.
They should be done at the transformation zone for reasons explained before
What are the risk factors for CIN and is persistent infection common?
Persistent infection is actually relatively rare, and is required to develop CIN
Risk factors: Smoking! Important one
Immunodeficiency -> squamous cell carcinoma of anus or cervix is actually an AIDS-defining illness (CD4 < 500, pg 173)
What is seen on histology of condyloma acuminatum?
Hyperkeratosis, parakeratosis, and mild dysplasia with koilocytic change (raisinoid, hyperchromatic, perivaculolar clearing)
Warty exophytic structure
Where does HPV-related adenocarcinoma arise?
Arises in endocervical glandular epithelium
What is the hallmark of invasive cervical carcinoma and a feared complication?
Invasion of the stroma.
Often, it can invade anteriorly into the bladder wall, leading to ureteral obstruction
-> post-renal azotemia is a common cause of death in advanced carcinoma
Other than adenocarcinoma and squamous cell carcinoma, what is one cancer type that HPV can rarely cause?
Small cell carcinoma -> tumor of neuroendocrine differentiation which may show rosette formation. High grade necrosis (like small cell cancer of the lungs)
How does the treatment of CIN and invasive carcinoma differ and why?
CIN - oftentimes very conservative management with followup Pap smear, or cryosurgery / lazer therapy, or removal of the small area.
This is because CIN is still reversible (though less likely from CIN-1 to CIN-3)
Invasive carcinoma - aggressive management -> hysterectomy and lymph node dissection with radiation therapy.
This is because invasive carcinoma is IRREVERSIBLE.
