Diseases of Vulva, vagina, cervix/fallapian tubes, uterus Flashcards
Etiology of condyloma acuminatum
HPV 6 and 11 associated;
condyloma acuminatum increases risk of what?
cervical CA
where is condyloma acuminatum distributed
vulva; perineum; vagina; cervix
Give gross and micro description of condyloma acuminatum
gross=> verrucous, wartlike lesions
micro=>koilocytosis, acanthosis, hyperkeratosis; parakeratosis
Give gross description of papillary hidradenoma
gross: benign tumor similar to intraductal papilloma of breast
distribution of papillary hidradenoma
occurs along milk line
Give gross and micro description of extramammary Paget disease of vulva
gross: erythematous, crusted rash
micro: intraepidermal malignant cells w/ pagetoid spread
distribution of extramammary Paget disease of vulva
labia majora
T/F extramammary Paget disease of vulva is always assoc w/ underlying tumor
FALSE => not associated w/ underlying tumor
Gross description of Candida vulvovaginitis
erythema, thick white discharge
distribution of Candida vulvovaginitis
vulva and vagina
Candida vulvovaginitis etiology
extremely common => especially in diabetics and after antibiotic use
Define vaginal adenosis
benign condition thought to be precursor of clear cell carcinoma
What increases risk for clear cell adenocarcinoma of vagina?
females exposed to deithylstilbestrol (DES) in utero during the 1940-1970s
What ages are associated with highest risk of clear cell adenocarcinoma of vagina?
40-70 years old
Define embryonal rhabdomyosarcoma
rare, grapelike soft tissue tumor affecting female infants and children <4
describe micro picture of embryonal rhabdomyosarcoma
polyploid;
spindle cell tumor showing cross striations
How can you prove the origin of the embryonal rhabdomyosarcoma?
positive for desmin => skeletal muscle origin
How would a patient with pelvic inflammatory disease present?
vaginal discharge/bleeding;
midline abdominal pain to bilateral lower abdominal/pelvic pain;
abdominal tenderness; peritoneal signs;
fever
Define pelvic inflammatory disease
ascending infection from cervix to endometrium, fallopian tubes and pelvic cavity
What are the 2 common etiologies of pelvic inflammatory disease?
Neisseria gonorrhoeae (gram neg diplococcus);
Chlamydia trachomatis (intracytoplasmic inclusion in mucosal cells)
What are the disease manifestations of pelvic inflammatory disease?
cervicitis; endometritis; salpingitis; peritonitis; PELVIC ABSCESS ; chandelier sign
perihepatitis (Fitz-Hugh-Curtis syndrome)
complication assoc w/ pelvic inflammatory disease
tubo-ovarian abscess; tubal scarring; infertility; ectopic pregnancy; intestinal obstruction
What is the 3rd most common malignant tumor of genital tract in US? when does it peak in incidence?
cervical carcinoma => peak in 40s
Etiologies of cervical carcinoma
assoc w/ early 1st intercourse, multiple partners;
HPV 16, 18, 31, 33;
smoking and immunosuppression
Describe how cervical carcinoma progesses
1) cervical intraepithelial neoplasia
2) carcinoma in situ
3) invasive squamous cell cancer
How will a patient with cervical carcinoma present?
may be asymptomatic or may have postcoital bleeding, dyspareunia, discharge
How might cervical carcinoma be detected early?
Pap smear => koilocytic cells
Define endometritis
ascending infection from cervix
Where is endometritis located?
endometrium and decidua
What different pathologies can cause endometritis?
ureplasma, peptostreptococcus; Gardnerella; Bacteroides; Group B strept; Chlamydia trachomatis; Actinomyces
If endometritis is caused by actinomyces, what will be present on IUD?
yellow granular filaments
What are the 2 associations with endometritis?
associated w/ pregnancy or abortions (acute);
chronic PID (pelvic inflam disease) and IUD
Etiology of endometriosis
presence of endometrial glands and stroma outside uterus;
women of reproductive age
Location for endometriosis
ovary; ovarian and uterine ligaments;
Pouch of Douglas;
Serosa of bowel and bladder;
Peritoneal cavity
How does endometriosis present grossly? include buzzwords
red brown serosal nodules => “powder burns”
What are 2 types of endometriosis?
endometrioma;
adenomyosis
Define endometrioma and buzz words
ovarian “chocolate” cyst
Define adenomyosis
endometrial glands in myometrium
How will a patient with endometriosis present?
chronic pelvic pain linked to menses
dysmenorrhea, dyspareunia;
rectal pain and constipation;
infertility
Define Leiomyoma
benign smooth muscle tumor that grows in response to estrogen
Define malignant form of leiomyoma
leiomyosarcoma => smooth muscle sarcoma of uterus
Who has the highest incidence of leiomyoma?
African americans
Where can a leiomyoma be located?
subserosal, intramural or submucosal locations in myometrium
What does a leiomyoma look like?
well circumscribed;
rubbery, white tan ‘whorled’ masses
generally multiple
How will a patient with leiomyoma present?
menorrhagia;
abdominal mass;
pelvic pain, back pain, suprapubic discomfort;
infertility
Where is leiomyosarcoma located?
myometrium
Gross pathology for leiomyosarcoma
bulky tumor w/ necrosis and hemorrhage
micro pathology for leiomyosarcoma
malignant smooth muscle cells=> nuclear pleomorphism an dincreased mitotic rate
Who is at highest likelihood to get a leiomyosarcoma?
increased incidence in blacks
What are characteristics of leiomyosarcoma?
aggressive tumor that tends to recur;
may present w/ cervical bleeding
most common malignant tumor of female genital tract
endometrial adenocarcinoma
highest risk for endometrial adenocarcinoma
postmenopausal women
location for endometrial adenocarcinoma
begins in endometrium and may invade myometrium
gross pathology for endometrial adenocarcinoma
tan polyploid endometrial mass;
INVASION of myometrium is diagnostically important
micro pathology for endometrial adenocarcinoma
endometrioid adenocarcinoma (most common)
How will a patient present with endometrial adenocarcinoma?
postmenopausal vaginal bleeding
What are the Risk factors for endometrial adenocarcinoma?
EARLY MENARCHE / LATE MENOPAUSE; NULLIPARITY; HTN and diabetes; obesity; CHRONIC ANOVULATION ESTROGEN PRODUCING OVARIAN TUMORS; ERT; TAMOXIFEN; endometrial hyperplasia; Lynch syndrome (colon, endometrial and ovarian cancers =HNPCC)
