Female Genital Pathology 1 Flashcards
6 disorders that can affect the vulva
V-vulvitis
I- imperforate hymen in children
I-impeding secretions and menstrual flow later in life
P- Painful Bartholin cysts
N- non neoplastic epithelial disorders
C-carcinomas
Vulvitis is most often related to STDs T/F
T
What organisms are typically related to sexually transmitted vulvitis
HPV
HSV1 AND 2
Gonoccocal suppurative infections
Syphillis
Candida
Condyloma acuminata is also known as?
Caused by?
What strains?
Anogenital/genital warts
HPV
6 and 11
Treponema pallidum causes syphillis in which there is soft painful chancroid T/F
F…it causes hard painless chance
Soft painful is caused by H.ducreyi
The two types of dermatitis seen in vulvitis
Contact irritant dermatitis
Contact allergic dermatitis
Contact irritant dermatitis
Most common cause of vulvar pruritus
Presents as a well defined, erythematous weeping with crusting papules and plaques
May be a reaction to urine, soaps detergent, antiseptics or alcohol
Contact allergic dermatitis
Same as Cid
From allergy to perfumes, additives in creams soaps etc
Resolves with steroid use
Non neoplastic epithelial disorders
Consists of lichen sclerosus and lichen simplex chronicus
Both may appear macroscopically as leukoplakia
What is Lichen sclerosus
A non neoplastic epithelial disorder chxd by atrophic epithelium and dermal fibrosis which leads to an increased risk of developing squamous cell carcinoma
What is lichen simplex chronicus
A non neoplastic epithelial disorder chxd by a triad of SEE
Epithelial thickening
Expansion of stratum granulosum(CLOGS)
Surface hyperkeratosis
There is no increased predisposition of cancer but often present at margins of established cancer.
Tumors of the vulva
Condyloma lata and alumina
High grade VIN
Condyloma lata
Not common
Flat moist, minimally elevates lesions
Secondary to syphillis
Going due to treatment
Treatment of condyloma lata
Benzathine penicillin
Condyloma acuminata
More common
Also called anogenital warts
Significant chx- Perinuclear cytoplasmic vacuolisation
Not really precancerous
High grade Vulval intraepithelial neoplasms
90% are HPV related, younger people
90% are SCC
10%are non hpv related seen in older women
Ass with lichen sclerosus or other inflammatory conditions
Microscopically, extramammary paget’s disease of the vulvar is chxd by
Red scaly plaques chxd by spread of malignant cells within the epithelium , occasionally with invasion of underlying dermis
The vagina is most often the site of primary disease. T/F
F..rather it’s typically involved in the spread of infxn or cancers from vulva cervix etc
Primary disorders of the vagina include
Congenital anomalies
Vaginitis
Primary carcinomas
Congenital anomalies of the vafina include
Total absence of vagina
Separate or double vagina
Congenital small lateral Gartner duct cysts
What are Gartner duct cysts
Cysts formed from remnants of Wolffian ducts in females
In adults, primary gonorrheal infection of the vagina is quite common T/F
F….it’s not common but may occur in newborns due to infected mothers
Vaginitis is typically caused by 2 organisms. Name them
Trichomonas vaginalis
Candida albicans
Vaginitis caused by T.vaginalis is chxd by
Green watery copious discharge that is foul smelling.
Flagellated organism seen on microscopy
Part of normal flora so typically involves sti of new aggressive strains
Vaginitis caused by Candida albicans typically involves
Curdy white discharge
Also part of NF
Non specific atrophic Vaginitis
Seen in post menopausal women
Preexisting atrophy due to loss of estrogen
Vaginal epithelial neoplasia is associated with hpv infxn like vulval t/f
T
Vaginal clear cell adenocarcinoma is typically encountered in
Young women whose mothers took diethystilbestrol a synthetic estrogen, during pregnancy
1in 1000 of those exposed in utero
Vaginal adenosis is chxd by
Small glandular inclusions in vaginal mucosa that appear as red glandular foci lined by mucus secreting cell
Vaginal clear cell adenocarcinoma typically arises from?
Vaginal adenosis
What is typically referred to as the seat of disease in females
Cervix
At birth, the squamous cell epithelium of the exocervix meets the columnar epithelium of the endocarditis at the external os. T/f
T
In young women, the squamocolumnar junction lies?
Visibly On the exocervix…extropion
Regeneration of the squamocolumnar jxn leads to formation of the
Transformational zone
What are nabothian cysts
They are cysts formed due to the blockage of the orifices of endocervical glands in the transformation zone as a result of epithelial oergrowth
Most common Causative agent of cervicitis
C.trachomatis(40%) ….followed by N.gonorrhea
Others include staph strep E.coli HS genitalis HPV T.vaginalis candida
The most successful SCREENING test for cervical cancer ever developed
Pap smear
Although the incidence of cervical cancer is said to have plummeted, the incidence of cervical intraepithelial neoplasia has increased to more than 50000 yearly. Why
This is because the pap smear is useful for screening and as such early detection prevents the cin from progressing to cancer
However the cause of the cancers have not been curbed or tackled yet and thus the increasing incidence of the precursor
Nearly all invasive cervical SCC arise from epithelial CIN and vice versa
False. It doesn’t occur vice versa
Only a fraction of cases of CIN progress to invasive carcinoma
Risk factors for cervical cancer
Early age at first intercourse
Multiple sexual partners
Male partner with multiple sexual partners
Persistent infxn by high risk HPV
Other influences like cigarette smoking
Immunodeficiency
High risk HPv strains include
16, 18, 45, 31
Viral dna integrates into host genome and expressses E6 and 7 which inactivate p53 and RB respectively
Low risk Hpv
6,11,42,44
Vaccine effective
The invasive carcinomas of the cervix include
SCC -75%
Adenocarcinoma and adenosquamous carcinoma -20%
Squamous cell neuroendocrine carcinoma -5%
Glandular lesions are well detected by pap smear as well. T/f
F
Typical presentation of symptomatic cervical tumors
Unexpected vaginal bleeding
Leukorrhea
Painful coitus
Dysuria
PLUD
Most effective method of cervical cancer prevention
Detection of precursors by cytoloic exam(CIN) and their eradication by laser vaporisation or cone biopsy
Barrel cervix is a typical presentation of
Invasive carcinomas especially adenocarcinoma
What is pelvic inflammatory disease
An infection of the upper part of the female reproductive system including the uterus, fallopian tubes, ovaries and inside the pelvis
Endometritis
Typically seen with PID
Could be acute or chronic
Causes include ‘ foreign bodies or retained tissue from miscarriage
Both of which act as nodes for infection
Acute endometritis
Predominantly neutrophils
Frequently due to N.gonorrhea and C.trachomatis
Chronic Endometritis
Primarily lymphoplasmocytic
Due to TB ‘granulomatous endometritis
Clinical presentation of endometritis
E Ectopic pregnancy
N
D
O- Abdominal pain
M- menstrual abnormalities
E
T
R
I-infertilty
T- Fever
I
S
What is adenomyosis
Growth of the basal layer of the endometrium down into the myometrium leading to thickening of uterine wall
Because they are derived from the stratum basalis, they do not undergo cyclical bleeding but may produce menorrhagia, dysmenorrhoea and pelvic pain. What are we referring to?
Adenomyosis
What is endometriosis
Chxd by endometrial glands and stroma in a location outside the endometrium
May present as a pelvic mass filled with degenerating blood
Tell me about Samson’s theory of retrograde menstruation 🩸
Also known as the regurgitation theory. It proposes that endometriosis occurs due to menstrual backlog through the fallopian tubes, ovaries and other parts of the peritoneal cavity with subsequent implantation. That the menstrual endometrium is viable and survives when implanted into the aawall .
The hormonal changes of the menstrual cycle then affect the misplaced endometrial tissue causing it to grow, become inflamed and breakdown with no way to flow out and thus becomes trapped in the pelvis
This then brings about irritation, scar formation, adhesions, dysmenorrhoea and fertility problems
The 4Ds of endometriosis
Dysmenorrhoea
Dyschezia
Dysuria
Deep dyspareunia(painful intercourse)
Pelvic pain
Dysfunctional uterine bleeding
Abnormal bleeding in the absence of a well defined organic lesion in the uterus
Failure of ovulation-increased estrogen
Inadequate luteal phase- decreased progesterone
Contraceptive induced bleeding-decidua like stroma
Endomyometrial disorders like chronic endometritis, endometrial polyps,leiomyomas
Endometrial hyperplasia
Increase in estrogen leading to increase in size of endometrial gland greater than 10mm
3 types of endometrial hyperplasia
Simple
Complex
Atypical
Risk of developing uterine carcinoma is dependent on the severity of hyperplasia changes. T/F
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Endometrial polyps
Sessile i.e no stalk attached at base, usually hemispheric
Occurs most commonly at menopause
Rarely gives rise to cancer
Commonest causes of abnormal uterie bleeding
Fibroid
Adenomyosis
Polyps*
The commonest benign tumor of the fgs
Leiomyoma
About leiomyomas
30-50% of women during reproductive life
Often referred to as fibroid because of firmness
Estrogen and oral contraceptives stimulate their growth and this they shrink postmenopausal
Most frequent manifestation- menorrhagia with or without metrorragia.
Liomyosarcomas
Typically solitary tumors that arise de novo from mesenchymal cells of the myometrium
Frequently soft, hemorrhagic and necrotic
Diagnostic factors- tumor necrosis, cytology atypical and mitotic activity
Endometrial carcinoma is the most frequent cancer in the Female genital system in the U.S and other western countries. T/f
T
Endometrial carcinoma
Due to endometroid excess in perimenopausal women
Risk factors include HTN, obesity, infertility, DM
Similar to normal endometrial gland
The two familial cancer syndromes associated with endometriosis
Hereditary non polyposis colon cancer syndrome- lynch syndrome
Cowdens syndrome ‘mutations in PTEN
Serous carcinoma
Endometrial atrophy in postmenopausal women(decreased estrogen)
Predominantly p53 mutations
Rarely PTEN
The first clinical indications of all endometrial carcinomas
Marked leukorrhea and Irregular bleeding
