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Morbid Anatomy > Female Genital Pathology 1 > Flashcards

Female Genital Pathology 1 Flashcards

1
Q

6 disorders that can affect the vulva

A

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

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2
Q

Vulvitis is most often related to STDs T/F

A

T

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3
Q

What organisms are typically related to sexually transmitted vulvitis

A

HPV
HSV1 AND 2
Gonoccocal suppurative infections
Syphillis
Candida

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4
Q

Condyloma acuminata is also known as?
Caused by?
What strains?

A

Anogenital/genital warts
HPV
6 and 11

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5
Q

Treponema pallidum causes syphillis in which there is soft painful chancroid T/F

A

F…it causes hard painless chance
Soft painful is caused by H.ducreyi

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6
Q

The two types of dermatitis seen in vulvitis

A

Contact irritant dermatitis
Contact allergic dermatitis

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7
Q

Contact irritant dermatitis

A

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

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8
Q

Contact allergic dermatitis

A

Same as Cid
From allergy to perfumes, additives in creams soaps etc
Resolves with steroid use

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9
Q

Non neoplastic epithelial disorders

A

Consists of lichen sclerosus and lichen simplex chronicus
Both may appear macroscopically as leukoplakia

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10
Q

What is Lichen sclerosus

A

A non neoplastic epithelial disorder chxd by atrophic epithelium and dermal fibrosis which leads to an increased risk of developing squamous cell carcinoma

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11
Q

What is lichen simplex chronicus

A

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.

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12
Q

Tumors of the vulva

A

Condyloma lata and alumina
High grade VIN

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13
Q

Condyloma lata

A

Not common
Flat moist, minimally elevates lesions
Secondary to syphillis
Going due to treatment

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14
Q

Treatment of condyloma lata

A

Benzathine penicillin

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15
Q

Condyloma acuminata

A

More common
Also called anogenital warts
Significant chx- Perinuclear cytoplasmic vacuolisation
Not really precancerous

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16
Q

High grade Vulval intraepithelial neoplasms

A

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

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17
Q

Microscopically, extramammary paget’s disease of the vulvar is chxd by

A

Red scaly plaques chxd by spread of malignant cells within the epithelium , occasionally with invasion of underlying dermis

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18
Q

The vagina is most often the site of primary disease. T/F

A

F..rather it’s typically involved in the spread of infxn or cancers from vulva cervix etc

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19
Q

Primary disorders of the vagina include

A

Congenital anomalies
Vaginitis
Primary carcinomas

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20
Q

Congenital anomalies of the vafina include

A

Total absence of vagina
Separate or double vagina
Congenital small lateral Gartner duct cysts

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21
Q

What are Gartner duct cysts

A

Cysts formed from remnants of Wolffian ducts in females

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22
Q

In adults, primary gonorrheal infection of the vagina is quite common T/F

A

F….it’s not common but may occur in newborns due to infected mothers

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23
Q

Vaginitis is typically caused by 2 organisms. Name them

A

Trichomonas vaginalis
Candida albicans

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24
Q

Vaginitis caused by T.vaginalis is chxd by

A

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

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25
Q

Vaginitis caused by Candida albicans typically involves

A

Curdy white discharge
Also part of NF

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26
Q

Non specific atrophic Vaginitis

A

Seen in post menopausal women
Preexisting atrophy due to loss of estrogen

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27
Q

Vaginal epithelial neoplasia is associated with hpv infxn like vulval t/f

A

T

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28
Q

Vaginal clear cell adenocarcinoma is typically encountered in

A

Young women whose mothers took diethystilbestrol a synthetic estrogen, during pregnancy
1in 1000 of those exposed in utero

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29
Q

Vaginal adenosis is chxd by

A

Small glandular inclusions in vaginal mucosa that appear as red glandular foci lined by mucus secreting cell

30
Q

Vaginal clear cell adenocarcinoma typically arises from?

A

Vaginal adenosis

31
Q

What is typically referred to as the seat of disease in females

A

Cervix

32
Q

At birth, the squamous cell epithelium of the exocervix meets the columnar epithelium of the endocarditis at the external os. T/f

A

T

33
Q

In young women, the squamocolumnar junction lies?

A

Visibly On the exocervix…extropion

34
Q

Regeneration of the squamocolumnar jxn leads to formation of the

A

Transformational zone

35
Q

What are nabothian cysts

A

They are cysts formed due to the blockage of the orifices of endocervical glands in the transformation zone as a result of epithelial oergrowth

36
Q

Most common Causative agent of cervicitis

A

C.trachomatis(40%) ….followed by N.gonorrhea
Others include staph strep E.coli HS genitalis HPV T.vaginalis candida

37
Q

The most successful SCREENING test for cervical cancer ever developed

A

Pap smear

38
Q

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

A

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

39
Q

Nearly all invasive cervical SCC arise from epithelial CIN and vice versa

A

False. It doesn’t occur vice versa
Only a fraction of cases of CIN progress to invasive carcinoma

40
Q

Risk factors for cervical cancer

A

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

41
Q

High risk HPv strains include

A

16, 18, 45, 31
Viral dna integrates into host genome and expressses E6 and 7 which inactivate p53 and RB respectively

42
Q

Low risk Hpv

A

6,11,42,44
Vaccine effective

43
Q

The invasive carcinomas of the cervix include

A

SCC -75%
Adenocarcinoma and adenosquamous carcinoma -20%
Squamous cell neuroendocrine carcinoma -5%

44
Q

Glandular lesions are well detected by pap smear as well. T/f

A

F

45
Q

Typical presentation of symptomatic cervical tumors

A

Unexpected vaginal bleeding
Leukorrhea
Painful coitus
Dysuria
PLUD

46
Q

Most effective method of cervical cancer prevention

A

Detection of precursors by cytoloic exam(CIN) and their eradication by laser vaporisation or cone biopsy

47
Q

Barrel cervix is a typical presentation of

A

Invasive carcinomas especially adenocarcinoma

48
Q

What is pelvic inflammatory disease

A

An infection of the upper part of the female reproductive system including the uterus, fallopian tubes, ovaries and inside the pelvis

49
Q

Endometritis

A

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

50
Q

Acute endometritis

A

Predominantly neutrophils
Frequently due to N.gonorrhea and C.trachomatis

51
Q

Chronic Endometritis

A

Primarily lymphoplasmocytic
Due to TB ‘granulomatous endometritis

52
Q

Clinical presentation of endometritis

A

E Ectopic pregnancy
N
D
O- Abdominal pain
M- menstrual abnormalities
E
T
R
I-infertilty
T- Fever
I
S

53
Q

What is adenomyosis

A

Growth of the basal layer of the endometrium down into the myometrium leading to thickening of uterine wall

54
Q

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?

A

Adenomyosis

55
Q

What is endometriosis

A

Chxd by endometrial glands and stroma in a location outside the endometrium
May present as a pelvic mass filled with degenerating blood

56
Q

Tell me about Samson’s theory of retrograde menstruation 🩸

A

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

57
Q

The 4Ds of endometriosis

A

Dysmenorrhoea
Dyschezia
Dysuria
Deep dyspareunia(painful intercourse)
Pelvic pain

58
Q

Dysfunctional uterine bleeding

A

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

59
Q

Endometrial hyperplasia

A

Increase in estrogen leading to increase in size of endometrial gland greater than 10mm

60
Q

3 types of endometrial hyperplasia

A

Simple
Complex
Atypical

61
Q

Risk of developing uterine carcinoma is dependent on the severity of hyperplasia changes. T/F

A

T

62
Q

Endometrial polyps

A

Sessile i.e no stalk attached at base, usually hemispheric
Occurs most commonly at menopause
Rarely gives rise to cancer

63
Q

Commonest causes of abnormal uterie bleeding

A

Fibroid
Adenomyosis
Polyps*

64
Q

The commonest benign tumor of the fgs

A

Leiomyoma

65
Q

About leiomyomas

A

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.

66
Q

Liomyosarcomas

A

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

67
Q

Endometrial carcinoma is the most frequent cancer in the Female genital system in the U.S and other western countries. T/f

A

T

68
Q

Endometrial carcinoma

A

Due to endometroid excess in perimenopausal women
Risk factors include HTN, obesity, infertility, DM
Similar to normal endometrial gland

69
Q

The two familial cancer syndromes associated with endometriosis

A

Hereditary non polyposis colon cancer syndrome- lynch syndrome
Cowdens syndrome ‘mutations in PTEN

70
Q

Serous carcinoma

A

Endometrial atrophy in postmenopausal women(decreased estrogen)
Predominantly p53 mutations
Rarely PTEN

71
Q

The first clinical indications of all endometrial carcinomas

A

Marked leukorrhea and Irregular bleeding

Morbid Anatomy (6 decks)

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