Female Genital (Pathoma)

Question 1

25 y.o. women with a painful cystic lesion that is palpable at the 5 o’clock position of the vaginal introitus. Dx?

Answer 1

Bartholin cyst

Question 2

Sexually active women found to have verruca on her labia. Biopsy show koilocytic change. Dx and is the causative agent’s genome double stranded or single stranded, linear or circular, or RNA or DNA?

Answer 2

Condyloma: HPV is circular, DS, DNA

Question 3

What are the low and high risk types of HPV?

Answer 3

Low: 6, 11
High: 18 > 16, 31, 33

Question 4

60 y.o. women with SLE has a thin leukoplakia lesion on her vulva. Dx?

Answer 4

Lichen Sclerosis

Question 5

Middle age woman complains of moderate itching and irritation around her vigina. You notice leukoplakia and thickening of the skin around her vulva. Biopsy reveals hyper plastic squamous cells, with no increased mitoses, or local invasion. Dx?

Answer 5

Lichen simplex chronicus

Question 6

30 year old promiscuous woman presents with leukoplakia on the vulva. Biopsy reveals mitotic bodies, nuclear polymorphism, and invasive cells. What is the diagnosis and most likely underlying cause?

Answer 6

Vulvar carcinoma - HPV 16 or 18

Question 7

Woman comes in with erythematous, pruritic, and ulcerative vulva. Biopsy shows hyper plastic cells with mitotic bodies, nuclear polymorphism, but no infiltration of the basement membrane. The cells are shown to be PAS +, Keratin +, and S100 -. What is the diagnosis? What would it be if they were PAS -, Keratin -, and S100+?

Answer 7

Extramammary Paget Disease

Melanoma

Question 8

50 y.o. woman comes in for her well women. Non invasive columnar metaplasia was noticed in in the upper part of the vaginal canal. Diagnosis, Most likely cause, and concerning complication?

Answer 8

Adenosis
Her mother using DES during pregnancy
Clear cell adenocarcinoma

Question 9

2 y.o. female with grape-like mass protruding through the vagina introitus. Histology shows striated, design and myogenin positive cells. Dx?

Answer 9

Embryonal Rhabdomyosarcoma

Question 10

What are the “high risk” HPV strains? What is meant by high risk?

Answer 10

HPV 16, 18, 31, 33

These have the highest risk of causing carcinoma

Question 11

To which lymph nodes do the lower 1/3 and upper 2/3 of the vagina drain?

Answer 11

Lower 1/3 Inguinal

Upper 2/3 Iliac

Question 12

What type of cells are normally lining the external and internal os of the cervix?

Answer 12

External: Squamous
Internal: Columnar

Question 13

What are the two main causes of cancer related to HPV?

Answer 13

E6 protein: increase destruction of p53. This results in loss of apoptosis due to recognized DNA damage.
E7 protein: Destroys Rb, which normally inactivates E2F (Free E2F results in increased G1 –> S phase)

Question 14

45 y.o. women complains of post-coidal bleeding and pap reveals squamous cells with dark nuclei and a high nucleus to cytoplasm ratio. What is your next step in her care? What do you suspect?

Answer 14

Colposcopy

Cervical carcinoma

Question 15

What is the most common cause of Asherman?

Answer 15

Secondary amenorrhea due to loss of basalis from aggressive dilation and curettage

Question 16

What age group/s are most commonly anovulatory? What is the pathophysiology behind it?

Answer 16

Menarche and early menopause
Estrogen is driving endometrial proliferation, but a lack of progesterone (normally supplied by the corpus luteum) results in absence of shedding.

Question 17

What is the most common cause of acute endometritis?

Answer 17

Retained birth products

Question 18

How does tamaxofen cause uterine polyps?

Answer 18

It is a SERM with anti-estrogen effects of breast and pro-estrogen effects on the uterus.

Question 19

What is the histological requirement for diagnosing endometriosis?

Answer 19

Glands + Stroma

Question 20

What is the term used for myometrium that has glands and stroma?

Answer 20

Adenomyosis

Question 21

Is there an increased risk of carcinoma with endometriosis?

Answer 21

YES

Question 22

What is the pathophys of increased incidence of endometrial hyperplasia in obese women?

Answer 22

Increased aldosterone –> estrogen conversion by adipose tissue

Question 23

What is the most likely source of endometrial carcinoma in a middle age women? What about an elderly woman?

Answer 23

Middle age: Endometrial hyperplasia (estrogen exposure)

Elderly: Sporadic p53 mutation

Question 24

What is seen on histology of leiomyoma?

Answer 24

Multiple, well demarcated whorled masses

Question 25

What is seen in histology of a leiomyosarcoma?

Answer 25

Singular hemorrhagic and necrotic areas.