Female Genital System Flashcards
……is a specific vulvar infection that is not an STD
Candidal vulvitis
HPV is a associated with……..(vulvar diseases)
Condyloma accuminatum, VIN, one type of vulvar squamous cell carcinoma
Compare lichen scelrosus & lichen simplex chronicus
Both present clinically as…..
- Scelrosus: chct by atrophic thinning epithelium, usually with dermal fibrosis. It carries inc risk of developing squamous cell carcinoma
- Simplex chronicus: chct by thickening of epithelium usually with an inflammatory infiltrate
Leukoplakia
VIN I & condyloma accuminatum are associated with….
Low risk starins of HPV 6 & 11
Describe morphology of vulvar condyloma accuminatum
G: multiple may be papillary elevated (acuminata) or flat & red, pink in colour
M: consists of tree like proliferation of startified squamous epithelium with pecularr perinuckear cytoplasmic vacuolations & nuckear atypia called koilocytosis attributed to viral effect.
Mention grades of VIN
Mild dysplasia (I)
Moderate dysplasia (II)
Severe dysplasia (III)
Carcinoma in situ
HPV 16 is present in 80-90% of……
Cases of high grade VIN (II & III)
Most common microscopic variety of vulvar carcinoma is …..
Squamous cell carcinoma
Compare HPV-related cases & unrelated cases of squamous cell carcinoma of vulva
Related: in middle-aged women, usually proceeded by VIN. Cigarette smoking & immunodeficinecy increase risk of prgression into carcinoma. Poorly differentiated
Non-related: older women, . Associated with lichen sclerosus & lichen simplex chronicus. Usually well-differentiated
Describe morphology of Paget disease of vulva
G: red crusted sharply demarcated areas mostly on labia majora that may mimic appearance of inflammatory dermatitis
M: chct by large epithelioid vacuolated cells infiltrate singly or in clusters within epidermis
Sarcoma botryoides occurs in……., the microscopic picture is…….
Young girls
It is a rhabomyosarcoma with myxomatous areas
Clear cell adenocarcinoma occurs in women whose mothers took…..during pregnancy
Diethylstilbestrol (DES)
List causes of PID
- Gonococcal infection is most common cause
- Postpartum or postabortal: staph, strept, coliform bacteria
- Chlamydial infection
List complications of PID
- Salpingitis: salpingo-oophritis, pyosalpinx & tubo-ovarian abscess. Untreated cases lead to infertility if bilateral
- Acute suppurative peritonitis, localized or generalized. Fibrous adhesions & blockage of oviducts
- Blood spread leading to bacteremia, septicemia & systemic pyaemia
- Intestinal obstruction: due to adhesions between small bowel & pelvic organs
Describe microscopic features of chronic cervicitis
There is infiltrtion by many inflammatory cells & nabothian cysts
The mucosa may show squamous metaplasia with/out reactive atypia
Describe pathogenesis, morphology & C/P of endocervical polyp
Path: inflammation trauma pregnancy have been implicated
Morphology: G: may be small & sessile to large & soft, M: made up of CT stroma containing dilated mucus secreting glands & covered by columnar epithelium may show squamous metaplasia
Clinically resents with post coital bleeding or vaginal discharge & backache
Describe pathogenesis of cervical neoplasia
-HPV shows tropism to immature epitheliumin the transformation zone, detected in nearly all cases of CIN & cervical carcinoma
-The main risk factors for developing CIN include:
1. Early age of onset of sex intercourse
2. Multiple high risk sex partners
3. Persistent HPV infection: HPV 16 & 18 strains integrate into host genome & produce E6 & E7 proteins that inactivate p53 & RB genes. Affected cells become transformed capable of autonomous growth
4. Cofactirs as immunodeficiency, gene mutations & smoking
Describe classification of CIN
- CIN I: mild dysplasia where dysplastic changes take place in lower 1/3 & shows koilocytotic changes
- CIN II: moderate dysplasia, dysplastic changes extend into middle third of epithelium. Itvtakes form of delayed maturation of keratinocytes & superficial layer shows more differentiation & may show koilocytotic changes
- CIN III: severe dysplasia, complete loss of maturation, greater atypia * mitoses, koilocytotic changes are usually absent
For simplification, CIN I is termed low-grade squamous intraepithelial lesion & CIN II & III are termed high-grade squamous intraepithelial lesion
Mention diagnostic methods for CIN
- Exfoliative cytology & Pap smear, most successful cancer screening test
- HPV detection by molecular methods
- Colposcopy:
A. Schiller’s test, involves painting teh cervix with a solution of lugol’s iodinenormal cervix is rich in glycogen & stains, neoplastic foci fail to stain
B. Painting cervix with 5% acetic acid, areas of white epithelium (aceto-white areas) with abnormal vascular patterns (mosaic or ounctutation) - Biopsy: punch or scraping
List most common invasive carcinomas in order of prevalenr
- Squamous cell carcinoma (75%)
- Adenocarcinoma & adenosquamous carcinomas (20%)
- Small-cell neuroendocrine carcinomas (<5%)
Cervical squamous cell carcinoma peak age is …..
45, 10 to 15 yrs after CIN detection
Describe morphology of squamous cell carcinoma of cervix
G: develops in transformation zone usually friable bleeds to touch may be fungating mass projecting into vagina, ulcerative type, infiltrative type
M: coventional squamous cell crcinoma grades 1-4
Describe spread of cervical carcinoma
Local to vgina urinary bladder rectum uterus broad ligaments
Lymphatic to iliac sacral and hypogastric nodes
Blood borne in lte and advanced cases
Describe clinical features of cervical carcinoma
- Patients usually present with vaginal bleeding, postcoital leukorrhea, dyspareunia dysurua.
- Malignant fistula vesicovaginal or rectovaginal
- Pyometria
- Uraemia is acommon cause of death
Acute suppurative endometritis shows infiltration by………
Neutrophils & pus cells
Diagnosis of chronic non-specific endometritis depends on…..
Plasma cells
…..is common with IUD
Actinomyces israeli
Describe etiology of endometriosis
- Regurgitation theory: from menstrual flow with subsequent implantation
- Metaplastic theory: due to endometrial differentiation from coelomic epithelium
- Vascular & lymphatic dissemination theory for extrapelvic lesion
- Extrauterine stem/progenitor cell: bone marrow cells differentiate into endometrial tissue
Describe pathogenesis of endometriosis
Studies suggest it is not only misplaced by also abnormal as:
1. Produces large amounts of inflammatory mediators esp PGE2
2. The unflammation results from recruitment of & activation of macrophages by factors made by endometrial stromal cells
3. Stromal cells also make aromatas leading to local estrogen production
-These factors enhance survival & persistance of the endometriotic tissue within a foreign location, which helps explain benefifical effect of COX-2 inhibitors
Ovarian endometriosis shows……due to….
Chocolate cyst
periodic bleeding with each menstrual cycle at site
Describe microscopic pic & effects of adenomyosis
M: nests of stroma &/or glands seen deep in myometrium
Effects: uterine enlargement as this endometrial tissue shows reactive hypertrophy of myometrium resulting in thickened uterine wall. Dysmenorrhea & pelvic pain before menses
Describe etiology of endometrial hyperplasia
Exposure to high levels of estrogen compred to progestin due to:
1. Failure of ovulation with abnormal persistance of Graafian follicle
2. Administration of estrogenic steroid
3. Estrogen producing diseases as PCO & granulosa-theca cell tumors
4. Obesity as adipose tissue converts steroid precursors to estrogen
Describe microscopic classification of endometrial hyperplasia & its prognosis
Classified according to presence of cytologic atypia into:
1. Hyperplasia without atypia (cells lining glands are columnar epithelium with inc number of mitosis) carries a low risk (1-3%) for progression to endometrial carcinoma
2. Hyperplasia with atypia (cells lining glands are atypical) also called EIN RISK OF PROGRESSION TO CANCER IS 20-50%
When hyperplasia with atypia is discovered in patient no longer desiring fertility……is done
In younger patient ttt is…..
Hystrectomy
High dose progestin in attempt to presesrve uterus
Regardless cytologic atypia microscopic exam of endometrial hyperplasia may show….or….form
Simple/complex
The most common tumor of uterus is……
Leiomyoma