Female Genital System Flashcards
Thinned epidermis Hydropic degeneration at basal layer Sclerotic stroma Dermal inflammation Dermal fibrosis Atrophic epithelium
Lichen sclerosus
Thickened epidermis (acanthosis)
Hyperkeratosis
Dermal inflammation
Lichen simplex chronicus
Carries a slightly increased risk for development of SCC
Lichen sclerosus
Flat, moist, minimally elevated in secondary syphilis
Condyloma lata
Papillary, distinctivelt elevated or flat and rugose
Anywhere on anogenital surface
Strongly associated with HPV
Condyloma acuminata
6 & 11 (low risk of malignant transformation)
Characteristic cellular feature of HPV
Perinuclear cytoplasmic vacuolization
Wrinkled nuclear contours
Koilocytosis
Less common Related to HPV: Middle aged women Cigarette smokers Preceded by precancerous changes termed VIN (valvular intraepithelial neoplasia) Progresses to greater degree of atypia Immunodeficiency
HPV related VULVAR SCC
16 and 18
Older women with reactive epithelial changes like lichen sclerosus
Lacks cytologic changes of VIN
but with atypia of basal layer and keratinization
Invasive is well differentiated and keratinizing
Non HPV related VULVAR SCC
Leukoplakia -> exophytic or ulcerative endophytic tumors -> HPV + are multifocal -> poorly diff SCC whereas negative are unifocal and manifest as well differentiated keratinizing SCC
SCC of Vulva
Red scaly plaque caused by prolif of malignant epithelial cells within epidermis
No underlying carcinoma unlike that of nipple
Paget disease of the vulva
This differentiates Paget disease cells from melanoma
Positive staining PAS lacks mucin
Watery copious discharge gray green in which parasites are identified with microscopy
Trichomonas vaginalis vaginitis
Uncommon, older than 60 yrs
Similar risk factors as in vulvar CA
Precursor lesion is vaginal IN assoc with HPV
SCC of Vagina
Very rare tumor
Identified in young women whose mothers took diethylstilbestrol to prevent threatened abortion
Clear cell Adenocarcinoma of VAGINA
Agent associated with elevated risk of cancer when exposed
1/3 will present with small glandular or microcystic inclusions appearing in mucosa
Red, granular appearing foci lined by mucus-secreting ciliated columnar cells called
where clear cell adenocarcinoma arises
Diethylstilbestrol
Vaginal adenosis
Rare form of primary vaginal cancer manifesting as soft polypoid masses
Infants and children <5
Also in bladder and bile duct
Sarcoma botryoides
Embryonal rhabdomyosarcoma
Most common infection of cervix 40%
C trachomatis cervicitis
Acute form of cervicitis is usually in women
by
postpartum
staph or strep
Cervicits comes to attention because of
leukorrhea
During puberty, SC junction of cervix undergoes eversion causing columnar epithelium visibility in exocervix called
transformation zone
HPV has tropism for this site on cervix
immature squamous cells of transformation zone
Rf for cervical ca
HPV exposure Early coitarche Multiple sexual partners Male with multiple sexual partners Persistent infection of HPV
HPV infected squamous cells do not usually replicate but expression of two potent oncogenes encoded in HPV genome enable this
E6
E7
E6 and E7 genomes bind and INactivate two critical TSG namely
that promote growth and inc susceptibility to additional mutations leading to carcinogenesis
E6 - p53
E7 - Rb
Most important risk factor for development of CIN and carcinoma
HIGH RISK HPV 16 and 18
70%
Also 31, 33
Serine threonine kinase phosphorylating and activating AMPK, a metab sensor
AMPK regulates cell growth through mTOR
Somatic mutations in this protein (loss) is related to cervical ca, Peutz Jhegers and inactivated lung CA
LKBI
Episomal infection
HPV 6 and 11
Viral integration
HPV 16 and 18
Two tiered grading system for CIN
LSIL previously (CIN I) HSIL previously (CIN II and III)
Rationale for Pap smear
Most successful cancer screening test ever developed
Early detection of DYSPLASTIC changes
Dysplastic changes in lower third of squamous epithelium and koilocytic change in superficial layers of epithelium
CIN I
Dysplasia extending to middle third of epithelium
Delayed keratinocyte maturation
Assoc with variation in nuclear and cell size
Heterogeneity of chromatin
Presence of mitoses above basal layer
CIN II HSIL
Complete loss of maturation with greater variation in cell and nuclear size Chromatin hererogeneity Disorderly orientation of cell Normal/abnormal mitoses Affects ALL layers of epithelium ABSENT koilocytic change
CIN III HSIL
Abnormal pap smear -> colposcopy with acetic acid test
LSIL positive:
HSIL:
Observation
Cone biopsy
HPVs can cause these types of cervical ca
SCC 75%
Adeno
Adeno squamous 20%
Small cell neuroendocrine 5%
Invasive carcinomas of cervix develop in
transformation zone
Tumors encircling cervix and penetrate underlying stroma produce
barrel cervix
Growth of basal layer of endometrium down to myometrium inducing reactive hypertrophy (enlarged, globular uterus with thickened uterine wall)
No bleeding bec infiltrative glands come crom basalis
Adenomyosis of endometrium
Ectopic endometrial glands and stroma
Endometriosis
3 hypotheses for endometriosis
1 regurgitant theory (menstrual backflow through fallopian tubes)
2 metaplastic theory (endomentrial differentiation of coelomic epithelium)
3 vascular or lymphatic dissemination (extrapelvic or intranodal implant)