Female genital tract 1 Flashcards
Covers disorders of the Vulva, vagina, cervix, Uterus, PID
Occurs in women with intrauterine exposure to DES
Cells have distinct cell membranes,
large
moderate to abundant clear cytoplasm
cuboidal and sometimes hobnail type with nuclei protruding into the lumen
Nuclei are round to irregular, hyperchromatic with conspicuous nucleoli
Clear cell adenocarcinoma
Proliferative/ secretory endometrium?
Gland architecture: straight, tubular
- Gland lining: regular, tall, pseudostratified columnar
- Secretory activity: no evidence of mucus secretion or vacuolation.
- Compact stroma
Proliferative Endometrium
Type of cellular adaptation seen in the image
Squamous Metaplasia
1. See the image provided and the clues below and formulate a diagnosis
38 year old female
dysmenorrhea
painful defecation at the time of menstruation
Endometriosis
right upper quadrant pain following the transabdominal spread of infection from pelvic inflammatory disease
violin string adhesions of anterior liver capsule to anterior abdominal wall or diaphragm
liver capsular infection without affecting hepatic parenchyma
Fitz Hugh Curtis Syndrome
most common cause of death in patients with advanced cervical carcinoma
local invasion of ureter, pyelonephritis and renal failure
What’s your diagnosis?
56 year old female with post coital vaginal bleeding assoc with malodorous discharge
Colposcopy shows a fungating mass
Microscopy shown in the attached image.
Cervical Squamous cell carcinoma
WHAT’S THE DIAGNOSIS?
TEMP >101 DEGREE FARENHEIT
ABNORMAL VAGINAL DISCHARGE
CERVICAL MOTION TENDERNESS
ADNEXAL TENDERNESS
PID
Mechanism of carcinogenesis by HPV E6 and E7?
Learn this till you go blue in the face!
- Describe the microscopic findings seen in this benign condition caused by HPV 6 and 11.
- What’s the diagnosis?
- Papillary, exophytic, treelike cores of stroma covered by thickened squamous epithelium with koilocytic atypia
- Condyloma acuminatum
1. Diagnosis?
32 year old woman
menometrorrhagia
*Enlarged globular uterus, c/s trabeculated appearance
2. What finding do you see on microscopy?
- Adenomyosis
- presence of endometrial tissue within the uterine wall (myometrium)
Unilateral painful labial swelling
Obstruction of gland duct
Cyst lining is transitional or squamous epithelium
Bartholin Cyst
45 year old female
H/O pruritus, dyspareunia
Clinical exam: parchment like appearance of vulva
M/E : marked thinning of epidermis, sclerotic changes in the dermis with hyalinization and bandlike lymphocytic infiltrate
Lichen sclerosus
Origin of this tumor?
<5 years of age
Gross: polypoid, round, bulky grapelike masses
Origin of the tumor is from Skeletal muscle cells
The tumor is embryonal Rhabdomyosarcoma.
Gross appearance: sharply circumscribed, discrete, round, firm, gray-white
characteristic whorled pattern of smooth muscle bundles on cut section
Microscopic appearance: see attached image
What’s your diagnosis?
Leiomyoma
List 6 morphologic lesions seen in the tubes and ovaries following PID
ACUTE SUPPURATIVE SALPINGITIS
SALPINGO-OOPHORITIS
TUBO OVARIAN ABSCESS
PYOSALPINX
CHRONIC SALPINGITIS
HYDROSALPINX
1. Diagnosis?
Pruritic, red, crusted , maplike area over the labia majora
lateral spread of cells in singles/clusters within epidermis, the cell are large rthan normal keratinocytes
pale cytoplasm containing mucopolysaccharide
2. Special stain?
- Extramammary Paget Disease
- PAS/Alcian Blue/Mucicarmine
Name the most frequent precursor to endometrial carcinoma
Endometrial hyperplasia
Proliferative endometrium / secretory endometrium?
- Gland architecture: tortuous, serrated or “saw-toothed
- Gland lining: shows subnuclear secretory basal vacuoles that move progressively to the apex
- Secretory activity: prominent
- Loose stroma
secretory endometrium
Diagnosis?
60 year old female
bulky, fleshy masses that invade the uterine wall
Tumor cells- irregular, hyperchromatic nuclei, Atypical mitoses and Foci of necrosis
Leiomyosarcoma
Give one word that best describes this image:
Atypical, enlarged hyperchromatic nuclei with wrinkled, raisinoid appearance with perinucelar halo
Koilocytic atypia
Consequence of rubbing of vulvar mucosa in response to pruritus
* acanthosis
* hyperkeratosis
Squamous cell hyperplasia
Diagnosis?
* Homogeneous, white/gray non-inflammatory discharge that adheres to vaginal walls
* Presence of clue cells on wet mount
* Vaginal pH greater than 4.5
* A fishy odor after addition of KOH/whiff test
Bacterial vaginosis
Diagnosis?
* Pruritic vaginitis with a white or thick (cottage cheese) discharge
* Vaginal pH>4.5
* Amine test (smell of vaginal fluid caused by release of amines) after mixing a sample of vaginal discharge with a few drops of KOH is negative (not malodorous).
Candidiasis
Lining epithelium of the vagina in vaginal adenosis
columnar mucinous
precursor lesion for vaginal clear cell adenocarcinoma
vaginal adenosis
Why should the transformation zone be sampled while performing a Pap smear?
TZ is where squamous dysplasia and cancer develop because Immature squamous metaplastic epithelial cells in the transformation zone areimost susceptible to HPV infection
Diagnosis?
50 year old woman, post coital bleeding
Exam reveals reddish mass protruding from external os
Endocervical polyp
Describe koilocytic atypia
nuclear enlargement, hyperchromasia (dark staining), coarse chromatin granules, and variation in nuclear size and shape + perinuclear cytoplasmic halo
Appearance of low grade SIL (LSIL) on biopsy
immature squamous cells are confined to the lower one third of the epithelium
Appearance of high grade SIL (HSIL) on biopsy
immature squamous cells expand to the upper two thirds of the epithelial thickness
Percent cases of HSIL that will progress to carcinoma
10
Percent cases of HSIL that will continue to persist
60
10 percent casesof LSIL will progress to which lesion?
HSIL
Criteria for microinvasive cervical squamous cell carcinoma
stromal invasion with a max depth of 5mm and horizontal spread of 7mm or less
Structural causes of abnormal uterine bleeding
(PALM)
Polyp
Adenomyosis
Leiomyoma
Malignancy
Non structural causes of abnormal uterine bleeding
Mnemonic: COEIN
Coagulopathy
Ovulatory dysfunction
Endomterial
Iatrogenic
Not yet classified
Endometrial biopsy finding in anovulatory AUB
abundant proliferative endometrium
Physiologic conditions associated with anovulatory cycles
Perimenarchal
Perimenopausal
Clinical conditions associated with chronic anovulation
PCOS
Thyroid disorders
Obesity
Unopposed estrogen tretament in post-menopausal women.
Mechanism of anovulation in obesity
- decreased SHBG–>increased free T and E
- Hyperinsulinemia–>increased ovarian production of androgens
- Peripheral conversion of androgens to estrogen by aromatase
2 causes for ovulatory DUB
A. Inadequate luteal phase defect
B. Irregular shedding of the endometrium
Endometrial biopsy findings in individuals with inadequate luteal phase
Poorly developed secretory phase
endometrial biopsy findings in individuals who experience abnormal uterine bleeding due to irregular shedding of the endometrium
mix of secretory and proliferative endometrium
History of delivery
fever, abdominal pain with uterine tenderness on palpation, foul smelling vaginal discharge
acute endometritis
Morphologic hallmark of chronic endometritis
Plasma cells in the endomterial stroma
Pathogenesis of endomteriosis
The regurgitation theory proposes that endometrial tissue implants at ectopic sites via retrograde flow of menstrual endometrium.
Sites for endometriosis
Ovaries - most common site
rectal pouch, fallopian tubes, intestine
Gross appearance of endometriotic implants
red-blue to yellow-brown nodules aka powder burn lesions
Gross morphology of ovarian endometriosis
chocolate cyst - filled iwth brown fluid due to previous hemorrhage
Main pathogenic factor for endometrial hyperplasia
prolonged estrogenic stimulation
Eg: Obesity, PCOS, functioning granulosa cell tumors of the ovary
Identify this complication of PID
* Fever
* Leukocytosis
* bilateral pelvic tenderness worse on one side during palpation +adnexal mass+ rectal discomfort
Tubo-ovarian abscess
List 2 genes whose mutations are associated with Type 1 endometrial carcinoma
PTEN (30-80%)
MSI (20%)
Genetic basis of Lynch syndrome
autosomal dominant germline mutation of mismatch repair genes (MLH1, MSH2, MSH6, PMS2) leading to microsatellite instability
Precursor for Type 1 endometrial carcinoma
endometrial hyperplasia
2 complications of submucosal leiomyomas
1.Menorrhagia –>iron deficinecy anemia
2.Increased risk of spontaneous abortion
Pattern of urinary incontinence associated with leiomyomas
Stress urinary incontinence.
