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Reproductive Pathology > Female Genital Tract > Flashcards

Female Genital Tract Flashcards

1
Q

List the following in order of frequency of infection by herpes.

A

Most Frequent
Cervix
Vagina
Vulva
Least Frequent

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2
Q

What type of virus causes Mulloscum contagiosum?

A

Pox Virus (remember this is the only double stranded DNA virus that have its own DNA dependent RNA pols, stays in the cytomplasm, hence cytoplasmic inclusions with pox viruses)

**Remember lesion presents with a central umbilication

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3
Q

What factors put women at a higher risk of candida infection?
- Key histological features?

A
  • *1. Pregnancy
    2. Diabetes Mellitus
    3. Antibiotics
    4. Pregnancy
    5. Compromised Immune System**

Histology:
- Yeast with Hyphae that skew squamous cells

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4
Q

Trichomonas Vaginalis

  • Cervical Pathology
  • Histology
A

Cervical Pathology
- Stawberry Cervix

Histology:

  • *- Small Red Cytoplasmic Inclusions
  • Halo around Nucleus**
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5
Q

What is the most common venereal disease to cause PID?

A

Chlamydia Trachomatis - starts in the vagina and spreads upwards until you get PID

**Remember when it causes Peritonitis its cause FITZ-HUGH-CARTER SYNDROME

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6
Q

What is the Presentation of Acute Pelvic Inflammatory Disease?
- Acute Salpingitis?

A

Acute PID:
- After menstruation there may be vaginal discharge and a low grade fever lasting about a week

Acute Salpingitis:
- Pus-filled lumen of the fallopian tube with edema of the folds with inflammatory infiltrate

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7
Q

What histology can you expect to see in chronic salpingitis?
- complications?

A

Chronic Salpingitis
- Scarring and Fusion of the Plicae

Complications:
- Increased chances of ectopic pregnancy and infertility

***Often associated with PID***

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8
Q

How is the vulvular epithelium supposed to appear?

A
  • Should be stratified Squamous Epithelium Non-Keritonized

**Remember the vulva consists of everything outside of the hyman

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9
Q

Bartholin’s Cysts

  • why do we need to remove them?
  • Commonly associated with?
A

Need to be removed because high risk of infection and abscess

Commonly associated with STDs and Sexual Activity

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10
Q

Lichen Sclerosis

  • What does it look like on gross inspection?
  • Histology?
  • Associated risk?
A

Gross:
- presents as white parchment skin and dyspariunia because there can be narrowing of the vaginal cavity

Histology:
Epidermal layer of squamous cells with extensive underlying sclerosis that is avascular

Risk:
- These women have a slight increased risk for SCC

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11
Q

Condyloma Accumulatum

  • what HPV types is this associated with?
  • Histological Appearence?
A

HPV types 6 and 11 are responsible for warts

Histological Appearance:
- Granular Layer has large Halos = Viropathic Effect, looking for Koilocytes

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12
Q

Lichen Simplex Chronicus

  • Histology
  • Etiology
  • Associated Risks?
A

Histology:
Thickened Squamous Epithelium of the Vulva (compare to lichen sclerosis)

Etiology:
Often this is caused by Chronic Irritation

Associated Risks:
NOT associated with an increased risk of SCC like lichen sclerosis

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13
Q

Where will cancer of the lower 1/3 or the vagina first metastasize to?
- where will the upper 2/3 metastasize to?

A

Lower 1/3 will metastasize to the inguinal lymph nodes
the upper 2/3 will metastasize the the iliac (perioaortal) lymph nodes

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14
Q

How does the Etiology or vulvular intraepithelial neoplasia (VIN) differ in older women and younger women?

A

Older Women:
- Lichen Sclerosis is often the cause of SCC in situ in women in their 60’s

Younger Women:
- HPV 16 (or 18) is most often implicated in VIN in younger women

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15
Q

An 65 year old women with a 10 year history of lichen sclerosis complains of worsening of her condition.
What cancer should you suspect?
What do you expect to see on histology?

A

This woman has a history of Long Standing Lichen Sclerosis
Cancer:
- Vulvovaginal Intraepithelial Neoplasia - essentially SCC in situ

Histology:
- Cells appear pleomorphic with edema and keritin pearls

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16
Q

A 33 year old female presents with what appears to be SCC in situ (aka Vulvular Intraepithelial Neoplasia) of the vulva.

  • Etiology?
  • what do you expect to see on Histology?
  • Prognosis?
A

Etiology:
HPV 16 most likely (or 18, 31, 33)

Histology:
Basal cells extend up from the stratum basal to where the stratum corneum. Because this has an HPV etiology you would expect to see Koilocytes, mitosis, and some atypia

Prognosis:
VIN typically has a good Px, unless there is lymph envolvement or the primary lesion is really large

17
Q

Paget’s Disease (of the Vulva)

  • Compare Cancer Risk to associated Cancer Risk in the breast
  • Presentation
A

NOT associated with underlying carcinoma like Paget’s of the Nipple

Presentation:
Red Scaly Rash that may be pruitic on the labia majora

18
Q

What do you expect to see on histology of Paget’s Disease of the Vulva?

  • what is your differential?
  • How do you make the Dx?
A

Histology:
Similar to Nipple, cells with light purple cytoplasm move up through the epithelium

DDx:
- Melanoma based on Histo
Need to do RAS, CK7, and S100 staining. Expect PAS+, CK+ and S100-, Melanin A -

19
Q

Embryonal Rhabdomyosarcoma

  • Presentation
  • Histology
  • How do these kill you?
A

Presentation:
- Vaginal Tumor (grapes) protruding from the vagina in a child under 5

Histology:

  • Cross-Striations (strap cells)
  • *- Desmin +, Myogenin +**

Death usually occurs as a result of local invasion and penetration in the peritoneal cavity or obstruction of the uninary tract

20
Q

Bowenoid Papulosis

  • what diseases is this a subtype of?
  • Presentation
A

Bowenoid Papulosis
- Subtype of VIN

Presentation:
- single or multiple small, red, brown, or flesh colored spots on the genitals (HPV associated)

21
Q

You see subepithelial glands on a biopsy of the Vulva.

  • what is this pathology called?
  • what agent is known to cause this pathology?
A

Pathology:
- Vaginal Adenosis

Cause:
- Children born of mothers who took DES

22
Q

Vaginal Clear Cell Adenocarcinoma

  • Histology
  • What chemical can cause this in rare cases
A

Histology:
Malignant Proliferation of glands with clear cytoplasm

Cause:
DES exppsoure

23
Q

Where in the cervix are you most likely to see cancer arise from HPV?

A

Transitional Zone is from Non-Keritonized Squamous Epithelium to Columnar Epithelium is the most common place for HPV to arise.

24
Q

What is the most important risk factor for cervical cancer?

A

HPV

25
Q

HPV 16 vs HPV 18

  • What potential types of Cervical Cancer can be caused by these two types?
  • Common way that Cervical Caricinoma presents?
A

2 Types:

  • *HPV 16** (60% of cervical CA)- associated with Squamous Caricinoma
  • *HPV 18** (10% of cervical CA) - can cause squamous but also has the potential to cause ADENOCARCINOMA

Presentation:
BOTH COMMONLY PRESENT WITH POST COIDAL DISCHARGE

26
Q

True or False: A large percentage of of HPV cause CIN that Progresses all the way to invasive cervical carcinoma.

A

False, only a small percentage progess to carcinoma

27
Q

What Cell Cycle checkpoint is compromised by HPV 16 and 18?
- how?

A

G1/S transition is made easier because:

  • circular viral genome inserts into our genome aberrently and E2 (the regulatory domain) loses function
  • E6 and E7 get constinuatively. E6 prevents P53 from activating P21, and 27.
  • E7 binds RB and RB lets go of EF2 which upregulates protein synthesis and G1/S transition

***Also P53 detects DNA damage, if it can’t be fixed then it triggers the mitochondrial death pathway (Bcl-2 => Bax/Bak dimerization => Cytochrome C leakage => Apaf-1 activation => caspases break down proteins)

28
Q

How do you grade Cervical Intraepithelial Neoplasia (CIN)?

A

1/3 Atypia = CIN 1

2/3 Atypia = CIN 2

almost full Atypia (but not fully) = CIN 3

*once you get to full Atypica its just carcinoma in situ

29
Q

Do you still need to get pap smears if you’ve had the HPV vaccine?

A

Yes, all of the subtypes are not covered by the vaccine

30
Q

Does a negative pap smear rule out cervical cancer?

A

NO, it only detects squamous cell carcinoma but remember that HPV 18 causes adenocarcinoma. This could still be present and go undetected in a pap smear

31
Q

What is the 2nd most common cervical neoplasia?
- what percentage of cases are associated with HPV?

A

Cervical Adenocarcinoma (15% of cases are associated with HPV18)

32
Q

What does cervical adenocarcinoma look like on histology?

A

Resembles NL endocervical glands but there is reduced mucin and increased chromatin

Reproductive Pathology (6 decks)

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