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Q5 GNMD > Female genital tract lasku > Flashcards

Female genital tract lasku Flashcards

1
Q

how does HSV present initially ?

A

red painful papules that become vesicles and ulcers

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2
Q

clinical features of HSV

A

malaise, fever, inguinal LAO

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3
Q

how long does hsv outbreak take to heal

A

1-3 weeks

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4
Q

mycotic and candida infection clinical features

A

leukorrhea, pruritus, small white patches

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5
Q

risk factors for mycotic and candida infections

A

pregnancy, diabetes, oral contraceptives

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6
Q

Trichomonas vaginalis sx

A

purulent discharge
discomfort
strawberry cervix: red appearance

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7
Q

at what age does trichomonas vaginalis usually present

A

it can happen at any age
seen in 15% of women seen in STD clinics

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8
Q

Pelvic inflammatory disease(PID) definition

A

common disorder characterized by pelvic pain, adnexal tenderness, fever , and vaginal discharge

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9
Q

what is the most common etiology of PID

other etiologies

A

Chlamydia, gonococcus: most common

others: staph, strep, enteric bacteria, clostridia (After abortion)

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10
Q

morphology of PID

A

-Acute suppurative salpingitis: hyperemia of the tubal mucosa

-Salpingo-oophoritis: inflammation of the tubes and ovaries

-Hydrosalpinx: pus within a follicular salpingitis undergoes proteolysis : cavity filled with serous fluid: more serious

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11
Q

what are possible complications of PID

A

-Infertility
-ectopic pregnancy
- adhesions
-peritonitis

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12
Q

Papillary hidradenoma presentation

A
  • Sharply circumscribed nodule on the labia majora or interlabial folds with tendency to ulcerate
  • Benign tumor of gland
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13
Q

Condyloma acuminatum (LSIL) presentation

A

wartlike tumors that involve the perianal, vulvar, vagina and cervix

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14
Q

Condyloma acuminatum etiology

A

HPV 6,11 (not considered precacerous)

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15
Q

Are condyloma acuminatum lesions considered precancerous ?

A

no

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16
Q

Histology of Condyloma acuminatum (LSIL)

A

Koilocyte/ koilocytosis: dark, enlarged, and wrinkled nuclei with cytoplasmic perinuclear “vacuolization”

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17
Q

what usually causes vulvar carcinoma

A

stromal invasion

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18
Q

incidence and risk factors of vulvar carcinoma

A
  • rare: 3% of all female gential cancers
  • > 60years of age
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19
Q

Two pathways of vulvar carcinoma

A
  • HPV related:
    -younger women
    -associated with smoking
    -poorly differentiated(basaloid)
    -more aggressive
    -10-30% co-exist with squamous tumor in cervix or vagina
    -multicentric
  • Non-HPV:
    -older women
    -unicentric
    -well differentiated
    -associated with vulvar dystrophies(squamous cell hyperplasia, lichen sclerous)
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20
Q

What other type of cancer commonly co-exists with with vulvar carcinoma

A

10-30% of HPV related vulvar carcinomas co-exist with squamous tumor in cervix or vagina

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21
Q

What is the name of the precursor lesion associated with vaginal squamous cell carcinoma

A

VIN: vaginal intraepithelial neoplasia

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22
Q

Incidence of vaginal squamous cell carcinoma

A
  • Rare
  • Only 1% of malignant neoplasms in females
  • Associated with high risk HPV
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23
Q

Morphology in vaginal SCC

A

koilocytosis - hpv

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24
Q

Clinical features in vaginal SCC

A
  • Mostly asx , if sx present it will be:
  • leukoplakia
  • vaginal and rectal fistulas
  • plaque-like mass on** upper posterior vagina **
  • may invade cervix or metastasis to inguinal lymph nodes
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25
Q

Adenocarcinoma incidence

A

Younger women whose mothers had been treated with DES (diethylstilbestrol)

-rare

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26
Q

Where does an Adenocarcinoma present?

A

0.2-10 cm nodules in anterior wall of the vagina

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27
Q

Sarcoma botryoides clinical features

A
  • Polypoid, rounderd, bulky mass that projects out of the vagina
  • Can invade the peritoneal cavity or obstruct urinary tract
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28
Q

Sarcoma botryoides morphology

A

Strap cells: small blue round cells that tend to cluster beneath the mucosal surface

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29
Q

Sarcoma botryoides incidence

A

common in infants or children younger than 5y/r old

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30
Q

How would the cervix present in acute cervicitis

A
  • Glossy red, swollen, w/pus
  • Inflammatory cells: Neutrophils, erosion, reactive and reparative epithelial change
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31
Q

How would the cervix present in chronic cervicitis

A
  • Hyperemia with erosions
  • Inflammation with lymphocytes, macrophages, plasma cells
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32
Q

which is more common, chronic or acute cervicitis

A

chronic cervicitis is more common

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33
Q

Nabothian cysts

A

Cystic formation caused by the closure of the ducts of the nabothian glands in the cervix uteri

  • A result of the healing of an erosion
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34
Q

Cervical polyps : clinical features

A

-Small to large protruding mass in the cervix
-SX:Irregular vaginal spotting or bleeding

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35
Q

Cervical intraepithelial neoplasia grading

A

LSIL: low grade squamous
CN1= mild dysplasia

HSIL: high grade :
CN2= moderate
CIN 3= severe = carcinoma in situ

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36
Q

Etiology of Cervical carcinoma

A

-HPV: 85%
- E6 (types 16,18): accelerates p53 degradation
-E7: bind to retinoblastoma and displaces the transcription factors

75% are squamous cell carcionomas and the rest are adenocarcinomas

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37
Q

Risk factors of Cervical intraepithelial neoplasia (CIN)

A
  • Early age of first intercourse
  • Multiple sexual partners
  • Male partner with multiple previous partners
  • Oral contraceptives
  • fhx
  • Genital infections
  • Cigarette smoking
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38
Q

SX of Cervical intraepithelial neoplasia (CIN)

A

-condylomata acuminatum: genital warts

-white plaque

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39
Q

Morphology of Cervical intraepithelial neoplasia (CIN)

A

koilocytotic atypia

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40
Q

Squamous cell carcinoma of the cervix incidence

A

peak incidence: 40-50years old

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41
Q

Squamous cell carcinoma of the cervix etiology

A

75% are scc and the rest are adenocarcinomas

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42
Q

sx of Squamous cell carcinoma of the cervix

A

-fungating, ulcerating and inflitrave cancer
-white patches in the cervix
-irregular vaginal bleeding
-leukorrhea
-bleeding or pain on coitus
-dysuria

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43
Q

Squamous cell carcinoma of the cervix prognosis

A

5 year survival in 80-90% with I

10-15% with stage IV

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44
Q

What is the #1 most common spread of endometriosis

A

ovaries

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45
Q

Endometriosis cases theories

A
  1. regurgitation theory: retrograde menstruation spreads endometrial tissue to the peritoneal cavity
  2. metaplastic theory: endometrium arises from coelomic epithelium
  3. vascular or lymphatic theory: explains presence of endometrium in th elungs or lymph nodes
46
Q

s&s of endometriosis

A

-severe dysmenorrhea
-dyspareunia
-pelvic pain
-dysuria

47
Q

Endometriosis morphology

A

-red-blue to yellow-brown nodules
-chocolate cysts of ovaries: large cystic areas 3-5cm filled with brown blood debris

48
Q

endometriosis complications

A

infertility :30-40%

49
Q

Endometrial polyps

A

sessile masses from 0.5-3cm that project into the endometrial cavity

composed of functional endometrium or hyperplastic endometrium

50
Q

endometrial polyps sx

A

asymptomatic or cause uterine bleeding

51
Q

Endometrial hyperplasia

A

hyperplasia of endometrial glands relative to stroma as a consequence of unopposed estrogen

52
Q

what is the most important predictor for progression to endometrial carcinoma

A

endometrial hyperplasia

53
Q

Etiology of endometrial hyperplasia

A

-prolonged high levels of estrogen
-persistent anovulation in young women
-pcos
-functioning granulose cell tumors of the ovary
-estrogenic substances

54
Q

morphology of endometrial hyperplasia

A

cystic, adenomatous, or adenomatous hyperplasia with atypia

55
Q

sx of endometrial hyperplasia

A

abnormal bleeding

56
Q

incidence of carcinoma of the endometrium

A

-7% of all cancers
-post-menopausal women

57
Q

in carcinoma of the endometrium, how many are scc vs adenocarcinoma

A

85% are adenocarcinomas

58
Q

pathogenesis of endometrial carcinoma

A

-obesity: androgens turn to estrogen, endometrial hyperplasia, cancer
-diabetes
-HTN
-infertility
-breast cancer

59
Q

morphology of endometrial carcinoma

A

-polypoid or diffuse growth invading myometrium
periuterine structures
spreads to lymph nodes, lungs, liver, bones, etc

60
Q

s&s of endometrial carcinoma

A

-irregular vaginal bleeding
-excessive leukorrhea

61
Q

would endometrial carcinoma be diagnosed with a pap smear?

A

no, pap smear would be negative bc its in the endometrium not the cervix

62
Q

prognosis of endometrial carcinoma

A

90% 5 year survival in stage 1

3-50% in stage II

63
Q

Fibroids aka leiomyomas incidence

A

tumor of myometrium

most common tumor in females

64
Q

role of estrogen in leiomyomas

A

estrogen responsive:
-regress after menopasuse
-grow rapidly during pregannacy

65
Q

morphology of leiomyomas

A

-bundles of smooth muscle
-sharply circumscribed, round, firm, gray-white tumors from small to massive

66
Q

sx of leiomyomas

A

usually asx: when present, sx include

abnormal bleeding
urinary frequency
pain during menstruation
impaired fertility

malignant transformation rarely occurs but if it does, it causes leiomyosarcomas

67
Q

what is the most common cancer of the ovary

A

serous cystadenocarcinoma

68
Q

morphology of serous tumors of surface epithelium

A

lined by columnar, ciliated epithelial cells and filled with clear serous fluid
psammoma bodies

69
Q

how are serous cystadenocarcinoma spread

A

spread by seeding

70
Q

are serous tumors of surface epithelium more bilateral or unilateral

A

mor bilateral

71
Q

mucinous tumors of surface epithelial

A

large cystic masses of multiloculated tumors filled with sticky, gelatinous fluid rich in glycoproteins

72
Q

morphology of mucinous tumors of surface epithelial

A

-lack psammoma bodies
-endocervix-like or interine -like lining cells

73
Q

incidence of mucinous adenocarcinomas

A

second most common ovarian cancer

74
Q

surface epithelial cell tumors

A

-serous tumor
-mucinous tumor
-endometrioid tumor
-clear cell tumor
-brenner tumor
-cystadenofibroma

75
Q

germ cell tumors

A

-teratoma
-dysgerminoma
-yolk sac tumor
-choriocarcinoma

76
Q

sex cord stroma tumors

A

-fibroma
-granulosa-theca
-fibrothecoma
-sertoli-leydig

77
Q

metastatic tumor of the ovaries

A

krukenberg tumor

78
Q

struma ovarii

A

tumor composed of mature thyroid tissue may cause hyperthyroidism

79
Q

carcinoid tumor of the ovaries

A

produces 5-HTP (Serotonin) and induces carcinoid syndrome : flushes face, inc BP, damages valves of R heart

80
Q

immature malignant teratomas

A

bulky solid tumors with areas of necrosis, hemorrhage, and immature tissue differentiation towards cartilage,, glands, bone, muscles, etc

-excellent prognosis

81
Q

Dysgerminomas : prognosis and bilateral or uni?

A

malignant and usually unilateral
-extremely radiosensitive

82
Q

morphology of dysgerminomas

A

solid large masses composed of large vesicular cells with clear cytoplasm and round nuclei (resemble oocyte)

83
Q

what hormome can dysgerminomas produce

A

HCG

84
Q

Yolk sac tumor morphology

A

rare, solid mass composed of glomerulus like structures (shiller-duval bodies)

85
Q

yolk sac tumor markers

A

AFP(alpha fetoprotein)

a1-antitrypsin (enzyme produced by the liver to break down elastase)

86
Q

yolk sac tumor incidence

A

children or young women with abdominal pain and mass

87
Q

Choriocarcinoma

A

derives from the extraembryonic differentiation of malignant germ cells: placenta like structures

88
Q

do choriocarcinomas metastasize?

A

they metastasize to the lungs, liver, bone and viscera by the time of dx

89
Q

what hormone is produced by choriocarcinomas?

A

HCG

90
Q

which ovarian tumors can produce HCG ?

A

choriocarcinoma and dysgerminoma

both germ cell ovarian tumors

91
Q

Granulosa-theca cell tumors incidence and definiton

A

any age, unilateral
solid or cystic encapsulated masses composed of granulosa cells or mixed with theca cells

92
Q

what is the characteristic increased hormone in granulosa-theca cell tumor

A

large amounts of estrogen

93
Q

can granulosa-theca cell tumor become malignant

A

yes it can

94
Q

clinical features/complications of granulosa-theca cell tumor

A

may induce precocious sexual development, endometrial hyperplasia with bleeding from the uterus or vagina, cystic disease of the breast, and endometrial carcinoma

95
Q

Fibrothecoma thecoma-fibroma

A

unilateral, solid, lobulated, encapsulated masses covered by ovarian serosa

96
Q

morphology of fibrothecoma

A

composed of fibroblasts and spindle cells with lipid droplets (thecomas) which produce estrogen

97
Q

sx of fibrothecoma

A

pain and pelvic mass, ascites(40%), hydrothorax(right side)

98
Q

what syndrome is fibrothecoma associated with

A

meigs syndrome: ovarian tumor, hydrothorax and ascites

99
Q

Sertoli-leydig cell tumors (Androblastomas)

A

solid, unilateral, large tumors composed of well-differentiated sertoli and leydig cells tubules

100
Q

what do Sertoli-leydig cell tumors (Androblastomas) produce?

A

androgens and some are malignant

101
Q

sx of Sertoli-leydig cell tumors (Androblastomas)

A

induce masculinization : atrophy of the breast, amenorrhea, sterility, loss of hair, hirtuism, virulism, voice change

102
Q

morphology of Sertoli-leydig cell tumors (Androblastomas)

A

crystal of reinke are diagnostic

103
Q

Vaginal pruritus ddx

A

mycotic and candida infections
lichen sclerosis

104
Q

bleeding between periods (Metrorrhagia) ddx

A

cervical polyps
endometrial polyps
squamous cell carcinoma of cervix
endometrial hyperplasia
carcinoma of endometrium
fibroids (leiomyomas)

105
Q

squamous cell carnoma of the female gential tract by incidence percentages

A

vulva 90%
vagina 95%
cervix 75%

106
Q

two types of adenocarcinoma of the female genital tract

A

vaginal adenocarcinoma (from DES )
endometrium (85%)

107
Q

HPV 16 and 18 incidence

A

90% of precancerous conditions
85% of cervical carcinoma
most VIN and vaginal SCC
90% of vulvar carcinoma

108
Q

most common cancer of the ovary

A

serous cystadenocarcinoma

109
Q

second msot common cancer of the ovaries

A

mucinous adenocarcinoma

110
Q

most common tumor of the female genital tract

A

fibroid aka leiomyoma

Q5 GNMD (15 decks)

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