Female genital tract lasku Flashcards
how does HSV present initially ?
red painful papules that become vesicles and ulcers
clinical features of HSV
malaise, fever, inguinal LAO
how long does hsv outbreak take to heal
1-3 weeks
mycotic and candida infection clinical features
leukorrhea, pruritus, small white patches
risk factors for mycotic and candida infections
pregnancy, diabetes, oral contraceptives
Trichomonas vaginalis sx
purulent discharge
discomfort
strawberry cervix: red appearance
at what age does trichomonas vaginalis usually present
it can happen at any age
seen in 15% of women seen in STD clinics
Pelvic inflammatory disease(PID) definition
common disorder characterized by pelvic pain, adnexal tenderness, fever , and vaginal discharge
what is the most common etiology of PID
other etiologies
Chlamydia, gonococcus: most common
others: staph, strep, enteric bacteria, clostridia (After abortion)
morphology of PID
-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
what are possible complications of PID
-Infertility
-ectopic pregnancy
- adhesions
-peritonitis
Papillary hidradenoma presentation
- Sharply circumscribed nodule on the labia majora or interlabial folds with tendency to ulcerate
- Benign tumor of gland
Condyloma acuminatum (LSIL) presentation
wartlike tumors that involve the perianal, vulvar, vagina and cervix
Condyloma acuminatum etiology
HPV 6,11 (not considered precacerous)
Are condyloma acuminatum lesions considered precancerous ?
no
Histology of Condyloma acuminatum (LSIL)
Koilocyte/ koilocytosis: dark, enlarged, and wrinkled nuclei with cytoplasmic perinuclear “vacuolization”
what usually causes vulvar carcinoma
stromal invasion
incidence and risk factors of vulvar carcinoma
- rare: 3% of all female gential cancers
- > 60years of age
Two pathways of vulvar carcinoma
-
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)
What other type of cancer commonly co-exists with with vulvar carcinoma
10-30% of HPV related vulvar carcinomas co-exist with squamous tumor in cervix or vagina
What is the name of the precursor lesion associated with vaginal squamous cell carcinoma
VIN: vaginal intraepithelial neoplasia
Incidence of vaginal squamous cell carcinoma
- Rare
- Only 1% of malignant neoplasms in females
- Associated with high risk HPV
Morphology in vaginal SCC
koilocytosis - hpv
Clinical features in vaginal SCC
- 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
Adenocarcinoma incidence
Younger women whose mothers had been treated with DES (diethylstilbestrol)
-rare
Where does an Adenocarcinoma present?
0.2-10 cm nodules in anterior wall of the vagina
Sarcoma botryoides clinical features
- Polypoid, rounderd, bulky mass that projects out of the vagina
- Can invade the peritoneal cavity or obstruct urinary tract
Sarcoma botryoides morphology
Strap cells: small blue round cells that tend to cluster beneath the mucosal surface
Sarcoma botryoides incidence
common in infants or children younger than 5y/r old
How would the cervix present in acute cervicitis
- Glossy red, swollen, w/pus
- Inflammatory cells: Neutrophils, erosion, reactive and reparative epithelial change
How would the cervix present in chronic cervicitis
- Hyperemia with erosions
- Inflammation with lymphocytes, macrophages, plasma cells
which is more common, chronic or acute cervicitis
chronic cervicitis is more common
Nabothian cysts
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
Cervical polyps : clinical features
-Small to large protruding mass in the cervix
-SX:Irregular vaginal spotting or bleeding
Cervical intraepithelial neoplasia grading
LSIL: low grade squamous
CN1= mild dysplasia
HSIL: high grade :
CN2= moderate
CIN 3= severe = carcinoma in situ
Etiology of Cervical carcinoma
-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
Risk factors of Cervical intraepithelial neoplasia (CIN)
- Early age of first intercourse
- Multiple sexual partners
- Male partner with multiple previous partners
- Oral contraceptives
- fhx
- Genital infections
- Cigarette smoking
SX of Cervical intraepithelial neoplasia (CIN)
-condylomata acuminatum: genital warts
-white plaque
Morphology of Cervical intraepithelial neoplasia (CIN)
koilocytotic atypia
Squamous cell carcinoma of the cervix incidence
peak incidence: 40-50years old
Squamous cell carcinoma of the cervix etiology
75% are scc and the rest are adenocarcinomas
sx of Squamous cell carcinoma of the cervix
-fungating, ulcerating and inflitrave cancer
-white patches in the cervix
-irregular vaginal bleeding
-leukorrhea
-bleeding or pain on coitus
-dysuria
Squamous cell carcinoma of the cervix prognosis
5 year survival in 80-90% with I
10-15% with stage IV
What is the #1 most common spread of endometriosis
ovaries
Endometriosis cases theories
- regurgitation theory: retrograde menstruation spreads endometrial tissue to the peritoneal cavity
- metaplastic theory: endometrium arises from coelomic epithelium
- vascular or lymphatic theory: explains presence of endometrium in th elungs or lymph nodes
s&s of endometriosis
-severe dysmenorrhea
-dyspareunia
-pelvic pain
-dysuria
Endometriosis morphology
-red-blue to yellow-brown nodules
-chocolate cysts of ovaries: large cystic areas 3-5cm filled with brown blood debris
endometriosis complications
infertility :30-40%
Endometrial polyps
sessile masses from 0.5-3cm that project into the endometrial cavity
composed of functional endometrium or hyperplastic endometrium
endometrial polyps sx
asymptomatic or cause uterine bleeding
Endometrial hyperplasia
hyperplasia of endometrial glands relative to stroma as a consequence of unopposed estrogen
what is the most important predictor for progression to endometrial carcinoma
endometrial hyperplasia
Etiology of endometrial hyperplasia
-prolonged high levels of estrogen
-persistent anovulation in young women
-pcos
-functioning granulose cell tumors of the ovary
-estrogenic substances
morphology of endometrial hyperplasia
cystic, adenomatous, or adenomatous hyperplasia with atypia
sx of endometrial hyperplasia
abnormal bleeding
incidence of carcinoma of the endometrium
-7% of all cancers
-post-menopausal women
in carcinoma of the endometrium, how many are scc vs adenocarcinoma
85% are adenocarcinomas
pathogenesis of endometrial carcinoma
-obesity: androgens turn to estrogen, endometrial hyperplasia, cancer
-diabetes
-HTN
-infertility
-breast cancer
morphology of endometrial carcinoma
-polypoid or diffuse growth invading myometrium
periuterine structures
spreads to lymph nodes, lungs, liver, bones, etc
s&s of endometrial carcinoma
-irregular vaginal bleeding
-excessive leukorrhea
would endometrial carcinoma be diagnosed with a pap smear?
no, pap smear would be negative bc its in the endometrium not the cervix
prognosis of endometrial carcinoma
90% 5 year survival in stage 1
3-50% in stage II
Fibroids aka leiomyomas incidence
tumor of myometrium
most common tumor in females
role of estrogen in leiomyomas
estrogen responsive:
-regress after menopasuse
-grow rapidly during pregannacy
morphology of leiomyomas
-bundles of smooth muscle
-sharply circumscribed, round, firm, gray-white tumors from small to massive
sx of leiomyomas
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
what is the most common cancer of the ovary
serous cystadenocarcinoma
morphology of serous tumors of surface epithelium
lined by columnar, ciliated epithelial cells and filled with clear serous fluid
psammoma bodies
how are serous cystadenocarcinoma spread
spread by seeding
are serous tumors of surface epithelium more bilateral or unilateral
mor bilateral
mucinous tumors of surface epithelial
large cystic masses of multiloculated tumors filled with sticky, gelatinous fluid rich in glycoproteins
morphology of mucinous tumors of surface epithelial
-lack psammoma bodies
-endocervix-like or interine -like lining cells
incidence of mucinous adenocarcinomas
second most common ovarian cancer
surface epithelial cell tumors
-serous tumor
-mucinous tumor
-endometrioid tumor
-clear cell tumor
-brenner tumor
-cystadenofibroma
germ cell tumors
-teratoma
-dysgerminoma
-yolk sac tumor
-choriocarcinoma
sex cord stroma tumors
-fibroma
-granulosa-theca
-fibrothecoma
-sertoli-leydig
metastatic tumor of the ovaries
krukenberg tumor
struma ovarii
tumor composed of mature thyroid tissue may cause hyperthyroidism
carcinoid tumor of the ovaries
produces 5-HTP (Serotonin) and induces carcinoid syndrome : flushes face, inc BP, damages valves of R heart
immature malignant teratomas
bulky solid tumors with areas of necrosis, hemorrhage, and immature tissue differentiation towards cartilage,, glands, bone, muscles, etc
-excellent prognosis
Dysgerminomas : prognosis and bilateral or uni?
malignant and usually unilateral
-extremely radiosensitive
morphology of dysgerminomas
solid large masses composed of large vesicular cells with clear cytoplasm and round nuclei (resemble oocyte)
what hormome can dysgerminomas produce
HCG
Yolk sac tumor morphology
rare, solid mass composed of glomerulus like structures (shiller-duval bodies)
yolk sac tumor markers
AFP(alpha fetoprotein)
a1-antitrypsin (enzyme produced by the liver to break down elastase)
yolk sac tumor incidence
children or young women with abdominal pain and mass
Choriocarcinoma
derives from the extraembryonic differentiation of malignant germ cells: placenta like structures
do choriocarcinomas metastasize?
they metastasize to the lungs, liver, bone and viscera by the time of dx
what hormone is produced by choriocarcinomas?
HCG
which ovarian tumors can produce HCG ?
choriocarcinoma and dysgerminoma
both germ cell ovarian tumors
Granulosa-theca cell tumors incidence and definiton
any age, unilateral
solid or cystic encapsulated masses composed of granulosa cells or mixed with theca cells
what is the characteristic increased hormone in granulosa-theca cell tumor
large amounts of estrogen
can granulosa-theca cell tumor become malignant
yes it can
clinical features/complications of granulosa-theca cell tumor
may induce precocious sexual development, endometrial hyperplasia with bleeding from the uterus or vagina, cystic disease of the breast, and endometrial carcinoma
Fibrothecoma thecoma-fibroma
unilateral, solid, lobulated, encapsulated masses covered by ovarian serosa
morphology of fibrothecoma
composed of fibroblasts and spindle cells with lipid droplets (thecomas) which produce estrogen
sx of fibrothecoma
pain and pelvic mass, ascites(40%), hydrothorax(right side)
what syndrome is fibrothecoma associated with
meigs syndrome: ovarian tumor, hydrothorax and ascites
Sertoli-leydig cell tumors (Androblastomas)
solid, unilateral, large tumors composed of well-differentiated sertoli and leydig cells tubules
what do Sertoli-leydig cell tumors (Androblastomas) produce?
androgens and some are malignant
sx of Sertoli-leydig cell tumors (Androblastomas)
induce masculinization : atrophy of the breast, amenorrhea, sterility, loss of hair, hirtuism, virulism, voice change
morphology of Sertoli-leydig cell tumors (Androblastomas)
crystal of reinke are diagnostic
Vaginal pruritus ddx
mycotic and candida infections
lichen sclerosis
bleeding between periods (Metrorrhagia) ddx
cervical polyps
endometrial polyps
squamous cell carcinoma of cervix
endometrial hyperplasia
carcinoma of endometrium
fibroids (leiomyomas)
squamous cell carnoma of the female gential tract by incidence percentages
vulva 90%
vagina 95%
cervix 75%
two types of adenocarcinoma of the female genital tract
vaginal adenocarcinoma (from DES )
endometrium (85%)
HPV 16 and 18 incidence
90% of precancerous conditions
85% of cervical carcinoma
most VIN and vaginal SCC
90% of vulvar carcinoma
most common cancer of the ovary
serous cystadenocarcinoma
second msot common cancer of the ovaries
mucinous adenocarcinoma
most common tumor of the female genital tract
fibroid aka leiomyoma
