Female GU Pathology I: Vulva/Cervix/Vagina

Question 1

What is the exo/ectocervix made of?

Answer 1

Nonkeratinized Stratified Squamous Epithelium

Question 2

What is the vaginal mucosa lined with?

Answer 2

Nonkeratinized Stratified Squamous Epithelium

Question 3

What is the endocervix lined by?

Answer 3

Simple Columnar Epithelium

Question 4

What is an inherent factor of the vagina that can encourage squamous metaplastic change?

Answer 4

Acidity of the vagina

Question 5

Transformation Zone

Answer 5

Band of squamous metaplasia lying between the original SCJ and new SCJ

Question 6

What happens to the cervix during puberty?

Answer 6

Eversion of the columnar epithelium occurs - normal physiologic response

Question 7

What is the final step of squamous metaplasia?

Answer 7

Cells mature into glycogen-rich squamous cells

Question 8

What is the site of cervical squamous carcinoma?

Answer 8

Transformation Zone

Question 9

What does the PAP smear screen for?

Answer 9

Cervical Cancer

Question 10

Wha tis Cervical Intraepithelial Neoplasia AKA?

Answer 10

Squamous Intraepithelial Lesion

Question 11

What types of HPV has the highest risk for cancer?

Answer 11

HPV-16 and 18

Question 12

How is HPV spread?

Answer 12

Sexual Intercourse

Question 13

How do high risk HPVs lead to cancer?

Answer 13

Infection leads to HPV integration in the metaplastic squamous cells of the cervix which can lead to cancer

Question 14

What are the functions of HPV oncoprotein, E6 and E7?

Answer 14

Bind to Rb and p53 and neutralize their function - inhibitor of tumor suppressors

Question 15

What HPV type infection is condyloma found in?

Answer 15

HPV-6 and 11

Question 16

Koilocyte

Answer 16

Nuclear enlargement with irregular nuclear membrane and hyperchromasia

Question 17

When are koilocytes seen?

Answer 17

In low risk HPV-6 and 11 infection with condyloma formation

Question 18

Nearly complete abnormal maturation of cells in cervix

Answer 18

CIN3

Question 19

CIN1 is AKA

Answer 19

Low-grade Squamous Intraepithelial Lesion (SIL)

Question 20

CIN2 and CIN3 are AKA

Answer 20

High-grade SIL

Question 21

Where are cells from a PAP smear scraped from?

Answer 21

Transformation Zone

Question 22

What types is the bivalent HPV vaccine made against?

Answer 22

HPV-16 and HPV-18

Question 23

What is the majority of the invasive carcinoma of the cervix?

Answer 23

Most are SCCs

Question 24

What is the key risk factory for invasive carcinoma of the cervix?

Answer 24

HPV Infection

Question 25

How common is SCC of the vulva and vagina?

Answer 25

VERY uncommon

Question 26

Lichen Sclerosis

Answer 26

Symptoms of pruritus, soreness, irritation with thinning of the epidermis and fibrosis of the dermis

Question 27

What will be seen on physical exam of lichen sclerosis?

Answer 27

Leukoplakia on the vulva

Question 28

A 23‐year old woman presents multiple vulvar lesions depicted in the image. The lesions are flat, moist, and minimally elevated. The physician believes the lesions represent condylomata lata. If the diagnosis is correct, which of the following is the etiologic agent? A. HPV 31 or 33 B. Treponema pallidum C. Chlamydia trachomatis D. Neisseria gonorrhea

Answer 28

B. Treponema pallidum Condyloma lata = syphilis Condyloma acuminata = HPV

Question 29

Lichen Simplex Chronicus

Answer 29

Associated with chronic irritation and scratching that leads to hyperplasia of vulva epithelium

Question 30

How does Lichen Simplex Chronicus present on physical exam?

Answer 30

Leukoplakia with thick leathery skin

Question 31

Is there an increased risk of malignancy with Lichen Simplex Chronicus?

Answer 31

NO

Question 32

What is the risk of progression from lichen sclerosis to cancer?

Answer 32

Small risk

Question 33

Paget Disease of the Vulva

Answer 33

Intra‐epidermal proliferation of malignant cells that arises from intra-epidermal progenitor cells

Question 34

How does Paget Disease of the Vulva present?

Answer 34

RED and scaly crusted plaque

Question 35

How is Paget disease of the vulva distinguished from melanoma?

Answer 35

Melanoma is S100 positive | Paget disease is PAS positive

Question 36

What disease is associated with diethylstilbestrol exposure in-utero?

Answer 36

Clear Cell Adenocarcinoma of the Vagina

Question 37

What will be a physical finding of clear cell adenocarcinoma of the vagina?

Answer 37

Red, granular areas adjacent to normal pale pink vaginal mucosa

Question 38

What is the origin of rhabdomyosarcoma?

Answer 38

Skeletal muscle

Question 39

Who does rhabdomyosarcoma of the vagina typically occur in?

Answer 39

Children less than 5 yrs

Question 40

How does rhabdomyosarcoma of the vagina present?

Answer 40

Bleeding, soft, grape‐like masses protruding through vagina

Question 41

A 68‐year‐old woman has had itching with irritation of the vulvar region for the past 6 months. On physical examination she has pale grey patches measuring 1 to 2 cm in size on the vulva. Biopsy of one lesion is performed and on microscopic examination shows epithelial thinning, dermal fibrosis, and perivascular chronic inflammation. Which of the following is the most likely diagnosis? ``` A. Extramammary Paget Disease B. Condyloma acuminatum C. Lichen sclerosis D. Lichen simplex chronicus E. Squamous cell carcinoma ```

Answer 41

C. Lichen sclerosis