Female GU Pathology I: Vulva/Cervix/Vagina Flashcards
What is the exo/ectocervix made of?
Nonkeratinized Stratified Squamous Epithelium
What is the vaginal mucosa lined with?
Nonkeratinized Stratified Squamous Epithelium
What is the endocervix lined by?
Simple Columnar Epithelium
What is an inherent factor of the vagina that can encourage squamous metaplastic change?
Acidity of the vagina
Transformation Zone
Band of squamous metaplasia lying between the original SCJ and new SCJ
What happens to the cervix during puberty?
Eversion of the columnar epithelium occurs - normal physiologic response
What is the final step of squamous metaplasia?
Cells mature into glycogen-rich squamous cells
What is the site of cervical squamous carcinoma?
Transformation Zone
What does the PAP smear screen for?
Cervical Cancer
Wha tis Cervical Intraepithelial Neoplasia AKA?
Squamous Intraepithelial Lesion
What types of HPV has the highest risk for cancer?
HPV-16 and 18
How is HPV spread?
Sexual Intercourse
How do high risk HPVs lead to cancer?
Infection leads to HPV integration in the metaplastic squamous cells of the cervix which can lead to cancer
What are the functions of HPV oncoprotein, E6 and E7?
Bind to Rb and p53 and neutralize their function - inhibitor of tumor suppressors
What HPV type infection is condyloma found in?
HPV-6 and 11
Koilocyte
Nuclear enlargement with irregular nuclear membrane and hyperchromasia
When are koilocytes seen?
In low risk HPV-6 and 11 infection with condyloma formation
Nearly complete abnormal maturation of cells in cervix
CIN3
CIN1 is AKA
Low-grade Squamous Intraepithelial Lesion (SIL)
CIN2 and CIN3 are AKA
High-grade SIL
Where are cells from a PAP smear scraped from?
Transformation Zone
What types is the bivalent HPV vaccine made against?
HPV-16 and HPV-18
What is the majority of the invasive carcinoma of the cervix?
Most are SCCs
What is the key risk factory for invasive carcinoma of the cervix?
HPV Infection
How common is SCC of the vulva and vagina?
VERY uncommon
Lichen Sclerosis
Symptoms of pruritus, soreness, irritation with thinning of the epidermis and fibrosis of the dermis
What will be seen on physical exam of lichen sclerosis?
Leukoplakia on the vulva
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
B. Treponema pallidum
Condyloma lata = syphilis
Condyloma acuminata = HPV
Lichen Simplex Chronicus
Associated with chronic irritation and scratching that leads to hyperplasia of vulva epithelium
How does Lichen Simplex Chronicus present on physical exam?
Leukoplakia with thick leathery skin
Is there an increased risk of malignancy with Lichen Simplex Chronicus?
NO
What is the risk of progression from lichen sclerosis to cancer?
Small risk
Paget Disease of the Vulva
Intra‐epidermal proliferation of malignant cells that arises from intra-epidermal progenitor cells
How does Paget Disease of the Vulva present?
RED and scaly crusted plaque
How is Paget disease of the vulva distinguished from melanoma?
Melanoma is S100 positive
Paget disease is PAS positive
What disease is associated with diethylstilbestrol exposure in-utero?
Clear Cell Adenocarcinoma of the Vagina
What will be a physical finding of clear cell adenocarcinoma of the vagina?
Red, granular areas adjacent to normal pale pink vaginal mucosa
What is the origin of rhabdomyosarcoma?
Skeletal muscle
Who does rhabdomyosarcoma of the vagina typically occur in?
Children less than 5 yrs
How does rhabdomyosarcoma of the vagina present?
Bleeding, soft, grape‐like masses protruding through vagina
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
C. Lichen sclerosis
