Female Reproductive Tract Pathology Dr. Hillard Flashcards
The skene glands and the bartholin glands
Skene = adjacent to urethra
Bartholian = posterior to vaginal orifice
(Secrete sexual fluids)
Cervix transformaion zone
Squamous mucosa to columnar mucosa
Germ cells forming uterus
Migrate from yolk sac to genital ridge = gonads
Gonads (2 ducts that are made?) become male or female how
Mullerian (paramesonephric) ——> MALE from SRY gene
Wolffian Duct (Mesonephric) ——> FEMALE from estogen
= no SRY gene —-> Ovary from the gonads
= Estrogen —-> female reproductive tract
Urogenital sinus becomes
Lower part of vagina close to cervix
Uterine Didelphys is what and casued by, assoicated with
2 uterus and 2 cervix made, 2 vagina cavities (septum)
= X fusion of mullarian ducts during development
= associated with kidney problems also
Mayer Rokitnsky Kuster Hauser Syndrome is what and cuased by
SX
= NO uterus and NO vagina
= Mullerian agenesis
= amenorrhea, normal breasts, normal pubic hair, normal vulvar development
Mullerian duct makes up
Fallopian tube, uterus, upper 1/3 vagina
Bartholin cyst
From obstruction of duct
= Cyst is nontender, unilateral**, soft mass, posterior to vaginal opening
= When infected —-> warm, tender, pussy, Cellulitis around
Lichen Sclerosis
Is caused by and who
Sx
Risk of what
Activated T-cell inflammation disorder, (effects vulva and genital skin)
= post-menopause usually
= Pruritis, dyspareunia, dysuria, White Plaques*
= TP53 keratinizing SSC
Lichen Sclerosis Histology
Thinning atrophy, edematous band lymphocytic infiltrate, hyperkeratosis
Lichen Simplex Chronicus
- Is what
- Cuased by
- SX + location
- Associated with 3 things
- Squamous cell Hyperplasia
- Chronic rubbin or scratiching
- Thickened (acanthosis), reddened surface —> can whiten over time + on vulva
- Dermatitis, psoriasis, lichen sclerosis, SCC
Histology of Condylomata Acuminata
HPV warts on genitals and anus
= Papillary projections
= superficial parakeratosis
= Koilocyte nuclei with Halo (from HPV proteins)
Vulvar Carcinoma
- Most common type , age
- 2 categories and comes from
- SCC , after 60yo
- Basaliod/warty SCC, Keratinizing SCC (both from precursor lesion Vulvar Intraepithelial Neoplasia (VIN) = immune system tried to keep it from becoming invasive
Basaloid / Warty SCC
- Age
- Precursor lesion
- Risk
- 60yo
- Classic VIN (vulvar High squamous intraepithelial lesion)
- High risk HPV (16, 18)
Keratinizing SCC
- Age
- Precursor lesion
- Risk
- 75yo
- Differentiated VIN
- Chronic irritation (long standing) Lichen Sclerosis or Squamous Cell Hyperplasia
SCC associated with what 2 things
- P53
2. Chronic itching and irritation
Histology of classic VIN
Full thickness atypia with clear mito tic figures, progressing to invasive basoloid SCC or invasive warty SCC
Differentiated VIN histology
Basal and parabasal atypia, ancanthosis, can lead do Keratinizing SCC
Papillary Hidradenoma
- What is it
- Histo
- Arise from
Benign
- Solid, dermal or subQ nodule
- Columnar myoepithelial + apocrine (sweat glands)
- Mammary type glands on the primitive milk line
Papillary Hidradenoma of the breast is called
Intraductal papilloma
Extramammary Pagets Disease (EMPD)
- Is what
- Histo
- SX
- Risk of
- Intraepithelial adenocarcinoma (vulvar and Ano/genital region)
- Sweat glands (apocrine + eccrine) + Keratinocytes,
- Pruritic, red/white crusted lesions, ill defined
- Synchronous noncontiguous carcinoma (can take long time)
Gartner duct cysts are from what and who , location , sx
= Wolffian (Mesonephric) remanants (cuboidal to low columnar)
= Reproductive age women
= Anterior lateral wall of vagina (can protrude out)
= asymptomatic (painful intercourses or vaginal pressure)
Mullerian Cysts are from what, who, location, sx
= Mullerian (paramesonephric) remanants (any epithelium, endocervial usually)
= Reproductive age women
= Anterior lateral wall of vagina (can protrude out)
= asymptomatic (painful intercourses or vaginal pressure)
Diethylstilbestrol (DES) Exposure
Disrupts vaginal epithelium causing clear cell adenocarcinoma = vaginal adenosis (glandular change) (transoplacental carcinogen affecting the daughters of pregnant women taking this)
Vaginal Embryonal Rhabdomyosarcoma (Sarcoma Botryoides)
- Who
- Looks like
- Complication
- Histo cell
- young to infant F, under 5yo
- Protruding bulky polypoid, grape like mass, bloody discharge
- Invasion causing death = bladder obstruction / peritoneal cavity invasion
- Embryonal rhabdomyoblasts (Cambium layer)(elongated eosinophilic cells**)
Vaginal SCC is similar to what other SCC
- Starts how
- From what
- Spreads to what
- Premalignant lesion vaginal intraepithelial neoplasm (VAIN)
- HPV type 16, 18
- (Lower 2/3 vagina = inguinal and femoral LNs), (Upper 1/3 vagina = iliac LNs —-> periaortic LNs)
High risk HPV types and does what
16 MOST , and 18, causes almost ALL of cervical + vaginal carcinomas
How does HPV cause carcinoma
Enters body making E6 = INCREASE telomerase, degrade p53
+ E7 = drives proliferation INactivating p21 and RB binding —-> E2F into cell cycle
Telomerase increased —> immortality
Mild dysplasia
Moderate dysplasia
Severe dysplasia
Carcinoma in situ
(SIL grade and CIN type)
- Mild dysplasia = LSIL (low grade squamous Intraepithelial lesion)
- Moderate dysplasia = HSIL (high grade squamous Intraepithelial lesion)
- Severe dysplasia = HSIL
- Carcinoma in situ = HSIL
HSIL and LSIL tx
LSIL = observe and monitor HSIL = Excise
- HSIL and LSIL that are HPV +
2. HSILs progression to carcinoma
- 80% LSILs + all HSILs
2. 10% progress (LSILs 60% regression , 10% progression to HSIL)
Ectocervical
Endocervical mucosa cell type
Ectocervical = stratified squamous mucosa
Endocervical = cuboidal mucosa
(Transition zone between them)
HPV happens in what layer of the cervix
Basal layer
LSILs histology looks like
Lower part of epithelium layer is not maturing normally
Upper part has koilocytes
CIN 2 histology HSIL
CIN 3 histology HSIL
- Middle 3rd of epithelium layer shows atypia
2. Entire epithelium is atypical , identifiable mitosis figures
Pap smear does what
Gets cells from top layer of epithelium
LSIL = see koilocytes
HSILs = dysplastic cells + basal cells
PAP test guidelines
21- 29yo, every 3 years if no abnormality
30-65yo, every 5 years + molecular testing if normal
Pap test after 65 is not needed when
If - test past 3 times (15 years) and - molecular test past 10 years
Colposcopy is done how and for what
Biopsy taken of lesion
1. Acetic acid applied (precipitation/ coagulation of proteins)
2. Turns white if dysplasia (acetowhite) CIN2,CIN3 = coarse punctation
CIN1 = faint punctation
3. TYPICAL BVs can be seen in acetowhite areas
HSILS TX how
- Cervical conization ( cutting cone shaped cervix off)
2. LEEP (Loop electro surgical excision) (electric current in wire cuts tissue)
HPV dysplasia if not TX becomes
- SCC ** (transition zone) 80%
- Or invasive adenocarcinoma in situ —-> cervical adenocarcinoma (if effecting cervical endocervical mucosa) atypical glandular cells, 15%
- Cervical carcinoma age average
- Age to take Gardasil (which protects from what strains)
- Males take it to protect from
- 45-50yo
- 11-12yo, low and high risk strains
- Penile, anal, oral pharyngeal carcinoma
Endocervical Polyps
- Are what and what age
- Sx
- Tx
- Histology
- Benign lesions during reproductive years after 40yo
- Spotting or bleeding
- Polypectomy = curative
- Endocervial glands , fibrovsuclar core,