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ENRP II > Female Reproductive Tract Pathology Part 1 > Flashcards

Female Reproductive Tract Pathology Part 1 Flashcards

1
Q

the vulva is comprised of what parts?

A

Labia Majora
Labia Minora
Clitoris
Vaginal Orifice
Glands

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2
Q

Where are the skenes glands located

A

adjacent to the urethra

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3
Q

where are the bartholin glands

A

posterior to the vaginal orifice/opening

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4
Q

both the skene and bartholin glands contribute to _ released during sexual actitivty

A

fluid

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5
Q

between the external genitalia and anus is the area known as?

A

perineum

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6
Q

the vagina is posterior to the _ and internally gives rise to?

A

urethra

uterus

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7
Q

the uterus is _ and _ to the bladder

A

posterior and superior

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8
Q

the vaginal is a _ lined spaced

A

squamous mucosal

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9
Q

the iterus has a surface _ endometrial lining which is under the myometrium which is composed of _

A

glandular

smooth muscle

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10
Q

the top of the uterus is called the?

A

fundus

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11
Q

the fundus and the uterine cavities feed into the bilateral?

A

fallopian tubes

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12
Q

the lower portion of the uterus is the cervix, the outside dome of the cervix is lined by? and the internal cervix is lined by?

A

ectocervix (outside) is lined by squamous mucosa

transitions to

endocervix (internal) is lined by columnar mucosa

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13
Q

the point where the ectocervix goes to the endocervix is termed the?

A

transition zone (also known as the SCJ, squamous columnar junction)

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14
Q

the transition zone is important because this is where _ occurs

A

HPV

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15
Q

female embryologic development starts with germ cells that migrate during the 5th/6th week to an area comprised of MESODERM to form the?

also what is this area comprised of mesoderm called?

A

migrate to the genital ridge (formed by mesoderm) to form the gonads

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16
Q

during the 6th week of gestation in female development bilateral ducts form called the _ ducts and later the bilateral ducts called _ ducts form

A

mullerian/paramesonephric

wolffian/mesonephric

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17
Q

lack of _ gene leads to ovary formation of the gonads

A

SRY (sex determinet region on the Y chromosome)

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18
Q

presence of _ leads to female from the ovary will lead to femal anatomical differentiation

A

estrogen

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19
Q

during female development under the influence of estrogen the mullerian ducts become?

A

fallopian tubes, uterus, upper portion of the vagina

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20
Q

during femal development what happens to the wolffian duct under estrogen control

A

the regress

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21
Q

if wollfian ducts dont regress what can happen?

A

they can form benign cysts like paratubal or gartner duct cysts

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22
Q

in femal development the urogenital sinus becomes?

A

the lower portion of the vagina

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23
Q

what is uterus didelphys?

A

a double uterus that presents with 2 uterine cavities and 2 cervices

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24
Q

uterine didelphys is caused by?

A

failure of fusion of the mullerian ducts during embryoloic development

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25
Q

septate vaginas are present in 3/4 of the cases of uterine didelphys, what is this?

A

there is a septum in the vagina that divides the vagina into 2 seperate cavities

double vaginas

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26
Q

uterine abnormalities are typically _ in origin

A

genetic

present with kidney abnormalities as well

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27
Q

what is the presentation of uterus didelphys and septate vagina

A

the presentation is variable amongst individuals

pain during intercourse/delivery
cyclic pain during meses

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28
Q

what is mayer-rokitansky-hauser-syndrome

A

when there is a complete absence or underdevelopment of structures formed by the mullarian ducts

uterine/vaginal absence

genetic cause

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29
Q

what causes mayer-rokitansky-kuster-hauser syndrome?

A

mullerian agenesis

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30
Q

clinical sign of mayer-rokitansky-kuster-hauser syndrome

A

amenorrhea

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31
Q

a bartholin cysts arises from?

A

obstruction (mucus cant get out)

infection or trauma can cause obstruction

32
Q

bartholin cysts present as?

A

unilateral, nontender, soft masses in the posterior aspect of the vaginal introitus

33
Q

if a batholin cyst becomes infected what can happen?

A

they will become painful with surrounding cellulitis, and edema

34
Q

what does a infect bartholin cyst look like inside?

A

an abcess with yellow of green fluid

35
Q

what pathogen is most notable a cause for an infected bartholin cyst?

A

E.Coli

36
Q

lichen sclerosis is a _ disorder which involves activated _ cells

A

inflammatory

T cells

37
Q

lichen sclerosus is associated with what 2 things

A

autoimmune disorders and low estrogenic states

38
Q

lichen sclerosus is most common is _ (menopausal/post menopausal) women

A

post menopausal

39
Q

lichen sclerosus typically affects what area of the skin

A

vulva and angiogenital skin

40
Q

common symptoms of lichen sclerosus

A

itching, painful sexual intercourse, and painful urination

41
Q

licehn sclerosus has an increased risk for what?

A

TP53 driven positive keratinizing squamous cell carcinoma

42
Q

what does the histology of lichen sclerosus look like?

grossly?

A

grossly it shows white plaques that can coalesce

histologically: hyperkeratosis and atrophy of the epidermis with an underlying lymphocytic infiltrate and a prominent edematous band (hyaline zone)

43
Q

squamous cell hyperplasia of the vulva is also known as?

A

lichen simplex chronicus

44
Q

what is lichen simplex chronicus/squamous cell hyperplasia?

A

thickening of the skin due to chronic rubbing or scratching of the vulva

45
Q

physical examination of lichen simplex chronicus shows?

A

thickened/reddened surface which can overtime turn white it exposed to urine, sweat or vaginal secretions

46
Q

lichen simplex chronicus is associated with what conditions

A

contact dermatitis/psoriasis
lichen sclerosus
squamous cell carcinoma

47
Q

histological findings of lichen simplex chronicus

A

markedly thickened (acanthosis) epidermis and hyperkaratosis

48
Q

condylomas acuminatum refers to

A

anogenital warts

49
Q

anogenital warts are caused by?

A

HPV

typically low risk HPV 6 and 11

50
Q

HPV is spread through

A

sexual contact

51
Q

how to anogential warts present

A

fleshy, skin like colored papules and plaques with a cauliflower like apperance

52
Q

how does a condyloma acuminatum look on histology?

A

hyperplastic papillary projections comprised of squamous cells and parakeratosis

squamous cells have koilocytes

53
Q

what is parakeratosis

A

surface keratinocytes that are nucleated

54
Q

what is a koilocyte?

A

enlarged hyperchromatic nuclei that have a cleared out halo space around it

some hpv strains cause perinuclear cavitations

55
Q

most vulvar carcinomas are _ carcinomas

A

squamous cell

56
Q

what are the two categories of vulvar carcinomas

A

basaloid/warty squamous cell carcinomas
keratinizing squamous cell carcinoma

57
Q

both types of vulvar squamous cell carcinomas arise from what precursor lesion?

A

VIN (vulvar intraepithelial neoplasia)

58
Q

affected age of basaloid warty squamous cell carcinoma

age for keratizing squamous cell carcinoma

A

60

75

59
Q

vin precursor lesion for basaloid/warty squamous cell carcinoma

vin for keratinizing squamous cell carcinoma

A

classical VIN

differentiated VIN

60
Q

risk factor for basaloid/warty SCC

risk factor for keratinizing SCC

A

High risk HPV 16,18

chronic irritation, longstanding lichen sclerosus or squamous cell hyperplasia (lichen simplex chronicus)

61
Q

_ increases the risk of progression to carcinoma from VIN

A

immunosuppression

62
Q

keratinzing SCC of the vulva has high frequency of _ mutations

A

TP53

63
Q

histologically what do classic vin precursors look like?

A

they have full thickness atypia and pleomorphism and mitotic figures

64
Q

basloid vs warty apperance histologically

A

basaloid- dark blue basaloid nests

warty- superficial papillae and underlying invasive nests

65
Q

how does differeniated vin look (precursor for keratinizing SCC)

A

basa, and parabasal atypia with parakeratosis and increased thickness

66
Q

how does keratinzing scc look histologically

A

with invasive nests of keratin termed keratin pearls

67
Q

what is a papillary hidradenoma

A

a benign neoplasm that presents as a dermal or subcutaneous nodule

68
Q

papillary hidradenomas arise from?

A

mammary type glands along the primitive milk line

69
Q

how does a papillary hidradenoma look? what is it comprised of what cells?

what differentiation does it have?

A

circumscribed nodule in the dermis

columnar cells, myoepithelial cells, and apocrine differentation

70
Q

extramammary pagets disease (EMPD) is an _ _ of unclear histogenesis

A

intraepithelial adenocarcinoma

71
Q

EMPD cells display differentation of what type

A

sweat gland (appocrine and eccrine) and squamous cell markers like keratinocytes

72
Q

it is postulated that EMPD tumor cells stem from

A

multipotent stem cells

73
Q

EMPD present like what clinically

A

itchy!
erythematous and white crusted lesion that looks like a map

74
Q

what immunochemical stain is positive in EMPD

A

Ki67

same as luminal ER+ breast cancers of high grade

75
Q

with EMPD there is a risk of _ carcinoma

A

noncontiguous syncrhonous

like bladder or urethra or any other gynecologic site

76
Q

histology of EMPD

A

clusters of single tumor cells in an intraepithelial location

ENRP II (25 decks)

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