Female Reproductive Tract Pathology Part 1 Flashcards
the vulva is comprised of what parts?
Labia Majora
Labia Minora
Clitoris
Vaginal Orifice
Glands
Where are the skenes glands located
adjacent to the urethra
where are the bartholin glands
posterior to the vaginal orifice/opening
both the skene and bartholin glands contribute to _ released during sexual actitivty
fluid
between the external genitalia and anus is the area known as?
perineum
the vagina is posterior to the _ and internally gives rise to?
urethra
uterus
the uterus is _ and _ to the bladder
posterior and superior
the vaginal is a _ lined spaced
squamous mucosal
the iterus has a surface _ endometrial lining which is under the myometrium which is composed of _
glandular
smooth muscle
the top of the uterus is called the?
fundus
the fundus and the uterine cavities feed into the bilateral?
fallopian tubes
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?
ectocervix (outside) is lined by squamous mucosa
transitions to
endocervix (internal) is lined by columnar mucosa
the point where the ectocervix goes to the endocervix is termed the?
transition zone (also known as the SCJ, squamous columnar junction)
the transition zone is important because this is where _ occurs
HPV
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?
migrate to the genital ridge (formed by mesoderm) to form the gonads
during the 6th week of gestation in female development bilateral ducts form called the _ ducts and later the bilateral ducts called _ ducts form
mullerian/paramesonephric
wolffian/mesonephric
lack of _ gene leads to ovary formation of the gonads
SRY (sex determinet region on the Y chromosome)
presence of _ leads to female from the ovary will lead to femal anatomical differentiation
estrogen
during female development under the influence of estrogen the mullerian ducts become?
fallopian tubes, uterus, upper portion of the vagina
during femal development what happens to the wolffian duct under estrogen control
the regress
if wollfian ducts dont regress what can happen?
they can form benign cysts like paratubal or gartner duct cysts
in femal development the urogenital sinus becomes?
the lower portion of the vagina
what is uterus didelphys?
a double uterus that presents with 2 uterine cavities and 2 cervices
uterine didelphys is caused by?
failure of fusion of the mullerian ducts during embryoloic development
septate vaginas are present in 3/4 of the cases of uterine didelphys, what is this?
there is a septum in the vagina that divides the vagina into 2 seperate cavities
double vaginas
uterine abnormalities are typically _ in origin
genetic
present with kidney abnormalities as well
what is the presentation of uterus didelphys and septate vagina
the presentation is variable amongst individuals
pain during intercourse/delivery
cyclic pain during meses
what is mayer-rokitansky-hauser-syndrome
when there is a complete absence or underdevelopment of structures formed by the mullarian ducts
uterine/vaginal absence
genetic cause
what causes mayer-rokitansky-kuster-hauser syndrome?
mullerian agenesis
clinical sign of mayer-rokitansky-kuster-hauser syndrome
amenorrhea
a bartholin cysts arises from?
obstruction (mucus cant get out)
infection or trauma can cause obstruction
bartholin cysts present as?
unilateral, nontender, soft masses in the posterior aspect of the vaginal introitus
if a batholin cyst becomes infected what can happen?
they will become painful with surrounding cellulitis, and edema
what does a infect bartholin cyst look like inside?
an abcess with yellow of green fluid
what pathogen is most notable a cause for an infected bartholin cyst?
E.Coli
lichen sclerosis is a _ disorder which involves activated _ cells
inflammatory
T cells
lichen sclerosus is associated with what 2 things
autoimmune disorders and low estrogenic states
lichen sclerosus is most common is _ (menopausal/post menopausal) women
post menopausal
lichen sclerosus typically affects what area of the skin
vulva and angiogenital skin
common symptoms of lichen sclerosus
itching, painful sexual intercourse, and painful urination
licehn sclerosus has an increased risk for what?
TP53 driven positive keratinizing squamous cell carcinoma
what does the histology of lichen sclerosus look like?
grossly?
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)
squamous cell hyperplasia of the vulva is also known as?
lichen simplex chronicus
what is lichen simplex chronicus/squamous cell hyperplasia?
thickening of the skin due to chronic rubbing or scratching of the vulva
physical examination of lichen simplex chronicus shows?
thickened/reddened surface which can overtime turn white it exposed to urine, sweat or vaginal secretions
lichen simplex chronicus is associated with what conditions
contact dermatitis/psoriasis
lichen sclerosus
squamous cell carcinoma
histological findings of lichen simplex chronicus
markedly thickened (acanthosis) epidermis and hyperkaratosis
condylomas acuminatum refers to
anogenital warts
anogenital warts are caused by?
HPV
typically low risk HPV 6 and 11
HPV is spread through
sexual contact
how to anogential warts present
fleshy, skin like colored papules and plaques with a cauliflower like apperance
how does a condyloma acuminatum look on histology?
hyperplastic papillary projections comprised of squamous cells and parakeratosis
squamous cells have koilocytes
what is parakeratosis
surface keratinocytes that are nucleated
what is a koilocyte?
enlarged hyperchromatic nuclei that have a cleared out halo space around it
some hpv strains cause perinuclear cavitations
most vulvar carcinomas are _ carcinomas
squamous cell
what are the two categories of vulvar carcinomas
basaloid/warty squamous cell carcinomas
keratinizing squamous cell carcinoma
both types of vulvar squamous cell carcinomas arise from what precursor lesion?
VIN (vulvar intraepithelial neoplasia)
affected age of basaloid warty squamous cell carcinoma
age for keratizing squamous cell carcinoma
60
75
vin precursor lesion for basaloid/warty squamous cell carcinoma
vin for keratinizing squamous cell carcinoma
classical VIN
differentiated VIN
risk factor for basaloid/warty SCC
risk factor for keratinizing SCC
High risk HPV 16,18
chronic irritation, longstanding lichen sclerosus or squamous cell hyperplasia (lichen simplex chronicus)
_ increases the risk of progression to carcinoma from VIN
immunosuppression
keratinzing SCC of the vulva has high frequency of _ mutations
TP53
histologically what do classic vin precursors look like?
they have full thickness atypia and pleomorphism and mitotic figures
basloid vs warty apperance histologically
basaloid- dark blue basaloid nests
warty- superficial papillae and underlying invasive nests
how does differeniated vin look (precursor for keratinizing SCC)
basa, and parabasal atypia with parakeratosis and increased thickness
how does keratinzing scc look histologically
with invasive nests of keratin termed keratin pearls
what is a papillary hidradenoma
a benign neoplasm that presents as a dermal or subcutaneous nodule
papillary hidradenomas arise from?
mammary type glands along the primitive milk line
how does a papillary hidradenoma look? what is it comprised of what cells?
what differentiation does it have?
circumscribed nodule in the dermis
columnar cells, myoepithelial cells, and apocrine differentation
extramammary pagets disease (EMPD) is an _ _ of unclear histogenesis
intraepithelial adenocarcinoma
EMPD cells display differentation of what type
sweat gland (appocrine and eccrine) and squamous cell markers like keratinocytes
it is postulated that EMPD tumor cells stem from
multipotent stem cells
EMPD present like what clinically
itchy!
erythematous and white crusted lesion that looks like a map
what immunochemical stain is positive in EMPD
Ki67
same as luminal ER+ breast cancers of high grade
with EMPD there is a risk of _ carcinoma
noncontiguous syncrhonous
like bladder or urethra or any other gynecologic site
histology of EMPD
clusters of single tumor cells in an intraepithelial location
