Female Reproductive Tract Pathology Part 2 Flashcards
what two cysts are the most common submucosal cysts in reproductive aged women
gartner duct cyst
mullerian cyst
gartner duct cysts is derived from _ remnants
wolfian (mesonephric)
mullerian cysts are derived from _ duct remnants
mullerian/paramesonephric
both gartner duct cysts and mullerian cysts are found on the _ _ walls of the vagina somtimes protruding from the _
anterior lateral walls
ofifice
when gartner and mullerian cysts are symptomatic they can cause?
vaginal pressure or painful intercourse
histology of a gartner duct cysts and mullerian cyst
gartner: low cuboidal lining
mullerian: endocervial type lining: tubal, squamous etc.
in utero DES exposure predisposed women to develop _ _ _ (type of cancer)
vaginal clear cell adenocarcinoma
in daughters of mothers who took the drug
DES is a _ estrogen utilized clinically in the past to address pregnancy issues like miscarriage, preterm delivery etc.
non-steroidal
no longer given after 1971
females exposed to DES in utero have increased pathes of?
vaginal adenosis
vaginal adenosis
normal vaginal squamous mucosa contains or is replaced by glandular epithelium
benign change
what is a vaginal embryonal rhadomyosarcoma (sarcoma botryoides)
uncommon vaginal tumor in infants and young girls (less than 5)
it presents as a grape like bulky protruding mass or with mloody mucousy discharge
complications of a vaginal embryonal rhabdomyosarcoma
death if invasion of tumor into the peritoneum or if it obstructs the bladder
what is the cell type in a vaginal embryonal rhabdomyosarcoma
embryonal rhadbdomyoblasts (they are supposed to differentiated into mature muscle cells)
will see these cells on histology
pathogenesis of vaginal squamous cell carcinoma
starts as a premalignant lesion: VAIN- vaginal intraepithelial neoplasia caused by HPV 16, 18 (high risk strain)
how does vaginal SCC metastasize
lower 2/3 of vagina:
upper vagina:
lower: inguinal/femoral lymph nodes
upper vagina: regional iliac nodes, periaortic lymph nodes
almost all cervical and vaginal carcinomas are caused by high risk _
HPV (16 most common, but 18 as well)
HPV is a _ virus and is transmitted through?
DNA
sexual contact
HPV integrates into the squamous cells genome where the _ and the _ oncogenes create proteins that promote oncogenesis
E6 and E7
what role does E6 play in HPV
increase TERT which increases telomerase and gives the ceel immortality (infinite amount of divisions)
it also degrades P53 which is a tumor suppresor gene (recognized DNA damage)
what role does E7 play in HPV
it drives cellular proliferation from the G1/S checkpoint by inhibitng p21 and and binding to RB which allows for the E2F complex to displace and cause advancement through the cycle
what are the cervical squamous lesions? CIN vs SIL
mild dysplasia is CIN I which is also known as LSIL (low grade squamous intraepithelial lesion)
Moderate/Severe/Carcinoma insitu (CIN II, III) are also known as HSIL (high grade squamous intrapeithelial lesion)
what is the progression of LSIL and HSIL
10% of LSIL go on to be HSIL
10% of HSIL go on to be carcinoma
human papilloma virus has a predilection for the _ zone which is the transition from ectocervical (Stratifiec squamous) to endocervical (columnar) mucosa
transformation zone
what is the transformation zone in the cervix comprised of (type of epithelium)
metaplastic squamous epithelium
infection by human papilloma virus occurs in the _ layer
basal
this means that cervical dyplasia is typed based on the maturation of the squamous epithelium (they clear as they reach the surface)
in mild squamous dysplasia/LSIL what does the histology look like
there is a lack of maturation in the lower 3rd of the epithelium with kolicytes in the upper layers
remember koilyctes are squamous cells with hyperchromatic nuclei with perinuclear clearing ( halo appearance)
as cervical dysplasia progresses to HSIL what is seen histologically
the progression of immature squamous cells (no cleared out) towards the top of the epithelium with mitotic figures (full thickness immaturity is the highest grade)
how do we screen for a squamous intraepithelial lesion of the cervix
pap test
pap tests are preformed at the _ zone
transformation
because this is where HPV has predileciton and most cervical dysplasia are caused by HPV
pap smears are stained with?
papanicolau stain
screen for squamous lesions
cytology of a low grade squamous intraepithelial lesion (LSIL)
bi nucleated kolicytes- hyperchromasia- perinuclear clearing
cytology of high grade squamous intraepithelial lesion
high nuclear to cytoplasmic ratio (resembling basal cells)
cytology of high grade squamous intraepithelial lesion
high nuclear to cytoplasmic ratio (resembling basal cells)
what are the molecular techniques you can do to screen for cervical neoplasia?
PCR or hybrid capture (uses fluid from vial from pap test) if pap test cant place in category (reactive vs dysplastic)
used to check for high risk strains of HPV
screening for pap smears start at age?
21
age 21-29 should? (regarding screening guidlines for pap)
get cytology every 3 years
at age 30, screening can occur every _ years with a pap test plus a molecular test to check for high risk HPV strains
- pap screening guidlines
5
screening is no longer needed after the age of _ if there have been _ consecutive negative PAP tests and the molecular test has been negative for the previous _ years
pap testing screening guidlines
65
3
10
If the pap tests picks up an abnormality a _ can be used to visualize the cervix and biopsy it. _ is applied to help visualize the cervix.
colposcope
acetic acid
with dysplasia areas of the cervix stained with acetic acid are more likely to turn what color?
acetowhite
low grade dysplasia the cervix turns what color when treated with acetic acid
high grade?
fine punctations
coarse punctations
in an acetowhite positive (dyplastic ) cervix treated with acetic acid what do atypical vessels raise a concern for
carcinoma
how do we treat h igh grade dyplasia of the cervix
cervical colonization and LEEP
cervical colonization is - removing the area of concern in a cone shape
LEEP- electric currents remove the area of concern
HSIL and LSIL can both lead to invase squamous carcinoma. what are the 2 types
keratinizing SCC (with keratin pearls)
Non-Keratinizing SCC
Sometimes HPV can infect the endocervical mucosa and cause a precursor lesion called _
which can progress to an invasive lesion called _
precursor lesion: cervical adenocarcinoma in situ (AIS)
invasive lesion: invasive adenocarcinoma
AIS is characterized by?
hyperchromatic nuclear enlargement with psuedostratification
invasive adenocarcinoma of the cervix looks like what?
histology
glandular tumor nests infiltrating the stroma
can precursor lesions adenocarcinoma insitu (AIS) be seen on pap smear?
yes
average age for cervical carcinoma
45-50 years old
what are the vaccinations for HPV
Cevarix- not available in the US
Gardasil (high and low risk HPV protection)
vaccination for the HPV vaccine is recommended a the age of _ for both males and females
11-12
endocervical polyps are _ (benign/malignant)
they occur during _ (reproductive years/menopause)
they can present with _ or discharge
_ (procedure) is curative
benign
reproductive years
bleeding/spotting
simple excision (polypectomy)
histology of an endocervical polyp
they arise from cervical _ epithelium
what causes them?
fibrovascular core with surface epithelium which is covered endocervical type dlands- benign glands and stroma
glandular
estrogen (postulated)
