Female Urogenital Tract Flashcards
1
Q
What type of virus is Herpes Simplex Virus?
A
DNA virus
HSVs are categorized as DNA viruses.
2
Q
How many serotypes does Herpes Simplex Virus have?
A
Two serotypes
The two serotypes are HSV-1 and HSV-2.
3
Q
What is the typical infection site for HSV-1?
A
Perioral infection
HSV-1 is commonly associated with infections around the mouth.
4
Q
What area is usually affected by HSV-2?
A
Genital mucosa and skin
HSV-2 primarily causes infections in the genital region.
5
Q
How many days after transmission do lesions typically develop?
A
3 to 7 days
This time frame is common for the appearance of lesions following HSV transmission.
6
Q
What type of symptoms are often associated with HSV lesions?
A
Systemic symptoms
Patients may experience systemic symptoms along with localized lesions.
7
Q
What do the earliest HSV lesions typically consist of?
A
Red papules
Initial lesions often start as red papules.
8
Q
What is the progression of HSV lesions after red papules?
A
Vesicles and then painful coalescent ulcers
Lesions evolve from red papules to vesicles and finally to painful ulcers.
9
Q
What is the typical healing time for mucosal and cutaneous lesions caused by herpes simplex virus (HSV)?
A
1 to 3 weeks
10
Q
Where does the herpes simplex virus migrate during acute infection?
A
Regional lumbosacral nerve ganglia
11
Q
What type of infection does HSV establish in the nerve ganglia?
A
Latent infection
12
Q
True or False: HSV infections persist indefinitely due to viral latency.
A
True
13
Q
List some factors that can trigger reactivation of the herpes simplex virus.
A
- Decrease in immune function
- Stress
- Trauma
- Concurrent viral infection
- Hormonal changes
14
Q
How does HSV infection affect the risk of HIV-1?
A
Increases the risk of HIV-1 acquisition and transmission
15
Q
How is herpes simplex virus (HSV) diagnosed?
A
Purulent exudate is aspirated from the lesions and inoculated into a tissue culture
This method allows for the observation of a viral cytopathic effect.
16
Q
What can be observed after 48 to 72 hours in a tissue culture inoculated with HSV?
A
Viral cytopathic effect
This effect allows for the serotyping of the virus.
17
Q
What tests are used for the detection of HSV in lesional secretions?
A
- Polymerase chain reaction tests
- Enzyme-linked immunosorbent assays
- Direct immunofluorescent antibody tests
These tests help in identifying HSV presence in lesions.
18
Q
Does primary acute HSV infection produce serum anti-HSV antibodies?
A
No
This indicates that the body has not yet developed an immune response to the initial infection.
19
Q
What does the detection of anti-HSV antibodies in serum indicate?
A
Recurrent/latent infection
This suggests that the virus is present in a dormant state, leading to potential future outbreaks.
20
Q
What are the three M’s associated with herpes simplex cytopathy?
A
M’s refer to the specific characteristics observed in herpes simplex cytopathy
The exact terms for the three M’s were not provided in the text.
21
Q
What type of lesion is caused by molluscum contagiosum?
A
Cutaneous or mucosal lesion
Molluscum contagiosum is caused by a poxvirus.
22
Q
How many types of molluscum contagiosum viruses are there?
A
Four types
MCV-I is the most prevalent type.
23
Q
Which type of molluscum contagiosum virus is most often sexually transmitted?
A
MCV-2
MCV-2 is more commonly associated with sexual transmission.
24
Q
What age group is most commonly affected by molluscum contagiosum?
A
Young children between 2 and 12 years of age
Transmission in children typically occurs through direct contact or shared articles.
25
In adults, how is molluscum contagiosum typically transmitted?
Sexually transmitted
## Footnote
In adults, it primarily affects the genitals, lower abdomen, buttocks, and inner thighs.
26
Describe the appearance of molluscum contagiosum lesions.
Pearly, dome-shaped papules with a dimpled center
## Footnote
Lesions measure 1 to 5 mm in diameter and have a central waxy core containing cells with cytoplasmic viral inclusions.
27
Fill in the blank: Molluscum contagiosum lesions measure _______ in diameter.
1 to 5 mm
## Footnote
This measurement refers to the size of the papules.
28
What is Molluscum Contagiosum?
A dome-shaped papule with dimpled center
## Footnote
Molluscum contagiosum is a viral skin infection characterized by raised, round lesions.
29
What are the intracytoplasmic viral inclusions found in Molluscum Contagiosum called?
Henderson-Patterson bodies
## Footnote
These inclusions are a histological hallmark of the virus associated with Molluscum contagiosum.
30
What is the main causative organism of bacterial vaginosis?
Gordnerella vaginolis
## Footnote
Gordnerella vaginolis is a gram-negative coccobacillus.
31
What are the characteristics of the vaginal discharge in bacterial vaginosis?
Thin, green-gray, malodorous (fishy) discharge
## Footnote
The discharge is often described as having a fishy odor.
32
What do Pap smears reveal in cases of bacterial vaginosis?
Superficial and intermediate squamous cells covered with a shaggy coat of coccobacilli
## Footnote
This finding is characteristic of bacterial vaginosis.
33
What complication has bacterial vaginosis been linked to in pregnant patients?
Premature labor
## Footnote
Bacterial vaginosis is a significant concern during pregnancy.
34
Fill in the blank: The main cause of bacterial vaginosis is _______.
Gordnerella vaginolis
35
True or False: Bacterial vaginosis is characterized by a thick, white vaginal discharge.
False
## Footnote
Bacterial vaginosis typically presents with a thin, green-gray discharge.
36
What is Pelvic Inflammatory Disease (PID)?
An infection that begins in the vulva or vagina and spreads upward to involve most of the structures in the female genital system, resulting in pelvic pain, adnexal tenderness, fever, and vaginal discharge.
37
What is a common cause of PID?
Neisseria gonorrhoeae.
38
Where does the initial infection in PID most commonly occur?
The endocervical mucosa.
39
How can organisms spread in PID?
Upward to involve the fallopian tubes and tuboovarian region.
40
What type of infections can lead to PID after surgical procedures?
Non-gonococcal bacterial infections.
41
What are acute complications of PID?
Peritonitis and bacteremia.
42
What serious conditions may result from acute complications of PID?
Endocarditis, meningitis, and suppurative arthritis.
43
What are chronic sequelae of PID?
Infertility, tubal obstruction, ectopic pregnancy, pelvic pain, and intestinal obstruction due to adhesions.
44
True or False: PID can result in infertility.
True.
45
Fill in the blank: PID is the most serious complication of __________ in women.
gonorrhea.
46
What is acute salpingitis characterized by?
Marked acute inflammation of involved mucosal surfaces
47
What do smears of the inflammatory exudate in gonococcal infection disclose?
Phagocytosed gram-negative diplococci within neutrophils
48
What is required for a definitive diagnosis of acute salpingitis?
Culture or detection of gonococcal RNA or DNA
49
What happens to the tubal mucosa during acute salpingitis?
Becomes congested and diffusely infiltrated by neutrophils, plasma cells, and lymphocytes
50
What fills the tubal lumen in acute salpingitis?
Purulent exudate that may leak out of the fimbriated end
51
What condition may result from the spread of infection from the tube to the ovary?
Salpingo-oophoritis
52
What can accumulate within the ovary and tube as a result of acute salpingitis?
Collections of pus, such as tubo-ovarian abscess or pyosalpinx
53
What are the tubal plicae?
The tubal plicae are structures that can adhere to one another and slowly fuse in a reparative, scarring process.
54
What occurs as a result of the scarring of the tubal lumen and fimbriae?
It may prevent the uptake and passage of oocytes, leading to infertility or ectopic pregnancy.
55
What is hydrosalpinx?
Hydrosalpinx is a condition that may develop as a consequence of the fusion of the fimbriae and the subsequent accumulation of tubal secretions and tubal distention.
56
True or False: The scarring process in the tubal plicae does not affect fertility.
False
57
Fill in the blank: The process of forming glandlike spaces and blind pouches in the tubal plicae is part of a _______ process.
[reparative scarring]
58
What is a Bartholin cyst?
A Bartholin cyst results from obstruction of the duct by an inflammatory process.
## Footnote
Bartholin cysts are fluid-filled sacs that can develop when the Bartholin glands become blocked.
59
What type of epithelium usually lines a Bartholin cyst?
Transitional or squamous epithelium.
## Footnote
This lining is typical for cysts formed in the region of the Bartholin glands.
60
What is the typical size range of a Bartholin cyst?
3 to 5 cm in diameter.
## Footnote
Bartholin cysts can vary in size and may become large enough to cause symptoms.
61
What symptoms may arise from a Bartholin cyst?
Pain and local discomfort.
## Footnote
Symptoms can occur if the cyst becomes large or infected.
62
What is leukoplakia?
A descriptive clinical term for opaque, white, plaquelike epithelial thickening that may produce pruritus and scaling
63
What are some causes of leukoplakia?
* Inflammatory dermatoses
* Lichen sclerosus
* Squamous cell hyperplasia
* Neoplastic conditions
64
What does lichen sclerosus present as?
Smooth, white plaques or macules that may enlarge and coalesce, resembling porcelain or parchment.
65
What happens to the labia in lichen sclerosus?
The labia become atrophic and agglutinated, and the vaginal orifice constricts.
66
In which demographic is lichen sclerosus most common?
Postmenopausal women.
67
Is lichen sclerosus pre-malignant?
No, it is not pre-malignant.
68
What is the risk associated with lichen sclerosus?
Slightly increased chance of developing squamous cell carcinoma of the vulva.
69
What is a key characteristic of lichen sclerosus?
Marked thinning of the epidermis, degeneration of the basal epithelial cells, excessive keratinization, sclerotic changes of the superficial dermis, and a bandlike lymphocytic infiltrate in the underlying dermis
## Footnote
These characteristics are crucial for diagnosis and understanding the condition.
70
What suggests the involvement of an autoimmune reaction in lichen sclerosus?
The pathogenesis of lichen sclerosus
## Footnote
Understanding the autoimmune aspect can influence treatment options and patient management.
71
Fill in the blank: Lichen sclerosus involves excessive _______.
keratinization
72
True or False: Lichen sclerosus is characterized by an increase in basal epithelial cells.
False
## Footnote
The condition involves degeneration of the basal epithelial cells.
73
List the main histopathological features of lichen sclerosus.
* Marked thinning of the epidermis
* Degeneration of the basal epithelial cells
* Excessive keratinization
* Sclerotic changes of the superficial dermis
* Bandlike lymphocytic infiltrate in the underlying dermis
74
What is squamous cell hyperplasia also known as?
Hyperplastic dystrophy or lichen simplex chronicus
## Footnote
This term refers to a skin condition characterized by an increase in the number of squamous cells.
75
What causes squamous cell hyperplasia?
Rubbing or scratching of the skin to relieve pruritus
## Footnote
Pruritus refers to itching, which leads to the skin being rubbed or scratched.
76
What are the key features of squamous cell hyperplasia?
Thickening of the epidermis (acanthosis) and hyperkeratosis
## Footnote
Acanthosis refers to thickening of the stratum spinosum of the epidermis, while hyperkeratosis refers to an excessive accumulation of keratin.
77
Is squamous cell hyperplasia considered premalignant?
No, it is not considered premalignant
## Footnote
However, it can be present at the margins of vulvar cancers.
78
True or False: Squamous cell hyperplasia can occur at the margins of vulvar cancers.
True
## Footnote
While squamous cell hyperplasia itself is not premalignant, its presence at cancer margins is noteworthy.
79
What is another term for squamous cell hyperplasia?
Hyperplastic dystrophy or lichen simplex chronicus
## Footnote
This term refers to the condition characterized by the thickening of the epidermis due to chronic irritation.
80
What causes squamous cell hyperplasia?
Rubbing or scratching of the skin to relieve pruritus
## Footnote
Pruritus refers to itching, which leads individuals to scratch the skin, causing hyperplasia.
81
What are the two main histological changes associated with squamous cell hyperplasia?
Acanthosis and hyperkeratosis
## Footnote
Acanthosis is the thickening of the stratum spinosum of the epidermis, while hyperkeratosis refers to the thickening of the stratum corneum.
82
Is squamous cell hyperplasia considered premalignant?
No
## Footnote
While not premalignant, it can be observed at the margins of vulvar cancers.
83
True or False: Squamous cell hyperplasia can sometimes be present at the margins of vulvar cancers.
True
## Footnote
This indicates a potential association with malignancy, although it is not itself considered premalignant.
84
What are benign exophytic lesions?
Benign growths that protrude from the surface of the tissue.
85
What are fibroepithelial polyps commonly known as?
Skin tags.
86
What are squamous papillomas?
Benign exophytic proliferations covered by nonkeratinized squamous epithelium that develop on vulvar surfaces.
87
What are benign genital warts caused by?
Low-risk HPV, mainly types 6 and 11
## Footnote
These warts are also known as condyloma acuminatum.
88
Where do condyloma acuminatum lesions more frequently occur?
Vulvar, perineal, perianal regions, vagina, and cervix
## Footnote
These lesions are often multifocal.
89
What is the structure of condyloma acuminatum?
Papillary, exophytic, treelike cores of stroma covered by thickened squamous epithelium
## Footnote
This description highlights the appearance of the lesions.
90
What are the characteristic viral cytopathic changes in condyloma acuminatum referred to as?
Koilocytic atypia
## Footnote
Koilocytic atypia is a hallmark of HPV infection.
91
Are condyloma acuminatum lesions considered precancerous?
No
## Footnote
These lesions are benign and not associated with cancer.
92
What percentage of all genital cancers in females are squamous neoplastic lesions?
3%
## Footnote
This indicates the rarity of these lesions among female genital cancers.
93
What is the most common histologic type of vulvar cancer?
Squamous cell carcinoma
## Footnote
This type of cancer is predominant in vulvar cases.
94
What age group do approximately two-thirds of vulvar neoplastic lesions occur in?
Women older than 60
## Footnote
This suggests a correlation between age and the incidence of vulvar neoplasia.
95
Which types of carcinoma are related to infection with high-risk HPVs?
Basaloid and warty carcinomas
## Footnote
These types are less common and typically affect younger women.
96
What is the most common high-risk HPV associated with basaloid and warty carcinomas?
HPV-16
## Footnote
This HPV type is a significant factor in the development of these carcinomas.
97
What percentage of vulvar neoplastic lesions are keratinizing squamous cell carcinomas?
70%
## Footnote
This indicates that the majority of vulvar cancers are keratinizing squamous cell carcinomas.
98
Are keratinizing squamous cell carcinomas related to HPV infection?
No
## Footnote
This type of carcinoma occurs independently of HPV.
99
What is the average age of women affected by keratinizing squamous cell carcinomas?
75 years
## Footnote
This reflects the demographic that is more likely to develop this type of carcinoma.
100
True or False: Basaloid and warty carcinomas are more common in older women.
False
## Footnote
These carcinomas are less common and occur in younger women.
101
Fill in the blank: Approximately two-thirds of vulvar neoplastic lesions occur in women older than _______.
60
## Footnote
This emphasizes the age-related prevalence of vulvar neoplasia.
102
What are the two types of squamous carcinomas mentioned?
Basaloid and warty carcinomas
## Footnote
These are types of squamous neoplastic lesions found in the vulva.
103
What is the precursor lesion for keratinizing squamous cell carcinomas?
Classic vulvar intraepithelial neoplasia (VIN)
## Footnote
This lesion is often associated with long-standing lichen sclerosus or squamous cell hyperplasia.
104
In which demographic does classic vulvar intraepithelial neoplasia (VIN) mainly occur?
Reproductive age women
## Footnote
This condition is particularly prevalent among women who are in their reproductive years.
105
What was the former designation for keratinizing squamous cell carcinomas?
Carcinoma in situ or Bowen disease
## Footnote
This terminology has evolved over time as understanding of the condition has improved.
106
What are the risk factors associated with differentiated vulvar intraepithelial neoplasia (differentiated VIN)?
* Young age at first intercourse
* Multiple sexual partners
* Male partner with multiple sexual partners
## Footnote
These factors increase the likelihood of developing differentiated VIN.
107
What is the relationship between age and risk of progression to invasive carcinoma?
Higher risk in women older than 45 years or who are immunosuppressed
## Footnote
Age and immunosuppression significantly increase the risk of progression.
108
What kind of genetic mutations are frequently associated with differentiated VIN?
TP53 mutations
## Footnote
These mutations are commonly observed in cases of differentiated vulvar intraepithelial neoplasia.
109
What are the two types of squamous carcinomas mentioned?
Basaloid and warty carcinomas
## Footnote
These are types of squamous neoplastic lesions found in the vulva.
110
What is the precursor lesion for keratinizing squamous cell carcinomas?
Classic vulvar intraepithelial neoplasia (VIN)
## Footnote
This lesion is often associated with long-standing lichen sclerosus or squamous cell hyperplasia.
111
In which demographic does classic vulvar intraepithelial neoplasia (VIN) mainly occur?
Reproductive age women
## Footnote
This condition is particularly prevalent among women who are in their reproductive years.
112
What was the former designation for keratinizing squamous cell carcinomas?
Carcinoma in situ or Bowen disease
## Footnote
This terminology has evolved over time as understanding of the condition has improved.
113
What are the risk factors associated with differentiated vulvar intraepithelial neoplasia (differentiated VIN)?
* Young age at first intercourse
* Multiple sexual partners
* Male partner with multiple sexual partners
## Footnote
These factors increase the likelihood of developing differentiated VIN.
114
What is the relationship between age and risk of progression to invasive carcinoma?
Higher risk in women older than 45 years or who are immunosuppressed
## Footnote
Age and immunosuppression significantly increase the risk of progression.
115
What kind of genetic mutations are frequently associated with differentiated VIN?
TP53 mutations
## Footnote
These mutations are commonly observed in cases of differentiated vulvar intraepithelial neoplasia.
116
What are the key characteristics of Classic Vulvar Intraepithelial Neoplasia?
Epidermal thickening, nuclear atypia, increased mitoses, and lack of cellular maturation
## Footnote
These characteristics indicate abnormal changes in the vulvar epithelium.
117
What type of cells are found in Classic Vulvar Intraepithelial Neoplasia?
Small, immature basaloid cells encompassing full thickness of the epithelium
## Footnote
These cells are indicative of the neoplastic process affecting the vulvar tissue.
118
What are the key characteristics of Classic Vulvar Intraepithelial Neoplasia?
Epidermal thickening, nuclear atypia, increased mitoses, and lack of cellular maturation
## Footnote
These characteristics indicate abnormal changes in the vulvar epithelium.
119
What type of cells are found in Classic Vulvar Intraepithelial Neoplasia?
Small, immature basaloid cells encompassing full thickness of the epithelium
## Footnote
These cells are indicative of the neoplastic process affecting the vulvar tissue.
120
What is Basaloid Vulvar Carcinoma?
A type of invasive carcinoma characterized by small, immature (basaloid) cells
## Footnote
Basaloid Vulvar Carcinoma consists of nests and cords of tightly packed cells that resemble the basal layer of normal epithelium.
121
What type of cells are predominant in Basaloid Vulvar Carcinoma?
Small, immature (basaloid) cells
## Footnote
These cells lack maturation.
122
What is a notable histological feature of Basaloid Vulvar Carcinoma?
Nests and cords of small tightly packed cells
## Footnote
These structures resemble the basal layer of the normal epithelium.
123
True or False: Basaloid Vulvar Carcinoma may have foci of central necrosis.
True
## Footnote
This feature can be observed within the tumor.
124
What is Basaloid Vulvar Carcinoma?
A type of invasive carcinoma characterized by small, immature (basaloid) cells
## Footnote
Basaloid Vulvar Carcinoma consists of nests and cords of tightly packed cells that resemble the basal layer of normal epithelium.
125
What type of cells are predominant in Basaloid Vulvar Carcinoma?
Small, immature (basaloid) cells
## Footnote
These cells lack maturation.
126
What is a notable histological feature of Basaloid Vulvar Carcinoma?
Nests and cords of small tightly packed cells
## Footnote
These structures resemble the basal layer of the normal epithelium.
127
True or False: Basaloid Vulvar Carcinoma may have foci of central necrosis.
True
## Footnote
This feature can be observed within the tumor.
128
What is marked atypia of the basal layer of the squamous epithelium?
Presence of abnormal cell features in the basal layer of squamous epithelial tissue
## Footnote
Atypia refers to structural abnormalities in cells that can indicate dysplasia or neoplasia.
129
What characterizes the differentiation of the more superficial layers in differentiated VIN?
Normal-appearing differentiation
## Footnote
Differentiation refers to the process by which cells become specialized in structure and function.
130
What is hyperkeratosis?
Thickening of the outer layer of the skin or mucous membranes
## Footnote
Hyperkeratosis often occurs in response to friction, irritation, or chronic inflammation.
131
What is the condition of the superficial layers in differentiated VIN?
Maturation of the superficial layers and atypia of basal epithelial cells
## Footnote
Maturation indicates that the superficial layers are developing normally, while atypia in basal cells suggests abnormal features.
132
Is there invasion present in differentiated VIN?
No invasion is present
## Footnote
This indicates that the abnormal cells have not penetrated deeper tissues, which is a critical factor in assessing the severity of the condition.
133
What type of carcinoma is characterized by nests and tongues of malignant squamous epithelium?
Invasive keratinizing squamous cell carcinomas
134
What are prominent central structures found in invasive keratinizing squamous cell carcinomas?
Keratin pearls
135
True or False: Invasive keratinizing squamous cell carcinomas do not contain keratin pearls.
False
136
Fill in the blank: Invasive keratinizing _______ cell carcinomas are characterized by nests and tongues of malignant squamous epithelium.
squamous
137
What does the risk of cancer development in Vulvar Intraepithelial Neoplasia (VIN) depend on?
Duration and extent of disease, immune status of the patient
## Footnote
The duration and extent of VIN can significantly influence the likelihood of progressing to cancer.
138
What factors determine the risk of metastatic spread once invasive cancer develops?
Size of tumor, depth of invasion, lymphatic invasion
## Footnote
These factors are critical in assessing the prognosis and treatment options for invasive cancer.
139
What is the 5-year survival rate for patients with lesions less than 2 cm in diameter after treatment?
90%
## Footnote
This high survival rate highlights the importance of early detection and treatment of vulvar lesions.
140
What treatments are mentioned for lesions less than 2 cm in diameter?
Vulvectomy and lymphadenectomy
## Footnote
These surgical procedures are typically performed to remove cancerous lesions and affected lymph nodes.
141
What is a Papillary Hidradenoma?
A sharply circumscribed nodule, most commonly on the labia majora or interlabial folds.
## Footnote
Papillary hidradenoma is a type of glandular neoplastic lesion.
142
Where do Papillary Hidradenomas most commonly present?
On the labia majora or interlabial folds.
## Footnote
This location is significant for clinical identification.
143
What clinical feature may lead to confusion with carcinoma in Papillary Hidradenoma?
Its tendency to ulcerate.
## Footnote
Ulceration can mimic malignant processes.
144
What are the two cell layers that make up Papillary Hidradenoma?
An upper layer of columnar secretory cells and a deeper layer of flattened myoepithelial cells.
## Footnote
These layers contribute to the structure of the lesion.
145
True or False: Papillary Hidradenomas are benign lesions.
True.
## Footnote
They are classified as glandular neoplastic lesions, indicating a benign nature.
146
What is a Papillary Hidradenoma?
A sharply circumscribed nodule, most commonly on the labia majora or interlabial folds.
## Footnote
Papillary hidradenoma is a type of glandular neoplastic lesion.
147
Where do Papillary Hidradenomas most commonly present?
On the labia majora or interlabial folds.
## Footnote
This location is significant for clinical identification.
148
What clinical feature may lead to confusion with carcinoma in Papillary Hidradenoma?
Its tendency to ulcerate.
## Footnote
Ulceration can mimic malignant processes.
149
What are the two cell layers that make up Papillary Hidradenoma?
An upper layer of columnar secretory cells and a deeper layer of flattened myoepithelial cells.
## Footnote
These layers contribute to the structure of the lesion.
150
True or False: Papillary Hidradenomas are benign lesions.
True.
## Footnote
They are classified as glandular neoplastic lesions, indicating a benign nature.
151
What are the clinical features of Paget disease of the vulva?
Pruritic, red, crusted, maplike area on the labia majora
## Footnote
Paget disease is characterized by its appearance and location.
152
Is Paget disease of the vulva typically associated with underlying cancer?
No, it is usually not associated with underlying cancer and is confined to the vulvar epidermis
## Footnote
This distinguishes it from other forms of vulvar disease.
153
What type of cellular proliferation is characteristic of Paget disease of the vulva?
Intraepithelial proliferation of malignant cells known as 'Paget cells'
## Footnote
These cells are larger than surrounding keratinocytes.
154
How are Paget cells typically arranged within the epidermis?
Seen singly or in small clusters
## Footnote
This arrangement helps in identifying the condition histologically.
155
What is a notable feature of the cytoplasm of Paget cells?
Pale cytoplasm containing mucopolysaccharide
## Footnote
This characteristic aids in the histological identification of Paget cells.
156
What specific marker do Paget cells express?
Cytokeratin 7
## Footnote
This expression is useful in differentiating Paget disease from other conditions.
157
What are septate vagina and uterine didelphys?
Manifestations of genetic syndromes, in utero exposure to diethylstilbestrol
## Footnote
These conditions involve the presence of double structures in the reproductive system.
158
What is the term for a double uterus?
Uterine didelphys
## Footnote
This condition occurs when there are two separate uteri.
159
What is the term for a double vagina?
Septate vagina
## Footnote
This condition involves the presence of two separate vaginal canals.
160
What does bicollis refer to?
Having two cervical canals
## Footnote
This condition is often associated with uterine didelphys.
161
What does unicollis refer to?
Having a single cervical canal
## Footnote
This is the more common anatomical configuration compared to bicollis.
162
What structures are involved in the conditions mentioned?
Vagina, fallopian tubes
## Footnote
These structures can be affected by developmental anomalies such as septate vagina and uterine didelphys.
163
What is vaginal adenosism?
Small patches of residual glandular epithelium that persist into adult life
## Footnote
Vaginal adenosism is characterized by abnormal glandular tissue in the vaginal epithelium.
164
Describe the appearance of vaginal adenosism.
Red, granular areas that stand out from the surrounding normal pale-pink vaginal mucosa
## Footnote
The contrast in color is a key diagnostic feature.
165
What type of epithelium is found in vaginal adenosism?
Columnar mucinous epithelium indistinguishable from endocervix
## Footnote
This similarity can complicate diagnosis.
166
What percentage of women exposed to DES in utero may exhibit vaginal adenosism?
35% to 90%
## Footnote
DES (diethylstilbestrol) exposure is a significant risk factor for developing this condition.
167
What are Gartner duct cysts?
Fluid-filled submucosal cysts along the lateral walls of the vagina derived from wolffian (mesonephric) duct rests
## Footnote
Gartner duct cysts are typically 1 to 2 cm in size.
168
Where are Gartner duct cysts located?
Along the lateral walls of the vagina
## Footnote
They are formed from remnants of the wolffian (mesonephric) duct.
169
What is the size range of Gartner duct cysts?
1 to 2 cm
## Footnote
These cysts are submucosal and filled with fluid.
170
Gartner duct cysts are derived from which duct?
Wolffian (mesonephric) duct
## Footnote
This duct is involved in the development of the male and female reproductive systems.
171
What type of carcinoma is virtually all primary carcinomas of the vagina?
Squamous cell carcinomas associated with high-risk HPV infection
## Footnote
High-risk HPV infection is a significant factor in the development of vaginal squamous cell carcinoma.
172
What percentage of malignant neoplasms in the female genital tract does vaginal carcinoma account for?
About 1%
## Footnote
Vaginal carcinoma is considered to be quite uncommon compared to other malignancies in the female genital tract.
173
What is the greatest risk factor for developing vaginal carcinoma?
A previous carcinoma of the cervix or vulva
## Footnote
History of cervical or vulvar carcinoma significantly increases the risk of developing vaginal carcinoma.
174
What premalignant lesion does vaginal carcinoma arise from?
Vaginal intraepithelial neoplasia
## Footnote
Vaginal intraepithelial neoplasia is a precursor to invasive vaginal carcinoma.
175
Where in the vagina does vaginal carcinoma most often affect?
The upper vagina, particularly the posterior wall at the junction with the ectocervix
## Footnote
This location is critical for understanding the spread and treatment of vaginal carcinoma.
176
To which nodes do lesions in the lower two-thirds of the vagina metastasize?
Inguinal nodes
## Footnote
Metastasis to inguinal nodes is significant for the management and prognosis of lower vaginal lesions.
177
To which nodes do lesions in the upper vagina tend to spread?
Regional iliac nodes
## Footnote
Understanding the metastatic pathways is important for staging and treatment decisions.
178
What is the alternative name for embryonal rhabdomyosarcoma?
sarcoma botryoides
## Footnote
This term is often used to describe this specific type of tumor.
179
What type of tumor is embryonal rhabdomyosarcoma?
uncommon vaginal tumor
## Footnote
It primarily occurs in the vaginal area.
180
What are the primary cellular components of embryonal rhabdomyosarcoma?
malignant embryonal rhabdomyoblasts
## Footnote
These are immature muscle cells that are malignant in nature.
181
What age group is most frequently affected by embryonal rhabdomyosarcoma?
infants and children younger than 5 years of age
## Footnote
This condition is particularly prevalent in very young children.
182
How do embryonal rhabdomyosarcomas typically present in terms of appearance?
grow as polypoid, rounded, bulky masses
## Footnote
They resemble grapelike clusters.
183
Fill in the blank: Embryonal rhabdomyosarcoma tends to have the appearance and consistency of _______.
grapelike clusters
## Footnote
This description helps in identifying the tumor's physical characteristics.
184
What is a characteristic feature of tumor cells in embryonal rhabdomyosarcoma?
Tumor cells are small and have oval nuclei, with small protrusions of cytoplasm resembling a tennis racket.
185
What indicates muscle differentiation in embryonal rhabdomyosarcoma?
Striations can be seen within the cytoplasm.
186
Where are the tumor cells located beneath the vaginal epithelium in embryonal rhabdomyosarcoma?
The tumor cells are crowded in a cambium layer.
187
What type of stroma do tumor cells lie within in the deep regions of embryonal rhabdomyosarcoma?
Loose edematous fibromyxomatous stroma.
188
What may be present in the stroma of embryonal rhabdomyosarcoma?
Many inflammatory cells.
189
What type of epithelium is found in the ectocervix?
Non-keratinizing stratified squamous epithelium
## Footnote
The ectocervix is the part of the cervix that protrudes into the vagina.
190
How many layers are present in the ectocervix?
3 layers
## Footnote
The layers include the basal cell layer, stratum spongiosum, and superficial cells.
191
List the three layers of the ectocervix.
* Basal cell layer
* Stratum spongiosum
* Superficial cells
## Footnote
These layers contribute to the structure and function of the ectocervix.
192
What type of cells line the endocervix?
Columnar mucus-secreting cells
193
What structures does the endocervix line?
Both the surface of the endocervical canal and underlying glandular structures
194
What type of cells line the endocervix?
Columnar mucus-secreting cells
195
What structures does the endocervix line?
Both the surface of the endocervical canal and underlying glandular structures
196
What are endocervical glands?
Cleft-like infoldings and tunnel-like collaterals
## Footnote
Endocervical glands are specialized structures within the cervix that secrete mucus and play a role in the reproductive system.
197
What is the squamocolumnar junction?
Point where squamous and columnar epithelium meet
198
What type of cells are found at the squamocolumnar junction?
Mature squamous cells and columnar glandular cells
199
Where does the squamocolumnar junction move upwards into?
The endocervical canal
200
What is a characteristic process occurring at the squamocolumnar junction?
Squamous metaplasia
201
What is another term for the area at the squamocolumnar junction?
Transformation zone
202
What type of cells are considered immature at the squamocolumnar junction?
Immature squamous cells
203
What are endocervical polyps?
Common benign exophytic growths that arise within the endocervical canal
## Footnote
They can vary in size and shape.
204
What is the size range of endocervical polyps?
They vary from small, sessile 'bumps' to large polypoid masses that may protrude through the cervical os
## Footnote
The term 'sessile' refers to polyps that are attached directly by their base.
205
What is the composition of endocervical polyps?
Composed of a fibrous stroma covered by mucus-secreting endocervical glands
## Footnote
The fibrous stroma provides structural support.
206
What symptom can endocervical polyps cause?
Irregular vaginal 'spotting' or bleeding
## Footnote
This symptom may prompt further investigation into cervical health.
207
What is cervical carcinoma ranked in terms of commonality among cancers in women?
Cervical carcinoma is the fourth most common cancer in women.
208
What is the most important factor in the development of cervical cancer?
High-risk HPVs are by far the most important factor in the development of cervical cancer.
209
How many high-risk HPVs are currently identified?
15 high-risk HPVs are currently identified.
210
Which HPV type accounts for almost 60% of cervical cancer cases?
HPV-16 accounts for almost 60% of cervical cancer cases.
211
Which HPV type accounts for another 10% of cervical cancer cases?
HPV-18 accounts for another 10% of cervical cancer cases.
212
What types of warts are caused by low oncogenic risk HPVs?
Low oncogenic risk HPVs cause sexually transmitted vulvar, perineal, and perianal warts.
213
At what age does the prevalence of HPV in cervical smears peak in women with normal Pap test results?
The prevalence of HPV in cervical smears peaks between 20 and 24 years of age.
214
What is required for productive, persistent HPV infection?
Viral entry into immature basal epithelial cells
## Footnote
This is a critical initial step for HPV to establish an infection.
215
Where does viral replication occur in HPV infections?
In maturing squamous cells
## Footnote
This process is essential for the progression of the infection.
216
What type of epithelium is normally resistant to HPV infection?
Mature, intact squamous epithelium
## Footnote
This resistance is due to the protective barrier that mature cells provide.
217
What are the susceptible sites in the female genital tract for HPV infection?
Areas of squamous epithelial trauma and repair
## Footnote
These sites allow the virus to access basal cells.
218
What specific cells at the squamocolumnar junction of the cervix are susceptible to HPV?
Immature metaplastic squamous cells
## Footnote
These cells are particularly vulnerable to HPV infection.
219
What are the key viral proteins of HPV that act as carcinogens?
E6 and E7 proteins
## Footnote
These proteins interfere with the activity of tumor suppressor proteins p53 and RB.
220
Which tumor suppressor protein does the HPV E6 protein interfere with?
p53
## Footnote
p53 is crucial for regulating the cell cycle and preventing tumor formation.
221
Which tumor suppressor protein does the HPV E7 protein interfere with?
RB
## Footnote
RB plays a key role in controlling cell division and preventing excessive cell growth.
222
True or False: A high percentage of young women infected with HPV develop cancer.
False
## Footnote
Although many young women are infected, only a few develop cancer.
223
What additional factors influence the development of cancer in HPV-infected individuals?
Exposure to co-carcinogens and host immune status
## Footnote
These factors can modify the risk of developing malignancy.
224
Fill in the blank: The ability of HPV to act as a carcinogen depends on the viral _______ and _______ proteins.
E6, E7
225
What types of cells are involved in the context of cervical neoplasms?
Mature squamous cells, Immature squamous cells, Squamocolumnar junction, Columnar glandular cells
## Footnote
These cell types are relevant in the pathology of cervical cancer.
226
What does CIN stand for?
Cervical intraepithelial neoplasia
## Footnote
CIN refers to the classification of squamous cervical precursor lesions.
227
What is the classification for mild dysplasia?
CIN I
## Footnote
CIN I is also categorized as low-grade SIL (LSIL).
228
What classification corresponds to moderate dysplasia?
CIN II
## Footnote
CIN II is categorized as high-grade SIL (HSIL).
229
What classification is used for severe dysplasia?
CIN III
## Footnote
CIN III is also classified as carcinoma in situ and high-grade SIL (HSIL).
230
True or False: LSIL progresses directly to invasive carcinoma.
False
## Footnote
Most cases of LSIL regress spontaneously and only a small percentage progress to HSIL.
231
What does LSIL represent in terms of HPV infection?
A productive HPV infection with high viral replication
## Footnote
LSIL indicates an active HPV infection rather than a premalignant lesion.
232
Fill in the blank: LSIL is categorized as _______.
Low-grade SIL (LSIL)
## Footnote
LSIL is the classification for mild dysplasia.
233
What is the classification system for severe dysplasia and carcinoma in situ?
CIN III
## Footnote
CIN III represents both severe dysplasia and carcinoma in situ.
234
What is the relationship between CIN and SIL classifications?
CIN corresponds to dysplasia levels, while SIL represents the severity of the lesions
## Footnote
CIN classifications are used to categorize dysplasia, while SIL classifications indicate the grade of squamous intraepithelial lesions.
235
What does CIN stand for in the context of cervical lesions?
Cervical intraepithelial neoplasia
## Footnote
CIN refers to the classification of precancerous changes in the cervical epithelium.
236
What is the classification for mild dysplasia?
CIN I
## Footnote
CIN I is also referred to as low-grade SIL (LSIL).
237
What classification corresponds to moderate dysplasia?
CIN II
## Footnote
CIN II is classified as high-grade SIL (HSIL).
238
What classification is used for severe dysplasia?
CIN III
## Footnote
CIN III is also categorized as high-grade SIL (HSIL).
239
What does HSIL represent in cervical lesions?
High-grade squamous intraepithelial lesion
## Footnote
HSIL indicates a higher risk for progression to carcinoma.
240
What is the classification for carcinoma in situ?
CIN IIII
## Footnote
CIN IIII is still categorized under high-grade SIL (HSIL).
241
What is the risk associated with HSIL?
High risk for progression to carcinoma
## Footnote
HSIL lesions are more likely to develop into cervical cancer if not treated.
242
What is the effect of HPV on the cell cycle in HSIL?
Progressive deregulation
## Footnote
HPV leads to increased cellular proliferation and decreased epithelial maturation.
243
What may happen to the derangement of the cell cycle in HSIL?
It may become irreversible
## Footnote
This irreversible change can lead to a fully transformed malignant phenotype.
244
Fill in the blank: HSIL is considered to be at ______ risk for progression to carcinoma.
high
## Footnote
This indicates the significance of monitoring and potential treatment for HSIL.
245
True or False: LSIL indicates a higher rate of viral replication compared to HSIL.
True
## Footnote
In HSIL, there is a lower rate of viral replication compared to LSIL.
246
What is the morphologic hallmark of Human Papilloma Virus?
Koilocytosis
## Footnote
Koilocytosis refers to the presence of koilocytic atypia in cells infected with HPV.
247
Define Koilocyte.
A cell with perinuclear vacuolation, enlarged nucleus, undulating nuclear membrane, and rope-like chromatin pattern
## Footnote
Koilocytes are characteristic of HPV infection and are used as a diagnostic feature.
248
What are the key features of a Koilocyte?
* Perinuclear vacuolation
* Enlarged nucleus
* Undulating nuclear membrane
* Rope-like chromatin pattern
249
What is the morphologic hallmark of Human Papilloma Virus?
Koilocytosis
## Footnote
Koilocytosis refers to the presence of koilocytic atypia in cells infected with HPV.
250
Define Koilocyte.
A cell with perinuclear vacuolation, enlarged nucleus, undulating nuclear membrane, and rope-like chromatin pattern
## Footnote
Koilocytes are characteristic of HPV infection and are used as a diagnostic feature.
251
What are the key features of a Koilocyte?
* Perinuclear vacuolation
* Enlarged nucleus
* Undulating nuclear membrane
* Rope-like chromatin pattern
252
What is the association between LSILs and HSILs with high-risk HPVs?
More than 80% of LSILs and 100% of HSILs are associated with high-risk HPVs
## Footnote
HPV-16 is the most common HPV type in both lesions.
253
What is the most common HPV type associated with squamous intraepithelial lesions?
HPV-16
## Footnote
This type is found in both LSILs and HSILs.
254
What percentage of LSILs regress within a 2-year follow-up?
60%
## Footnote
LSIL stands for low-grade squamous intraepithelial lesion.
255
What percentage of HSILs persist over a 2-year follow-up period?
60%
## Footnote
HSIL stands for high-grade squamous intraepithelial lesion.
256
What is the progression rate of LSIL to HSIL within 2 years?
10%
## Footnote
This indicates the potential for progression from low-grade to high-grade lesions.
257
What percentage of HSILs progress to carcinoma within 2 to 10 years?
10%
## Footnote
This highlights the risk of progression to carcinoma from HSIL.
258
Fill in the blank: More than 80% of _______ are associated with high-risk HPVs.
LSILs
259
Fill in the blank: The most common HPV type in both LSILs and HSILs is _______.
HPV-16
260
True or False: 30% of LSILs persist over a 2-year follow-up.
True
261
True or False: 60% of HSILs regress within a 2-year follow-up.
False
262
What is the average age of patients diagnosed with invasive cervical carcinoma?
Between 45 and 50 years
263
What is the most common histologic subtype of cervical carcinoma?
Squamous cell carcinoma (80% of cases)
264
What is the second most common tumor type in cervical carcinoma?
Adenocarcinoma (15%)
265
What precursor lesion develops into adenocarcinoma in cervical carcinoma?
Adenocarcinoma in situ
266
What are the rare types of cervical tumors?
Adenosquamous and neuroendocrine carcinomas (5%)
267
What causes all types of cervical carcinoma mentioned?
High-risk HPVs
268
What is squamous cell carcinoma of the cervix?
Nests and tongues of malignant squamous epithelium that invade the underlying cervical stroma
269
What are the two types of squamous epithelium in squamous cell carcinoma of the cervix?
Keratinizing and nonkeratinizing
270
What does squamous cell carcinoma of the cervix invade?
Underlying cervical stroma
271
What is adenocarcinoma of the cervix?
Proliferation of glandular epithelium
## Footnote
Adenocarcinoma of the cervix is a type of cancer that arises from the glandular cells of the cervix.
272
What type of cells are involved in adenocarcinoma of the cervix?
Malignant endocervical cells
## Footnote
These cells are characterized by significant changes compared to normal endocervical cells.
273
What are the characteristics of the nuclei in adenocarcinoma of the cervix?
Large, hyperchromatic nuclei
## Footnote
Hyperchromatic nuclei indicate an abnormal increase in chromatin, often associated with malignancy.
274
How is the cytoplasm of malignant endocervical cells described in adenocarcinoma of the cervix?
Relatively mucin-depleted cytoplasm
## Footnote
This depletion contributes to the darker appearance of the glands in adenocarcinoma.
275
What is the appearance of the glands in adenocarcinoma of the cervix compared to normal endocervical epithelium?
Dark appearance of the glands
## Footnote
This contrast is due to the changes in cell structure and composition in malignant cells.
276
What is the definition of adenosquamous carcinoma of the cervix?
Adenosquamous carcinoma of the cervix is a type of cancer that is characterized by intermixed malignant glandular and squamous epithelium.
## Footnote
This type of carcinoma combines features of both adenocarcinoma and squamous cell carcinoma.
277
What is aden squamous carcinoma of the cervix characterized by?
Sheets of small cells with scant cytoplasm and hyperchromatic nuclei
## Footnote
Adenosquamous carcinoma is a type of cervical cancer that contains both glandular and squamous cell components.
278
How does advanced cervical carcinoma spread?
By direct extension to contiguous tissues, including paracervical soft tissue, urinary bladder, ureters, rectum, and vagina.
279
What is the result of lymphovascular invasion in cervical carcinoma?
Local and distant lymph node metastases.
280
Where can distant metastases from cervical carcinoma be found?
In the liver, lungs, bone marrow, and other organs.
281
What percentage of invasive cervical cancers are detected in women who did not participate in regular screening?
More than one-half.
282
What factors influence the prognosis for invasive cervical carcinomas?
The stage of the cancer at diagnosis and histologic subtype.
283
What is the prognosis for small-cell neuroendocrine tumors in cervical carcinoma?
Very poor.
284
What is the 5-year survival rate for superficially invasive squamous cell carcinomas with current treatments?
100%.
285
What is the 5-year survival rate for tumors extending beyond the pelvis?
Less than 20%.
286
What is the most common cause of death in patients with advanced cervical cancer?
Consequences of local tumor invasion.
287
How does advanced cervical carcinoma spread?
By direct extension to contiguous tissues, including paracervical soft tissue, urinary bladder, ureters, rectum, and vagina.
288
What is the result of lymphovascular invasion in cervical carcinoma?
Local and distant lymph node metastases.
289
Where can distant metastases from cervical carcinoma be found?
In the liver, lungs, bone marrow, and other organs.
290
What percentage of invasive cervical cancers are detected in women who did not participate in regular screening?
More than one-half.
291
What factors influence the prognosis for invasive cervical carcinomas?
The stage of the cancer at diagnosis and histologic subtype.
292
What is the prognosis for small-cell neuroendocrine tumors in cervical carcinoma?
Very poor.
293
What is the 5-year survival rate for superficially invasive squamous cell carcinomas with current treatments?
100%.
294
What is the 5-year survival rate for tumors extending beyond the pelvis?
Less than 20%.
295
What is the most common cause of death in patients with advanced cervical cancer?
Consequences of local tumor invasion.
296
What is Stage 0 of cervical cancer?
Carcinoma in situ (CIN III, HSIL)
## Footnote
CIN stands for Cervical Intraepithelial Neoplasia and HSIL stands for High-Grade Squamous Intraepithelial Lesion.
297
What characterizes Stage I cervical cancer?
Carcinoma confined to the cervix
## Footnote
This stage is further divided into sub-stages la and Ib.
298
Define Stage la cervical cancer.
Preclinical carcinoma, diagnosed only by microscopy
## Footnote
Stage la is subdivided into la1 and la2 based on the depth of stromal invasion.
299
What is the depth of stromal invasion for Stage la1?
No deeper than 3 mm and no wider than 7 mm
## Footnote
This is classified as superficially invasive squamous cell carcinoma.
300
What distinguishes Stage la2 from Stage la1?
Maximum depth of invasion of stroma deeper than 3 mm and no deeper than 5 mm
## Footnote
Horizontal invasion for la2 must be no more than 7 mm.
301
What characterizes Stage Ib cervical cancer?
Histologically invasive carcinoma confined to the cervix and greater than stage la2
## Footnote
This indicates a more advanced level of invasion compared to la2.
302
What defines Stage II cervical cancer?
Carcinoma extends beyond the cervix but not to the pelvic wall. Involves the vagina but not the lower third.
303
What are the key features of Stage III cervical cancer?
Carcinoma has extended to the pelvic wall. No cancer-free space between the tumor and pelvic wall. Involves the lower third of the vagina.
304
What characterizes Stage IV cervical cancer?
Carcinoma has extended beyond the true pelvis or has involved the mucosa of the bladder or rectum. Includes cancers with metastatic dissemination.
305
What is Stage 0 of cervical cancer?
Carcinoma in situ (CIN III, HSIL)
## Footnote
CIN stands for Cervical Intraepithelial Neoplasia and HSIL stands for High-Grade Squamous Intraepithelial Lesion.
306
What characterizes Stage I cervical cancer?
Carcinoma confined to the cervix
## Footnote
This stage is further divided into sub-stages la and Ib.
307
Define Stage la cervical cancer.
Preclinical carcinoma, diagnosed only by microscopy
## Footnote
Stage la is subdivided into la1 and la2 based on the depth of stromal invasion.
308
What is the depth of stromal invasion for Stage la1?
No deeper than 3 mm and no wider than 7 mm
## Footnote
This is classified as superficially invasive squamous cell carcinoma.
309
What distinguishes Stage la2 from Stage la1?
Maximum depth of invasion of stroma deeper than 3 mm and no deeper than 5 mm
## Footnote
Horizontal invasion for la2 must be no more than 7 mm.
310
What characterizes Stage Ib cervical cancer?
Histologically invasive carcinoma confined to the cervix and greater than stage la2
## Footnote
This indicates a more advanced level of invasion compared to la2.
311
What defines Stage II cervical cancer?
Carcinoma extends beyond the cervix but not to the pelvic wall. Involves the vagina but not the lower third.
312
What are the key features of Stage III cervical cancer?
Carcinoma has extended to the pelvic wall. No cancer-free space between the tumor and pelvic wall. Involves the lower third of the vagina.
313
What characterizes Stage IV cervical cancer?
Carcinoma has extended beyond the true pelvis or has involved the mucosa of the bladder or rectum. Includes cancers with metastatic dissemination.
