Gyn. Flashcards
Squamous cell carcinoma of the labia majora
Note the ulcerated lesion on the labia minora. HPV 16 and 18 are the primary causes. (Neo091)
Vulvar leukoplakia
Note the white discoloration of the thin epidermis. This patient has lichen sclerosis (Gyn224)
Lichen sclerosis of vulva
Note the thinning of the epidermis and hypocellular area in the superficial dermis. It is not a precursor for cancer (Gyn225)
Squamous hyperplasia of vulva
Clinically, this would have looked like leukoplakia. Note the increased stratum corneum, increased thickness of the epidermis, and underlying inflammation. This is a precursor for squamous cancer. (Gyn226)
Vulva with Paget’s disease
Note the large cells surrounded by a clear halo in the epidermis. These are malignant glandular cells (mucin positive, S100 antigen negative). Paget’s is a cancer limited to the epithelium. (Gyn294)
Paget’s disease of the vulva
This slide shows large cells with clear appearing cytoplasm present in the lower portion of the epidermis. These represent Paget’s cells and would stain positive for mucin. (Gyn016)
Paget’s disease of the vulva
Notice that there are several nests of large clear cells present in the owner portion of the epidermis. These represent Paget’s cells. (Gyn017)
Gartner’s duct cyst
Note the cyst in the lateral wall of the vagina. Remnant of Wolffian duct (mesonephric duct). (Gyn227)
Rokitansky-Kuster-Hauser syndrome (Mullerian agenesis)
Note absence of the vagina. The uterus is often absent as well. The patient has primary amenorrhea due to an end-organ defect. (Gyn228)
Herpes genitalis on labia
Note the grouping of the areas of ulceration on the labia. (Gyn310) 765
Herpes genitalis on shaft of penis
Note the ulcers and vesicular lesions. (Gyn201)
Tzanck prep of Herpes genitalis lesion
Note the multinucleated squamous cell and the dark red intranuclear inclusions surrounded by a halo. (Gyn309)
Herpes genitalis cervicitis
Note the erosive nature of the inflammation (Gyn202)
Herpes genitalis proctitis
Note the vesiculoulcerative nature of the lesions (Gyn203)
Condyloma acuminata (“venereal wart”)
Note the fern-like appearance of the lesion on the shaft of the penis. It is caused by HPV 6 or 11. (Derm012)
Chlamydia trachomatis urethritis
Note the watery exudate exuding from the meatus of the penis. Gram stain reveals neutrophils but no visible organisms (sterile pyuria). Symptoms occur the second week after sexual exposure. (Gyn204)
Chlamydia trachomatis in cervical Pap smear
Note the cytoplasmic inclusions with the vacuoles (lysosomes) and centrally located elementary bodies. (Gyn308)
Chlamydia trachomatis conjunctivitis in a newborn (ophthalmia neonatorum)
Conjunctivitis is usually bilateral and occurs during the second week after delivery. Infection occurs from contamination of the eyes on passage through an infected endocervical canal. Chlamydia trachomatis pneumonia also commonly occurs at the same time. (Gyn205)
Neisseria gonorrhoeae urethritis/ cervicitis
Note the thick exudate from the penis and surrounding the external os of the cervix. Symptoms appear within the first week after sexual exposure. (Gyn206)
Neisseria gonorrhoeae gram stain
Note the neutrophil on the right of the screen. It contains numerous gram negative diplococci. The gram negative rods are Lactobacilli. (Gyn311)
Pelvic inflammatory disease due to Neisseria gonorrhoeae
Note the inflamed fallopian tubes and enlarged ovaries (contain abscesses). (Gyn208)
Pelvic inflammatory disease due to Neisseria gonorrhoeae
Note the pus in the lumens of both fallopian tubes and the multiloculated abscesses in both ovaries. (Gyn307)
Fitz-Hughes-Curtis syndrome
Note the adhesions between the parietal peritoneum and the capsule of the liver. Pus from pelvic inflammatory disease due to Neisseria gonorrhoeae and/or Chlamydia trachomatis may produce these adhesions. Patients complain of chronic pain in the RUQ. (Gyn209)
Vulvar lymphedema secondary to lymphogranuloma venereum
LGV is due to a variant of Chlamydia trachomatis. Unlike other STDs, this STD has papular lesions (not visible) rather than ulcers and granulomatous microabscesses in the inguinal lymph nodes. Obstruction of lymphatics leads to localized lymphedema. Rectal strictures are also common in women. (Gyn314)
Chancroid (Hemophilus ducreyi)
Note the ulcer on the shaft of the penis. Unlike syphilis, it is painful. Gram stain demonstrates a school of fish orientation of the gram negative organisms. (Gyn306)
Granuloma inguinale (Calymmatobacterium granulomatis)
Note the serpiginous ulcers. Unlike other STDs, there is no lymphadenopathy. (Gyn217)
Donovan bodies in macrophages in granuloma inguinale
Note the phagocytosed organisms. They are very similar in appearance to Histoplasma yeasts and leishmanial forms in leishmaniasis. (Gyn312)
Clue cell in bacterial vaginosis due to Gardnerella vaginalis
Note the granular material (adherent bacteria) covering the surface of the superficial squamous cell. These are called clue cells. (Gyn304)
Dark field of Treponema pallidum
Note the tightly wound spirochete. Dark field is considered the gold standard for diagnosing syphilis. (Gyn210)
Clear cell carcinoma of the vagina
This lesion is found in the daughters of women who took DES. Daughters are predisposed to vaginal adenosis (benign Mullerian epithelium), which is the precursor for clear cell adenocarcinoma. It occurs in the age group of 17-22 and occurs on the anterior wall of the upper third of the vagina where Mullerian epithelium joins with the urogenital sinus. Notice that the tumor forms glandular structures on the left or sheets of clear staining cells on the right. (Gyn022)
Embryonal rhabdomyosarcoma
This slide shows a classic feature of the embryonal rhabdomyosarcoma (skeletal muscle sarcoma), mainly cross striations. (Neo205)
Cervical pap smear with endocervical cells
Note the glandular appearing endocervical cells on your left. These indicate that there is adequate sampling of the transformation zone, the primary site for squamous dysplasia and cancer. (Gyn231)
Cervical pap smear with superficial squamous cells
Note the eosinophilic cytoplasm (may be blue) and pyknotic nucleus. These cells indicate estrogen stimulation. (Gyn315)
Cervical pap smear with intermediate squamous cells
Note the blue cytoplasm (may be eosinophilic) and less dense appearing nuclei. These indicate progesterone stimulation. (Gyn316)
Cervical pap smear with parabasal cells:
parabasal cells indicate the absence of estrogen and progesterone stimulation. (Gyn317)
Nabothian cysts
Nabothian cysts arise in endocervical glands where the gland duct has been blocked by squamous epithelium that has replaced endocervical epithelium. Nabothian cysts are a feature of chronic cervicitis. (Gyn038)
Carcinoma-in-situ (CIN III) of the cervix
Note the full thickness dysplasia of the epidermis and lack of surface maturation. HPV 16 or 18 are the MC causative agent. (Neo093)
Koilocytosis of cervix
Note the squamous cells with the pyknotic nuclei surrounded by a clear space (called koilocytosis). These cells have been infected by HPV. (Gyn318)
Cervical dysplasia mosaic pattern
This pattern is associated with dysplasia of the cervix. It is produced when acetic acid is applied to the surface of the cervix. This application coagulates the proteins of the nucleus and cytoplasm of the cervical cells and makes the proteins opaque and white. The term referring to this change is called acetowhite epithelium. The mosaic pattern is caused by terminal capillaries surrounding roughly circular or polygonal shaped blocks of acetowhite epithelium crowded together which causes the mosaic pattern similar to mosaic tile. The vessels form a basket around the blocks of abnormal epithelium. (Gyn047)
Invasive cervical squamous carcinoma
The rectal vault is to your left. A portion of distal vagina and ulcerated cervix, representing squamous cancer, is in the middle. The urinary bladder is on your right. Note the white appearing cancer extending through the wall of the cervix into the wall of the subjacent urinary bladder. Although not visible, the ureterovesical junction is in this area and is most likely blocked by the cancer. This explains why renal failure is the MC cause of death. (Gyn319)
Endometrial cycle
This slide shows the early proliferative phase which is evidenced as elongation of the endometrial glands. The cells lining the glands show scattered mitotic figures. There is no obvious stratification at this time. (Gyn051)