Gyne I Flashcards
What are the embryological structures that fuses to give the Uterus
Mullerian Ducts
Wolffian ducts AKA mesonephric duct for bladder, male reproductive;
Common Infective agents and presentations
+ Antibiotics, 2 each
Viruses
- HSV II, Herpes Ulcer
- HPV, Warts, IN, IC
- Poxvirus, Mulluscum Contagiosum
Bacteria
- N. Gonorrhea - IM Ceftriaxone (+ Azithromycin but CDC no more)
- Chlamydia trachomatis (Azithromycin, Doxycycline)
present w various infections - salpingitis, endometritis, cervicitis
Parasites
- Toxoplasmosis
- Trichomonas - STI
Fungi
- Candida
How does PID present and cause
Cx
Cause: infection spreading upwards or by blood
- mostly STD from vagina spread upwards hence
Vagina Discharge
Pelvic Pain
Cx
Peritonitis
Sepsis
Infertility, Ectopic Pregnancy
Adhesions - Adhesions develop as the body attempts to repair itself.
Fitz-Hugh–Curtis syndrome is a rare complication of pelvic inflammatory disease (PID) involving liver capsule inflammation leading to the creation of adhesions.
Vulva Anatomy
Labia Minora, Labia Majora
Vagina - Bartholin Gland openings beside vagina
Vulva epithelial non-neoplastic diseases [4]
Bartholin Cysts
Warts HPV 6, 11: Condyloma acuminata
Dermis Inflammations:
Lichen Sclerosus (autoimmune) - thin epi
Lichen Simplex Chronicus (itchy, scratching) - thick epi
- Lichen: any of various papular skin diseases in which the lesions are typically small, firm papules set very close together
Vulva Malignancies
- give origins
VIN - SCC
Origin: HPV 30%, dysplasia, then in situ neoplasia; or LS/LSC 70% then hyperplasia
VAC - Paget’s Disease, AC in situ
Origin: epithelial progenitor cells
- Originates from local organs such as the Bartholin gland, the urethra, or the rectum.
Rare Vagina Cancer now
DES - CCA
Clear Cell Adenocarcinoma, when mother treated w DES during pregnancy causing adenosis;
Clear Cell: Vacuolated tumor cells w glandular structures
Infant Vagina Cancer
Embryonal Rhabdomyosarcoma
aka Sarcoma Botryoides
Cluster, grape-like, skeletal muscle
Name all 3 Vagina Cancers
VAIN - Vagina Intraepithelial Neoplasia
- There are two primary types of vaginal cancer: squamous-cell carcinoma and adenocarcinoma; most common is SCC
CCA
E. Rhabdomyosarcoma
Gimme epithelium @ cervix
and cancer
Ectocervix - SS
Squamocolumnar Junction - where HPV hands
Endocervix - Simple Columnar
Cervical IN, SCC by HPV
Cervical Cancer risk factors
Since HPV…
- STD, multiple partners, infections, HPV 16, 18
Name 2 tumor suppressor genes involved in CC
p53 and Retinoblastoma
Rb active form inhibits cell cycle; HPV proteins inhibit this;
Rb blocks G1 to S
Should an oncogenic protein, such as those produced by cells infected by high-risk types of human papillomavirus, bind and inactivate pRb, this can lead to cancer.
HPV CPE [3]
Enlarged nuclei
Perinuclear Halos - cytoplasm pushed to periphery
Crinkled Nuclei
Which categoris of CIN is low grade Squamous Intraepithlial Lesion LSIL and which is HSIL
CIN I is LSIL
CIN II onwards is HSIL
Where can SCC cervical cancer spread to
Local: bladder, uterus, vagina, rectum
Blood, LN
Gimme every disease of the Uterus by layers
Note endometrium layer is not endothelium only
Endometrial Layer - Endometrial Cancer, Stromal Cancer, Endometriosis
Myometrial Layer - Leiomyoma (Fibroid), Adenomyosis, Leiomyosarcoma,
Gimme Endometrium and Egg changes WRT Menstrual Cycle and hormone involved
4 days bleeding
- oestrogen increases,
- Endometrium proliferative stage, glands become more coiled
14 Day
- Ovulation - rupture of Graafian Follicle
- Corpus Luteum maintains endometrium, secretory stage by Progesterone
28 Day
- Corpus Luteum dies, endometrium sheds
What if endometrium high oestrogen no progesterone?
[2 types]
Endometrial Hyperplasia - increase in glands;
also have PTEN TSG mutation
- Simple: cystic DILATED glands
- Complex: CROWDED glands, stratified epithelium, more glands than stroma proliferation, PTEN tsg
The endometrial lining fails to shed when there is an absence of progesterone. In these cases, there is a hormonal imbalance where there is too much estrogen and not enough progesterone.
Symptoms: amenorrhea; abnormal heavy bleeding
What if no oestrogen
Endometrium remains thin and inactive;
- Hence post menopausal or whatever
Amenorrhea
Endometrial Cancer
2 developmental types
Endometrial Carcinoma (adenocarcinoma)
2 Development
- Type I: Hyperplasia from oestrogen stimulation - EHP then EC (MAJORITY)
- Type II: De novo - mutations wo hyperplasia, start from atropic endometrium - mainly in (Post Menopausal women)
What is most common endometrial cancer
- gene involved
Endometrial Cancer - epithelial cancer - mostly adenocarcinomas; PTEN tsg mutated away;
Type I is most common - oestrogen influenced;
- low grade
- history of endometrial hyperplasia
Type II development in Post-menopausal women
- high grade
Most common benign uterine cancer
- Pathophysiology
- Presentation
What happens during pregnancy
Name the most common malignant uterine cancer
Fibroids - Leiomyoma
- hormone dependent - estrogen receptor
- white, tan solid nodules
- Whorled (fascicular) pattern of smooth muscle bundles
Pregnancy - rapid growth, infraction, haemorragic degeneration;
- due to high oestrogen during pregnancy
Most common malignant uterine cancer is Endometroid AC
Endometriosis
1 Presentation
Endometrial Tissues outside cavity - undergoing cyclic bleeding
- Pelvic pain
Adenomyosis
Gross Presentations [2]
Clinical Presentations [2]
Ectopic endometrium tissue form diverticular and detach into the myometrial layer;
- Smooth muscle hyperplasia - Trabeculation
- Note SMH is reactive to the displaced glands
- Hemorrhage, uterus thickening
- Dysmenorrhea
Heavy menstrual bleed w more endometrial tissue and its connection to the surface;
Painful menses from prostaglandins
Difference between adenomyoma vs invasive endometrial AC
Adenomyosis is benign - normal gland architecture, normal mitosis
- Responses to hormones
while cancer has cancer features and also WO stroma diverticulating downwards together w the glandular structure.
Compare and Contrast
- Adenomyoma and Leiomyoma
Pathology:
- ectopic endometrium grow into myometrium
- cause not known, estrogen def plays role in endometrium proliferation
- myometrium smooth muscle proliferation due to Oestrogen influence
Presentation:
- both leads to heavy bleeding
- pain in adenomyoma due to PG from endometrial tissues
