Gynecologic and Obstetrical Pathology - Witrak Flashcards
What are the acute signs/symptoms of STDs?
vulvar/vaginal pain/discomfort, discharge, or erythema, ulceration
What are the chronic or delayed signs/symptoms of STDs?
pelvic inflammatory disease (pelvic pain, sterility, ectopic pregnancy)
condyloma/squamous intraepithelial neoplasia/carcinoma
AIDS
chronic viral hepatitis
2°/3° syphilis
More than 95% of abnormal vaginal bleeding is due to what female reproductive origin?
Endometrial
What is dysfunctional uterine bleeding? Etiologies?
Disorders of ovulatory cycle (anovulation):
either idiopathic, perimenarchal, perimenopausal,
OR due to primary ovarian disease (PCOS, sex cord/stromal tumors), primary endocrine disorders, or systemic disease
Post-menopausal vaginal bleeding is due to what condition until proven otherwise?
Cancer
What are some of the various etiologies of abnormal vaginal bleeding?
Endometrial atrophy (post-menopausal)
Endometrial hyperplasia/carcinoma
Structural disorders of endometrium/myometrium: endometrial polyps, submucosal leiomyomas, adenomyosis, endometriosis
Abnormal gestation: early trimester miscarriage, ectopic gestation, mid/late trimester bleeding
Cervical or vaginal neoplastic disease
What are the major considerations in the setting of an Adnexal Mass?
Non-neoplastic ovarian/tubal disease: Pelvic inflammatory disease, Ectopic gestation
Cysts: paratubal, ovarian follicle and corpus luteal.
Endometriosis
Neoplastic disease (ovary dominant, tube rare)
Primary ovarian neoplasms
Tumors secondarily involving ovary
- adjacent GYN CA vs. other: appendix, colon, breast, stomach
What are the primary ovarian neoplasms to consider in the setting of an Adnexal Mass?
- epithelial: benign vs. malignant vs.
“borderline”; serous vs. mucinous vs.
endometrioid vs. clear cell vs. transitional cell - sex cord/stromal tumors (± estrogen or
testosterone secretion) - germ cell: esp. dermoid cyst
An adnexal mass in a post-menopausal female is what condition until proven otherwise?
Cancer
What conditions can cause pelvic floor insufficiency?
uterine prolapse, cystocele, rectocele with associated dysfunctional bladder or bowel symptoms
What is Urogynecology?
OBGYN specializing in hysterectomy with pelvic floor reconstruction
What are the clinical signs and symptoms of Pelvic Inflammatory Disease?
-classically: lower abdominal pain, purulent
endocervical discharge, deep dyspareunia,
cervical motion and adnexal tenderness on bi-
manual exam ± fever and abnormal vaginal bleeding
- Many cases are sub-clinical: first evidence of
PID may be tubal infertility
What patient population is commonly affected by Candida albicans infections?
overgrowth and infection usually ages 20-40:
especially if diabetes, on antibiotics, pregnancy,
immunosuppression
What is the terminology in HPV-related neoplasms? (e.g. CIN, VIN, VAIN, AIN, PAIN)
HPV: pre-invasive disease terminology by region
CIN: cervical intraepithelial neoplasia
VIN: vulvar intraepithelial neoplasia
VAIN: vaginal intraepithelial neoplasia
AIN: anal intraepithelial neoplasia
PAIN: perianal intraepithelial neoplasia
- grade 1 = low grade dysplasia; grade 2-3 = high grade dysplasia
- all above are squamous in type.
HPV also infects endocervical glandular mucosa
- can cause adenocarcinoma-in-situ (AIS)
with subsequent risk of invasive cervical adenocarcinoma
What are the early and late symptoms of Cervical Cancer?
- early Sx: irregular or heavy vaginal
bleeding, post-coital bleeding, or non-
bloody vaginal discharge - late Sx: invasion of parametrium
(pain), cervical stenosis (pyometra),
direct invasion of vagina with secondary
malignant fistulas into bladder (± ureteral
obstruction/hydronephrosis) or rectum; sacral
plexus invasion (sciatic pain)
