Module 3: Genital: Vular Carcinoma, Ectopic, Abortion, Hydatidiform and Chorio Flashcards
First topic of this set is vulvar carcinoma. There are two types of vulvar carcinoma. The first types is classic type. What are some features?
HPV 16,18,31,33 mutation
- -women around 40 years old
- –smoking/immunosuppressed patients
Leukoplakia is seen in patients with vulvar intraepithelial neoplasia classic types. What are the types of leukoplakia?
Lichen sclerous/Kraurosis Vulvae: autoimmune and in post menopausal women
–scaly plaques; thin parchment like with dense collagen
–slight increased risk for carcinoma
Squamous Cell Hyperplasia/Hyperplastic dystrophy: post menopausal women
–localized hyperplastic dermis
–no malignant potential
The next type of vulvar carcinoma is vulvar intraepithelial neoplasia differentiated type. what are some features?
More Common
- -greater than 60 years old
- -anterior 2/3rd of labia major most common site
- -squamous cell carcinoma
- -inguinal and pelvic lymph nodes
- -greater than 1mm than increased risk of metastasis
If invasion of either type ,what is a symptom?
Inguinal lymphadenopathy
Next topic dealing with pregnancy is ectopic pregnancy. what does the gross image look like?
Intratubal hematoma of the Ampulla of the Fallopian Tube with a small embryo
–congested and dilated
What is the etiology for an ectopic pregnancy?
Interference of passage of the ovum either due to:
- -chronic PID and scarring (untreated chlamydia from US)
- -Endometriosis (cause scarring of the tubes from inflammation)
- -any condition that causes blockage or fibrosis of the fallopian tubes or surrounding areas
What is the pathogenesis for an ectopic pregnancy?
Fertilized ovum implanted outside the uterine cavity
–Initially embryo is viable and women have amenorrhea and elevation of b-hCG which produces progesterone — causes hypersecretion in endometrium
After about 2-6 weeks post fertilization: Due to lack of space and blood supply embryo dies – drop in b-hCG–leads to degeneration of corpus luteum — decreased progesterone and estrogen – lower abdominal pain and vaginal bleeding due to the endometrium breaking down
What are common sites for ectopic pregnancy?
1% of pregnancies implant ectopically
–90%: Ampulla of fallopian tubes
other sites include cervix, ovaries and abdominal cavity
–in the Ampulla because fertilization happens here
What investigations are done for ectopic pregnancy?
Ultrasound most accurate tool
–visualize fetus in the fallopian tube, complete absence of uterine enlargement, expansion of adenxa
Surgical or Methotrexate treatment
What are complications of an Ectopic Pregnancy?
Rupture of ectopic pregnancy — sudden onset of intense abdominal pain – hypovolemic shock and death
- -prompt surgical intervention
- -Mimics acute appendicitis if on right side
If you do a D and C of the endometrium in patients with ectopic pregnancy what will you see?
Hypersecretory glands without chorionic villi
- -on histology you will see arias stella reaction due to increased progesterone
- -remember that spontaneous abortion also has hypersecretory glands except that it also has chorionic vili b/c implantation is in the right place.
Moving onto abortion around what time does this happen in the body?
Delivery 8-20 weeks due to defective chromosomes
What symptoms do patients get who are undergoing an abortion?
Vaginal Bleeding — rapid/severe shock
Lower abdominal pain due to uterine contractions
What is seen on D and C for abortion?
Have chorionic vili and hypersecretory glands because implanting in the right place
What are the three different types of placentas in a patient that can lead to an abortion?
- Placenta Previa: abnormal placental implantation, implants on LUS, internal OS in 3rd trimester
- Abruptio Placenta: implants normally but for some unexplained reason there is premature separation of placenta, leading to sudden massive hemorrhage
- Absence of plane of separation between vili and myometrium and vili go deep into the myometrium and mother will have retention of the placenta leading to severe hemorrhage.