path of vagina vulva and uterus Flashcards
Describe lymphatic drainage of vulvar, cervical and uterine lesions
VULVAR lesions: drains to inguinal, pelvic, periaortic nodes. Cervical lesions: pelvic (internal/external iliac) and periaortic nodes. Uterine lesions: pelvic (external iliac/ lumbar) and periaortic nodes
Define endophytic, exophytic and pagetoid
enDophytic =growing DOWN into the tissue. exOphytic =growing OUT from the surface. Pagetoid = Single cells/clusters PERCOLATING through the epithelium
Ddx for vulvar pruritis and papules
HSV, molluscum contagiosum, HPV
HSV pathology/ Sx
eosinophilic intranuclear inclusions. Painful red lesions 3-7 days after exposure (red papules > vesicle > coalescent ulcer)
Molluscum contagiosum pathology/ Sx
Flesh colored, pearly skin lesions. Genital in adults, extremities in children (sharing towels). Path: Endophytic growth with eosinophilic inclusion bodies
Condyloma acuminatum pathology
branching treelike cores of stroma covered by squamous epithelium with viral cytopathic change (koilocytic atypia- perninuclear clearing). Hyperparakeratosis: thickened stratum corneum with ghost nuclei. Elongated rete ridges and hypergranulosis
Trichomonas infection Sx and pathology
flagellated protozoan; frothy yellow d/c, dysuria, dyspareunia; “strawberry cervix” on colposcopy
Actinomyces
“sulfur granule” with clublike projections; non-copper IUD, non-pathogenic
Vulvar intraepithelial neoplasia pathology
Nuclear atypia (koilocytes with perinuclear clearing) and lack of maturation
VIN III/ squamous cell carcinoma in situ pathology
Grossly: Discrete white hyperkeratotic raised lesions. Increased mitoses, full thickness dysmaturity (cells at the surface look the same as those near the base)
HPV associated squamous cell carcinoma pathology
Infiltrating irregular nests of malignant squamous cell eliciting a desmoplastic stromal response (tissue with low cellularity, hyalinization, myxoid or sclerotic stroma and disorganized blood vessel infiltration). Basaloid (poorly differentiated) small dark cells infltrating in cords and nests
Inflammatory associated squamous cell carcinoma path
Prominent keratin “pearls” in well-differentiated carcinoma. Increased mitoses, pink cytoplasm
Lichen sclerosus
Itching, fissures/bleeding/pain, dyspareunia. Increased risk (not specified) for developing SCC. Possibly autoimmune related: activated T cells in subepithelial inflammatory infiltrate and increased frequency of autoimmune disorders.
Lichen sclerosus pathology
Smooth white plaques/papules, resembles parchment. Dermal fibrosis (top, solid pink) w/ perivascular mononuclear infiltrate . Thinned epidermis w loss of rete pegs, hydropic degeneration of basal cells & superficial hyperkeratosis.
Extramammary Paget disease pathology
Form of adenocarcinoma. Red, crusted sharply demarcated map like area on vulva. Marked hyperkeratosis and “pale” basal epidermis. Tumor cells with halo in epidermis, occasional gland formation
Malignant melanoma of vulva
rapid vertical growth.
List conditions associated with in utero DES exposure
DES is diethylsilbestrol, a synthetic estrogen prescribed to prevent miscarriage until 1971. Can cause adenosis, clear cell carcinoma
embryonal rhabdomyosarcoma pathology
Gross: Polypoid, rounded, bulky masses which fills and protrude from vagina, resembling grape-like clusters (sarcoma botryoides). Histology: Cambium layer: Dense zone of rhabdomyoblast present beneath the surface epithelium. Small spindle-shaped cells with abundant mitoses. Elongated spindle cells have striations with eosinophilic cytoplasm (rhabdomyogenic differentiation)
Adenosis pathology
Glandular tissue in vagina, mucinous epithelium. Red granular spots and patches. Can have overlying squamous metaplasia as healing phenomenon.
Clear cell carcinoma pathology
Affects anterior upper 1/3 of vagina, with discontinuous areas (kissing lesion). Occurs in women under 30. Tubulocystic pattern of growth with dense hyaline stroma; clear cytoplasm with bland nuclei
Endocervical polyps pathology and treatment
Polyp inside the OS of cervix. Loose fibromyxomatous stroma w dilated, mucus-secreting glands and inflammation. Eosinophilic stroma. Curettage is curative
Most common form of cervical cancer and the most common cause
squamous cell carcinoma- HPV. Adenocarcinoma is 15% of cervical cancer cases and is also caused by HPV
Squamous cell carcinoma pathology
Increased mitoses, full thickness dysmaturity. Infiltrating irregular nests of malignant squamous cells, eliciting a desmoplastic stromal response
Adenocarcinoma in situ pathology
Hyperchromasia, mucin depletion, luminal mitoses, high N: C ratio
Describe histology of proliferative phase of menstrual cycle
straight tubular glands, mitoses, nuclear stratification
Describe histology of secretory phase of menstrual cycle
“S-shaped” tortuous, coiling glands, secretory activity. Subnuclear vacuoles (piano keys)
Describe histology of menstrual phase of menstrual cycle
stromal/glandular breakdown, inflammation, intravascular fibrin
describe the histological effects of exogenous hormones on the uterine lining
Hypersecretory glands (short term), decidualized stromal cells, inactive glands (chronic) and incomplete response
Endometrial histology during pregnancy
stromal decidualization, Arias-Stella Reaction: hypersecretory glands with nuclear enlargement, no mitoses
endometrial histology during menopause
Thin endometrium w/o mitoses. Decreased Cervical mucous and glycogenation. Cystic atrophy
Causes of menometrorrhagia
aka heavy, irregular periods. Polyps, endometritis, mesenchymal neoplasm (adenomyosis, leiomyoma, leiomyosarcoma)
endometrial polyps pathology
Dense pink stroma, haphazardly arranged glands. Cystic dilatation, hormonally unresponsive.
Endometritis path and Sx
Sx: PID, infertility if chronic. Acute: increased PMNs in stroma and glands. Chronic: plasma cells.
adenomyosis vs endometriosis
adenomyosis: endometrial glands and stroma in uterine wall. Endometriosis: endometrial glands and stroma in abnormal exrauterine location. Both cause infertility and dysmenorrhea
Leiomyoma path
Can have single or multiple. Spherical, firm, white, whorled, well circumscribed masses of smooth muscle. Central ischemic necrosis or calcification common. Cigar shaped nuclei
Most common uterine tumor
leiomyoma
Leiomyoma Sx, treatment
Menometrorrhagia, infertility, mass. Treatment: surgery, embolization, GnRH agonist, nothing
Leiomyosarcoma path
Malignant smooth muscle tumor. Infiltrating polypoid mass. Hemorrhage, necrosis. Hypercellular, pleomorphic nuclei, mitoses
Leiomyosarcoma behavior
rapid increase in size, mets to lungs, low survival if high grade (15%)
Risk factors for endometrial cancer
unopposed estrogen supplements, later menopause, low parity, PCOS, obesity, ovarian lesions
simple endometrial hyperplasia pathology and progression and treatment
rarely progesses to cancer. Increased gland to stroma ratio- crowded hyperchromatic glands. Thickened, fluffy endometrium. Treated with progestins
Complex endometrial hyperplasia pathology, progression
nuclear atypia, glandular crowding and architectural complexity. Diffuse involvement of endometrial cavity. 5-30% progress to cancer
endometriod adenocarcinoma grade 1 path
Exophytic (protruding) mass of tightly packed glands without intervening stroma. Squamous metaplasia
endometriod adenocarcinoma grade 2-3 path
solid pattern of growth. Severe nuclear atypia and mitoses
Endometrod adenocarcinoma prognosis
Stage1: 96% survival at 5 years. Stage III: 23%
Serous carcinoma path
type II adenocarcinoma cancer. Papillary growth (fibrovascular stromal cores), atypia, disseminated at presentation.
Malignant Mixed Müllerian Tumor (Carcinosarcoma)
biphasic tumor. Can be Homologous = cell types of tissue normally found in the uterus (smooth muscle, fibroblasts) OR Heterologous = cell types of tissue NOT normally found in the uterus (cartilage, fat, bone, skeletal muscle)
compare type I vs type II endometrial cancers
Both are adenocarcinomas. Type I endometrial cancers occur in younger women and are estrogen-dependent with a generally good prognosis, while Type II endometrial cancers occur in older women, have higher grade histology and poorer prognosis
Both are adenocarcinomas. Type I endometrial cancers occur in younger women and are estrogen-dependent with a generally good prognosis, while Type II endometrial cancers occur in older women, have higher grade histology and poorer prognosis
genes involved in type I endometrial cancer
mutations in PTEN > MLH1 > KRAS > beta catenin
genes involved in type II endometrial cancer
p53 aneuploidy
