Path of Vulva, Vagina, & Uterus

Question 1

HSV-2

Answer 1

Painful red lesion 3-7 days after exposure Eosinophili intranuclear inclusion Purulent exudat

Question 2

Molluscum Contagiosum

Answer 2

Pox virus Endophytic growth pattern with eosinophilic inclusions Usually genital in adults, common in children on extremities via sharing of towels Flesh colored pearly, painless skin lesions

Question 3

Trichomonas

Answer 3

Flagellated protozoa “Strawberry cervix” on colposcopy Frothy yellow d/c, dysuria, dysparunia

Question 4

Candida

Answer 4

Normal but can overgrow Can see on wet mount Curdlike d/c, intense vaginal itching

Question 5

Actinomyces

Answer 5

Gram positive bacteria, assoc with non-copper IUD, not pathogenic “sulfur granule” with club like projections

Question 6

Vulvar Intraepithelial Neoplasia

Answer 6

precursor to vulvar squamous cell carcinoma)takes ~10-20 yrs to progress Koilocytic and nuclear atypia

Question 7

Vulvar Squamous Cell Carcinoma ADD PIC

Answer 7

HPV assoc: 16,18, 31 Non HPV: > 70 Lichen sclerosus/d-VIN is precursor lesion “butterfly lesion”smooth white plaques/papules (resembles parchment) Keratin pearls

Question 8

Extramammary Paget Disease

Answer 8

Red, crusted sharply demarcated map-like area Vulvar adenocarcinoma Marked hyperkeratosis Pale basal epidermis Tumor cells with “halo” Distinguish from melanoma (which is S-100 pos)

Question 9

Embryonal Rhabdomyosarcoma

Answer 9

Polypoid, rounded, bulky masses protruding from vagina (“grape like” clusters) From DES exposure Cambium layer: dense layer of small spindle shaped cells

Question 10

Adenosis

Answer 10

Glandular tissue in vagina Usually in women with DES exposure Red glandular spots & patches

Question 11

Vaginal Clear Cell Carcinoma

Answer 11

DES-associated Anterior 1/3 of vagina, often with discontinous area “kissing lesion” Tubulocystic pattern of growth with dense hyaline stroma Clear cytoplasm with bland nuclei

Question 12

Cervical SCC

Answer 12

80/90% cervical cancers Virtually w/HPC 16/18 Infiltrating irregular nests of malignant squamous cells, eliciting a desmoplastic stromal response

Question 13

Adenocarcinoma in Situ

Answer 13

Precursor to cervical adenocarcinoma p16 expression strongly correlated with HPV associated E6/E7

Question 14

Endometritis

Answer 14

PID Acute: PMNs, Curettage curative Chronic: Plasma cells, infertility

Question 15

Adenomyosis/Endometriosis

Answer 15

Endrometrial glands & stroma in abnormal location = painful periods Can cause infertility

Question 16

Leiomyoma

Answer 16

Benign, smooth muscle. Menometrorrhagia White, whorled bundles of bland smooth muscle cells (“cigar shaped nuclei”)

Question 17

Leiomyosarcom

Answer 17

Malignant smooth muscle tumor Infiltrating polpoid mass, hemorrhage necrosis; grows rapidly and often metastasize to lungs; chemoresistant Most common uterine sarcoma (40-60 yrs)

Question 18

Type I Endometrial Cancer

Answer 18

Premenopausal Risk factors: unopposed estrogen, genetics, PCOS, obesity, Lynch syndrome (MLH1, MSH2) Usually get mutations in PTEN, K-RAS, beta-catenin

Question 19

Type II Endometrial Cancer

Answer 19

Serous Adenocarcinomas usuallys affects POST-menopausal women Aggressive (usually p53 mutation) Papillary growth, fibrovascular cores, atypia Disseminated at presentation

Question 20

Answer 20

Vulvar Squamous Cell Carcinoma