Path: Vulva, Vagina, Cervix Flashcards
Top 3 most common sites of genital herpes infection.
- Cervix 2. Vagina 3. Vulva
Time it takes for lesions to appear after exposure to herpes.
3-7 days
Location of sequestered genital herpes viruses.
Lumbosacral dorsal root ganglia
If a herpetic lesion is active during labor and delivery, how should the delivery be handled?
C-section to prevent transmission to the newborn
What are 3 characteristics of cells of a pap smear when it is infected with Herpes?
Molding of nuclei
Margination of nucleoli
Multinucleation
Infectious agent of Molluscum Contaigiousum
Poxvirus
Most common population to develop Molluscum Contaigiosum.
Children between age 2 - 12
How does Molluscum Contaigiosum appear on microscopy?
The cells of the papules with be full of viruses and the nuclei are absent.
Patient presents with white clumpy vaginal discharge and complains of vulvar pruritis.
Candidiasis
-the image shows hyphae (or pseudospores) on papsmear
Patient complains of vaginal pain, speculum exam reveals bright red cervix. Pap smear reveals:
Trichomonas Vaginalis: protozoan infection
Patient presents with white/gray vaginal discharge with fish smell odor. Pap smear reveals
Bacterial Vaginosis caused by Garnerella vaginalis infection. The image shows clue cells.
Main causative agent of pelvic inflammatory disease (PID).
Chlamydia trachomatis
Why is PID caused by Chlamydia worse than PID caused by Gonorrhea?
Chlamydia takes longer to produce symptoms. Damage occurs before symptoms arise whereas Gonoccocal PID is treated earlier due to earlier symptoms.
Patient presents with persistent lower abdominal pain. Salpingo-oophorectomy reveals:
Tubo-ovarian abscess caused by Gonococcal infection.
Major complication of current or past PID.
Ectopic Pregnancy
Name the two major categories Non-neoplastic vulvar disorders.
- Lichen Sclerosis
- thinning epidermis, hyperkeratosis, dermal fibrosis - Squamous Cell Hyperplasia (Lichen Simplex Chronicus)
- epithelial thickening, leukocytes infiltrate the dermis
Causative agent of Condyloma Acuminatum
HPV
(aka genital warts or syphilitic lesion)
Infectious serotypes of agents that cause Condyloma Acuminatum that are oncogenic.
HPV 16 and 18
Name the two types of Squamous Cell Carcinoma of the vulva.
- Basal and Warty Carcinoma
- Keratinizing Squamous Cell Carcinoma
Major risk factor for developing Basal or Warty Carcinoma of the vulva.
Infection of HPV serotype 16 (18 and 31 are also possible but less common)
-usually sexually transmitted
What does this biopsy of vulvar tissue indicate?
Indicates Basal or Warty carcinoma that is still in situ or intraepithelial (VIN). The basement membrane is still intact. The cell layers show a lack of maturation characteristic of neoplasia. The patient is HPV (+).
What does this biopsy of vulvar tissue indicate?
Basal or Warty carcinoma that has invaded through the basement membrane.
What is different about the risk of developing Keratinizing Squamous Cell Carcinoma vs. Basal or Warty Carcinomas?
Keratinizing Squamous cell is NOT associated with HPV infection.
It is mainly a result of individuals with long-standing Lichen Sclerosus or Squamous cell hyperplasia.
What does this vulvar biopsy show?
Keratinizing Squamous Cell Carcinoma.
The dermis contains “nests and tongues” of squamous cells. This cell type is only supposed to be present in the EPIdermis.
What is the prognosis for patients with a Keratizing Squamous Cell Carcinoma lesion 2cm or less vs. one that has entered lymph nodes?
2cm lesion: high survival (60-80% at 5 years)
Lymph node involvement: low survival (less than 10% at 5 years)
What does this biopsy from a sharply circumscribed nodule of vulvar tissue indicate?
Papillary Hidradenoma: a glandular neoplastic lesion with intraductal papilloma projections
A patient presents with a red, pruritic, crusted vulvar lesion. Biopsy reveals this:
Extra-mammary Pagets Disease
-large tumor cells in the epidermis with a “clear halo” separating them from other epithelial tissue
Treatment for extramammary Paget Disease.
Surgical Excision
What is vaginal adenosis?
Persistence of columnar epithelium in the upper 1/3 of the vagina. It should be stratified squamous cells.
Major cause of vaginal adenosis.
Use of the medication Diethylstilbestrol by pregnant patients for estrogen replacement therapy. The adenosis would occur in the later in the life of the fetus of the pregnant patient.
Major complication of vaginal adenosis.
Clear cell vaginal carcinoma
Malnignant vaginal tumor in infants.
Sarcoma botryoides (embryologic rhabdomyosarcoma)
-grapelike
How does Sarcoma Botyroides appear on histological examination?
Cambium Layer: tumor cells appear crowded beneath the vaginal epithelium
Most common site of development of squamous cell carcinoma of the vagina.
At the junction of the upper vagina and ectocervix
What maintains acidic pH in the vagina and cervix?
Lactobacilli sp.
-secrete acid keeping vaginal pH below 4.5
What are endocervical polyps and how are they treated?
Cervical growths of fibromyxomatous stroma. Benign growths that can be removed with simple curettage or surgical excision.
Major risk factor for developing cervical carcinoma.
Infection with HPV serotypes 16 and 18
-carcinomas form once the patient is in an immunocompromised state
Cell type that HPV likes to infect.
Immature basal cells of squamous epithelium. Located at the squamocolumnar junction of the ectocervix and upper vagina.
What is the main classification system used for PREcancerous cervical lesions?
A simplified two-tiered system
- Low Grade (LSIL or Lowgrade Squamous Intraepithelial Lesion): involves Cervical Intraepithelial Neoplasia (CIN) I, the atypical cells exapnd less than 1/3 the epithelial thickness
- High Grade (HSIL): invovles CIN II and CIN III, the atypical cells expand 2/3 of the epithelial thickness
What does an exophytic lesion mean?
Tending to grow outward from its epithelial origin. Seen in a lot of squamous cell pathology.
What is the treatment for most invasive cervical carcinomas?
Hysterectomy with lymph node dissection
+
Radiation
