Pathology Of The Female Genital Tract Flashcards

1
Q

The principal parts of the female genital tract are:
– _________
– _________
– _________
– Uterus
– _________
– _________

A

The principal parts of the female genital tract are:
– Vulva
– Vagina
– Cervix
– Uterus( Endometrial pathology to be taken by Dr Dawodu)
– Fallopian tubes
– Ovaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of Vaginal bleeding
• In pregnancy
-Haemorrhage from placenta (e.g., ____________ ), placental bed (e.g. ____________) or deciduas (e.g., ____________)

• Post-coital Haemorrhage
-from _______ on _______ (e.g. ____________)

• Post-menopausal Haemorrhage
-from uterine ______ (e.g. _____, _____)

A

placenta praevia ; miscarriage

ectopic pregnancy

lesion ; cervix ; carcinoma

lesion ; polyp ; carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Abnormal menstruation

Causes:
• __________ disturbance, __________ dysfunction, Defects in __________, __________

A

Psychological ; Hormonal

local hemostasis

Fibroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pain In female genital tract

•Physiological distended or ruptured _______
•Pathological distension or rupture (e.g., ____________ pregnancy)

•Muscular spasm (e.g., __________), Ischaemia or inflammation (e.g., _________)

•Menstrual pain due to __________

A

CLH (corpus luteum Haemorrhage)

tubal ectopic

uterine contractions; ovarian torsion

adenomyosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Causes of Abdominal distension

• _________
• _________ enlargement
• Ovarian _____ and ______

A

Ascites

Uterine enlargement

Ovarian cysts and Tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of Abdominal distension

• Ascites
– e.g. ______ involvement by __________
– _____ Syndrome

• Uterine enlargement
– _________
– uterine ________

• Ovarian cysts and Tumours

A

peritoneal ; ovarian carcinoma

Meigs

pregnancy , uterine fibroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Meigs syndrome

ovarian _____, _________ and , _______)

A

Fibroma
Pleural effusion
Ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Infections- STI
• Genital herpes simplex virus (HSV-2)
• Chlamydia trachomatis
• Human papillomavirus (HPV)
• Molluscum contagiosum ,(MCV-2)
• Trichomoniasis
• Gonorrhoea
• Chancroid
• Granuloma inguinale
• Lymphogranuloma venereum /Syphilis
• Ureaplasma urealyticum & Mycoplasma hominis

A

LMAO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Symptoms of STI
• Vaginal _________
• Vulvar _______ (e.g., _________ and ______)
• Pelvic _________ or pelvic _________
• _________ during intercourse (_________)

A

discharge; lesions

vesicles ; ulcers

pain ; mass

Discomfort ;dyspareunia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Candida albicans

• Occurs in approximately ____% of women, who are usually (aware or unaware?) of the infection.
• __________ , __________, and __________ promote fungal growth
• Diagnosis is best made _____scopically on __________ or __________

A

10% ; unaware

Pregnancy ; oral contraceptives

diabetes ; microscopically

wet mounts ; Pap smear.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Candida albicans is considered an STI

T/F

A

F

is not considered an STI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical features of candidiasis
• Vulvovaginal __________
• __________
• __________
• Appears as __________ patches on the __________ surface and increased ____-like __________ with __________.
• Mucosal __________ in severe infections

A

pruritus; Erythema

Swelling; white

Mucosal ;curd

vaginal discharge ; itching.

ulcerations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Vaginitis- Gardnerella vaginalis:

• Causes _______ Vaginitis (____)
• >___% of women BV have no symptoms.
• The infection is best recognized on ________ by the appearance of “____ cells” (i.e., _____ cells covered with ______).

A

Bacterial Vaginitis (BV)

> 50%

Pap smear ; clue

squamous ; bacilli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Vaginitis- Gardnerella vaginalis:

• symptoms include:
– excessive, (thin or thick?) _____ or _____ vaginal discharge that ________________

– ________ or ________, unpleasant vaginal odour, most noticeable after ________
– Vaginal ________ and ________

A

thin ; gray or white

sticks to the vaginal walls

fishy or musty ; sex

itching and irritation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ureaplasma urealyticum and Mycoplasma hominis species

• These account for some cases of _______ and _______ and have been implicated in ____________ and _________ in pregnant patients.

A

vaginitis and cervicitis

chorioamnionitis

premature delivery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Pelvic Inflammation disease,(PID).

• The term PID is used for extensive infections involving more than one part of the upper female genital tract.
• ___________, (________)
• ____________ or
• __________ and ______.

A

salpingitis, (pyosalphinx)

endometritis

oophoritis and peritonitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Pelvic Inflammation disease,(PID).

– ____ may penetrate into the pelvis in pockets formed by _________________ with other pelvic organs (e.g., tubo-ovarian abscess).

A

Pus

fibrous adhesions with other pelvic organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Clinical consequences of PID

• ________ due to occlusion of fallopian tubes

• Chronic nonspecific infection, presenting with fever, malaise, and fatigue

• _____ pelvic mass associated with _____ during urinary bladder distension or defecation or intercourse (dyspareunia)

• _______, peritoneal _______, or generalized _________

A

Infertility ; Tender

pain ; Peritonitis

peritoneal adhesions ; bacteremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Aetiology of PID
• Complication of STI, secondary to _______ _______ and _______ ________

• Complication of _______ infections (i.e., _______ ————— infection during delivery or abortion).

A

Neisseria gonorrhoeae ; C. trachomatis.

puerperal ;polymicrobial ascending

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Condyloma acuminatum
•aka _________
•caused by _____ types ____ and ____

•The _______ epithelium is (benign or malignant?)

A

Vulvar wart

HPV; 6 & 11

squamous

benign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

vulvar wart (_____)

Characterized by
_____osis , _______osis, _________osis.

_______osis is a sign of HPV infection.

A

Condyloma acuminatum

Acanth

Hyperkerat; Parakerat

Koilocyt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Vulva tumours
• __________ —————

• Vulvar _________ ——————- (VIN)

A

Papillary hidradenoma

Vulvar intraepithelial neoplasia (VIN)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Vulva tumours
• Papillary hidradenoma

– (Benign or Malignant ?) tumor of the _________ gland
– (Painful or Painless?) nodule on the ___________

A

Benign ; apocrine sweat gland

Painful nodule

labia majora

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Vulva tumours

• Vulvar intraepithelial neoplasia (VIN)
– Dysplasia ranges from ____ to __________
– Strong human papillomavirus (HPV) type ____ association
– Precursor for developing _____________

A

mild to carcinoma in situ

16

squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Vulva cancers • (Common or Rare?) . •___% of the FGT cancers. • Usually diagnosed in (young or elderly?) women • Commonest: —————- carcinoma • Rare forms: ____________ disease, ______-.
Rare ; 3% elderly women squamous cell carcinoma extramammary Paget’s disease, melanoma.
26
Squamous cell carcinoma Most _______ Cancer Vulva Intra epithelial Neoplasm,(vulvar _________ or ______ disease, a ________ squamous cell carcinoma. • Histologically classified as _________ or _______ differentiated (basaloid) squamous cell carcinomas. • Metastasize first to the _________
common; carcinoma in situ Bowen; preinvasive keratinizing or poorly inguinal nodes
27
Squamous cell carcinoma Vulva Iintraepithelial Neoplasm, – Often _______ – Associated with HPV infection(type _____) cigarette smoking, ____
multicentric 16 AIDS
28
Extramammary Paget's disease – _____ color , _______ vulvar lesion – _____________ adenocarcinoma – Tumor derives from _______ ________ ________ cells – Malignant Paget's cells contain ______ that is __________(____) positive. – Spreads along the ________ – Rarely invades the _______
Red, crusted Intraepithelial primitive epithelial progenitor cells mucin ; PAS (periodic acid-Schiff) epithelium ; dermis
29
Developmental anomalies • _______ or _______ vagina/ Double _______ (_______ _______) • Vaginal __________ • ________ ——— cysts • _________ cysts • Endometriosis
Septate ; double uterus ; uterus didelphys adenosis ; Gartner duct Mucus
30
Vaginal adenosis,(associated with _____ use in ______ and _______ of the vagina)
DES utero carcinoma
31
Vagina tumours • Benign – __________ – Stromal __________ – __________ • Premalignant – ______________________ • Malignant – __________ – __________ carcinoma – Embryonal __________
– Leiomyomas – Stromal polyps – Hemangiomas – Vaginal intraepithelial neoplasm, (VAIN) – Metastasis – Squamous cell carcinoma – Embryonal rhabdomyosarcoma
32
Vagina cancers. • (Common or Rare?) •____% of all female genital cancers. • Most vaginal carcinomas diagnosed in _______ women are of the ______________ type.
Rare ; 1% adult women; squamous
33
Vagina cancers. • Clear cell adenocarcinomas – (common or rare?) vaginal tumors, – Found in _____ women whose mothers took _________________ during pregnancy.
Rare ;young diethyl stilbestrol(DES)
34
_____________ is a rare vaginal tumour of girls younger than 5 years.
Sarcoma botryoides
35
Cervicitis __________ _______cervicitis ________ persistent infection usually _____ ________ ________ chronic inflammation of the ___________
Mucopurulent acute Chronic; viral Mild nonspecific; endocervix
36
Cervicitis Mucopurulent acute cervicitis – STI- _________ Or _________ – Endometritis or PID. Chronic persistent infection usually viral – Caused by viruses ______ and _______
Chlamydia and N. gonorrhoeae. HPV and HSV-2.
37
Cervicitis Mild nonspecific chronic inflammation of the endocervix – Caused by vaginal _____- bacteria – Usually of ——- clinical significance. – In some women, it may lead to the formation of ____________, which cause "_______.
saprophytic bacteria; no endocervical polyps ; "spotting.
38
Chlamydial Cervicitis  Chlamydiae are (obligate or facultative ?) _____cellular organisms containing _____________ , and are (smaller or larger?) than viruses.  (Common or Rare?) STI  Often recognized by its _____________ following ___________________ in males (post-_____________ _____________).
obligate ; intracellular DNA and RNA ; larger Common ; persistence treatment for gonorrhea gonococcal
39
Chlamydial Cervicitis Isolated from the _______ of about _____% of asymptomatic females Follicular cervicitis subepithelial reactive lymphoid follicles
cervices 50%
40
The second most common type of cancer in women worldwide is ??
Cervical Cancer
41
Commonest cancer in women in the developing world is???
Cervical Cancer
42
In Nigeria, ______ cancer is second to breast cancer
Cervical Cancer
43
Distribution of Cervical Cancer • Approximately ____ new cases are diagnosed daily • Average age of diagnosis is ____years • Age range: ___-___ years
3 45 19-75
44
Predisposing factors to Cervical cancer • Multiple __________ • A male partner with __________________ • __________ age at first intercourse • (Low or High?) parity • Persistent infection with a high oncogenic risk HPV, e.g., HPV ____ or HPV___ • Immunosuppression • Certain ____ subtypes • Use of __________ • Use of __________ or __________
sexual partners multiple previous or current sexual partners Young ; High HPV 16 or HPV18 HLA subtypes; oral contraceptives nicotine ; smoking
45
HPV Types ➢ ____ types infect the genitals of males and females ➢ High risk types cause _________ ➢ Low-risk HPV types cause _______ , ___________
40 invasive cancer genital warts, cervical condylomas
46
HPV Types 70.9% of cervical cancers are caused by ________ by __________________________
infection high-risk HPV types 16 and/or 18
47
Natural History of Carcinoma of the Cervix • The development of cervical cancer is gradual and may take many years. • Initially, subtle changes occur in the __________ cells of the cervix. • As these changes become even more abnormal, they cause __________, which is a ______________ condition of the cervix. • The __________ can then progress to _______________ which invades only the __________ layer of the cervix. Eventually the cancer spreads
superficial ; dysplasia pre-malignant ; dysplasia invasive cancer ; outer
48
HPV Persistence and development of High grade Lesions/cervical cancer. Risk factor for HPV Persistence  Cigarette smoking  Compromised immune system.  Having a __________ disease (STD), like _______, _______, or _______
sexually transmitted disease (STD) HPV, Herpes, or cytomegalovirus (CMV).
49
HPV Persistence and development of High grade Lesions/cervical cancer. High risk HPV Types associated with cervical cancer include Types __,___,____,___,____ 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 73 and 82
16, 18,26,31,33,
50
How does HPV cause cervical cancer? • E___ and E___ induce cell “ ___________ .’’ • E6 from high-risk HPV binds __________ protein ____ and causes its rapid __________________. • The protein normally _________________ by arresting growth in the ____ phase of the cell cycle. • Therefore, with less, the cell cannot __________ uncontrolled cell growth.
6;7 ; immortalization tumour suppressor protein ; p53 rapid proteolytic degradation. suppresses cell proliferation G1 ;suppress
51
How does HPV cause cervical cancer? • E7 from high-risk HPV forms a complex with _______________________ , the __________ protein (___), and disrupts its binding to a transcriptional factor, ________ • The freed ________ then stimulates __________ and __________.
another human tumour suppressor the retinoblastoma protein (pRB) E2F-1. ; E2F-1 DNA synthesis ; uncontrolled cell growth.
52
HPV-16 E6 and E7 can also collectively cause cellular ______________
genetic instability.
53
Types of Squamous Intraepithelial lesion • Low Grade Squamous Intraepithelial lesion (LSIL) formerly referred to as ______ or _______ • High Grade Squamous Intraepithelial lesion(HSIL) formerly( ________ or ________ and ________ or ________)-
CIN I ; mild dysplasia CIN ; moderate dysplasia CIN III ; severe dysplasia
54
Signs and Symptoms of SIL • Usually, _____ signs and symptoms of SIL. • ______ test need to diagnose SIL. • A negative test means that there is _____________________ • A positive Pap test means that the test results ______________ ▪ ________ or ________ required for abnormal Pap test.
no ; Pap smear test probably no SIL or cancer. not normal. Colposcopy or biopsy
55
Ovarian surface epithelium _______ ______ epithelium _______ layer of cells Derived from ________ epithelium
Simple cuboidal Single coelomic epithelium
56
coelomic epithelium Epithelial lining of intraembryonic celom Space that gives rise to ________ and ________ cavities Forms (inner or outer?) layer of male/female gonads Also forms lining of body wall, liver, lungs, GI tract
thoracic and abdominal cavities outer
57
Epithelial cell tumors: clinical features Often a “________” disease Classic presentation: _______
silent Adnexal mass
58
Serous Cystadenoma Often ____lateral _____ filled with _____ fluid (Thin or Thick?) wall of single cells lining cyst Serous Cystadenocarcinoma Most common malignant ovarian tumor (Simple or Complex?) cysts with _____ fluid Growth of _______ layer Cells similar to _________ cells
bilateral Cyst watery Thin Complex watery epithelial fallopian tube cells
59
Mucinous tumors Mucinous cystadenoma (Thin or Thick?) walled cyst filled with _____ Often (smaller or larger?) than serous tumors Often “___________”: many ______________, recesses Mucinous cystadenocarcinoma ___________ variant of cystadenoma
Thin ; mucous larger ; multiloculated small cavities Malignant
60
Brenner Tumor (Common or Rare?) subtype of epithelial ovarian tumor Contains _______ epithelial (_______) cells Usually (benign or malignant?) Often found incidentally “_______” nuclei seen on biopsy
Rare bladder ; transitional benign “Coffee bean”
61
In epithelial cell tumors, (More or Less?) ovulation associated with more risk
More
62
In epithelial cell tumors, Nulliparity is associated with (more or less?) risk
More
63
Tubal ligation is Protective against epithelial cell tumors T/F
T Tubal ligation: Protective (↓ risk)
64
Sex cord stromal tumors ___________ , ___________ cells, ___________ cells Often produce hormones
Fibroblasts, theca cells, granulosa cells
65
Granulosa cell tumor Adult subtype (___% cases) Median age ___ to ___ years Symptoms from excess _______ production Juvenile subtype Develop before ______ “_______ _______ ” from excess estrogen production Puberty at ______ age (usually < ____ years old)
95% ; 50 to 54 estrogen ; puberty “Sexual precocity” very early age ; 8 years old
66
Fibroma has no hormone activity T/F
T
67
Ovarian germ cell tumors occurs in ______ women
Young
68
Tumors of germ cell derivatives ___________ (Teratoma) _________ (Dysgerminoma) ___________ (Yolk sac tumors) ______________ (Choriocarcinoma)
Germ layers Germ cells Yolk sack Placental tissue
69
Benign form of a teratoma is ?? Malignant form of a teratoma is ?? Rare form of a teratoma is ??
Dermoid cyst Immature teratoma Monodermal
70
Dermoid cyst (________ cytstic teratoma) Usually removed _______ to avoid complications: Torsion Rupture leads to tumor material in abdominal cavity which leads to _______ (Small or Large?) risk (<__%) of malignant transformation ________ may become malignant ______ malignancies common _____________ carcinoma most common
Mature peritonitis; Small ; 1 Elements ; Skin Squamous cell
71
Dysgerminoma May produce enzymes/hormones (tumor markers) List 3
Lactate dehydrogenase (LDH) Placental alkaline phosphatase Β-hCG
72
________ has a friends egg appearance
Dysgerminoma
73
_______ tumor has glomeruloid structures
Yolk sac
74
HCG in choriocarcinoma mimics _____ and ______
LH and TSH