Pathology Of The Female Genital Tract Flashcards by Iseoluwa Ojo

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

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

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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. _____, _____)

placenta praevia ; miscarriage

ectopic pregnancy

lesion ; cervix ; carcinoma

lesion ; polyp ; carcinoma

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Abnormal menstruation

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

Psychological ; Hormonal

local hemostasis

Fibroids

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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 __________

CLH (corpus luteum Haemorrhage)

tubal ectopic

uterine contractions; ovarian torsion

adenomyosis

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Causes of Abdominal distension

• _________
• _________ enlargement
• Ovarian _____ and ______

Ascites

Uterine enlargement

Ovarian cysts and Tumours

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Causes of Abdominal distension

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

• Uterine enlargement
– _________
– uterine ________

• Ovarian cysts and Tumours

peritoneal ; ovarian carcinoma

Meigs

pregnancy , uterine fibroids

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Meigs syndrome

ovarian _____, _________ and , _______)

Fibroma
Pleural effusion
Ascites

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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

LMAO

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

discharge; lesions

vesicles ; ulcers

pain ; mass

Discomfort ;dyspareunia

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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 __________

10% ; unaware

Pregnancy ; oral contraceptives

diabetes ; microscopically

wet mounts ; Pap smear.

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Candida albicans is considered an STI

T/F

is not considered an STI

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

pruritus; Erythema

Swelling; white

Mucosal ;curd

vaginal discharge ; itching.

ulcerations

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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 ______).

Bacterial Vaginitis (BV)

> 50%

Pap smear ; clue

squamous ; bacilli

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Vaginitis- Gardnerella vaginalis:

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

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

thin ; gray or white

sticks to the vaginal walls

fishy or musty ; sex

itching and irritation

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Ureaplasma urealyticum and Mycoplasma hominis species

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

vaginitis and cervicitis

chorioamnionitis

premature delivery

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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 ______.

salpingitis, (pyosalphinx)

endometritis

oophoritis and peritonitis.

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Pelvic Inflammation disease,(PID).

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

Pus

fibrous adhesions with other pelvic organs

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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 _________

Infertility ; Tender

pain ; Peritonitis

peritoneal adhesions ; bacteremia

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

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

Neisseria gonorrhoeae ; C. trachomatis.

puerperal ;polymicrobial ascending

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

•The _______ epithelium is (benign or malignant?)

Vulvar wart

HPV; 6 & 11

squamous

benign

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vulvar wart (_____)

Characterized by
_____osis , _______osis, _________osis.

_______osis is a sign of HPV infection.

Condyloma acuminatum

Acanth

Hyperkerat; Parakerat

Koilocyt

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Vulva tumours
• __________ —————

• Vulvar _________ ——————- (VIN)

Papillary hidradenoma

Vulvar intraepithelial neoplasia (VIN)

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Vulva tumours
• Papillary hidradenoma

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

Benign ; apocrine sweat gland

Painful nodule

labia majora

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Vulva tumours

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

mild to carcinoma in situ

squamous cell carcinoma

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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.

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

Squamous cell carcinoma Vulva Iintraepithelial Neoplasm, – Often _______ – Associated with HPV infection(type _____) cigarette smoking, ____

multicentric 16 AIDS

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

Developmental anomalies • _______ or _______ vagina/ Double _______ (_______ _______) • Vaginal __________ • ________ ——— cysts • _________ cysts • Endometriosis

Septate ; double uterus ; uterus didelphys adenosis ; Gartner duct Mucus

Vaginal adenosis,(associated with _____ use in ______ and _______ of the vagina)

DES utero carcinoma

Vagina tumours • Benign – __________ – Stromal __________ – __________ • Premalignant – ______________________ • Malignant – __________ – __________ carcinoma – Embryonal __________

– Leiomyomas – Stromal polyps – Hemangiomas – Vaginal intraepithelial neoplasm, (VAIN) – Metastasis – Squamous cell carcinoma – Embryonal rhabdomyosarcoma

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

Vagina cancers. • Clear cell adenocarcinomas – (common or rare?) vaginal tumors, – Found in _____ women whose mothers took _________________ during pregnancy.

Rare ;young diethyl stilbestrol(DES)

_____________ is a rare vaginal tumour of girls younger than 5 years.

Sarcoma botryoides

Cervicitis __________ _______cervicitis ________ persistent infection usually _____ ________ ________ chronic inflammation of the ___________

Mucopurulent acute Chronic; viral Mild nonspecific; endocervix

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.

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.

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

Chlamydial Cervicitis Isolated from the _______ of about _____% of asymptomatic females Follicular cervicitis subepithelial reactive lymphoid follicles

cervices 50%

The second most common type of cancer in women worldwide is ??

Cervical Cancer

Commonest cancer in women in the developing world is???

Cervical Cancer

In Nigeria, ______ cancer is second to breast cancer

Cervical Cancer

Distribution of Cervical Cancer • Approximately ____ new cases are diagnosed daily • Average age of diagnosis is ____years • Age range: ___-___ years

3 45 19-75

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

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

HPV Types 70.9% of cervical cancers are caused by ________ by __________________________

infection high-risk HPV types 16 and/or 18

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

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).

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,

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

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.

HPV-16 E6 and E7 can also collectively cause cellular ______________

genetic instability.

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

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

Ovarian surface epithelium _______ ______ epithelium _______ layer of cells Derived from ________ epithelium

Simple cuboidal Single coelomic epithelium

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

Epithelial cell tumors: clinical features Often a “________” disease Classic presentation: _______

silent Adnexal mass

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

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

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”

In epithelial cell tumors, (More or Less?) ovulation associated with more risk

In epithelial cell tumors, Nulliparity is associated with (more or less?) risk

Tubal ligation is Protective against epithelial cell tumors T/F

T Tubal ligation: Protective (↓ risk)

Sex cord stromal tumors ___________ , ___________ cells, ___________ cells Often produce hormones

Fibroblasts, theca cells, granulosa cells

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

Fibroma has no hormone activity T/F

Ovarian germ cell tumors occurs in ______ women

Young

Tumors of germ cell derivatives ___________ (Teratoma) _________ (Dysgerminoma) ___________ (Yolk sac tumors) ______________ (Choriocarcinoma)

Germ layers Germ cells Yolk sack Placental tissue

Benign form of a teratoma is ?? Malignant form of a teratoma is ?? Rare form of a teratoma is ??

Dermoid cyst Immature teratoma Monodermal

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

Dysgerminoma May produce enzymes/hormones (tumor markers) List 3

Lactate dehydrogenase (LDH) Placental alkaline phosphatase Β-hCG

________ has a friends egg appearance

Dysgerminoma

_______ tumor has glomeruloid structures

Yolk sac

HCG in choriocarcinoma mimics _____ and ______

LH and TSH

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Pathology Of The Female Genital Tract Flashcards

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