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House AMP > Pathology Of The Female Genital Tract > Flashcards

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

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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

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3
Q

Abnormal menstruation

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

A

Psychological ; Hormonal

local hemostasis

Fibroids

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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

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5
Q

Causes of Abdominal distension

• _________
• _________ enlargement
• Ovarian _____ and ______

A

Ascites

Uterine enlargement

Ovarian cysts and Tumours

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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

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7
Q

Meigs syndrome

ovarian _____, _________ and , _______)

A

Fibroma
Pleural effusion
Ascites

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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

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9
Q

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

A

discharge; lesions

vesicles ; ulcers

pain ; mass

Discomfort ;dyspareunia

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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.

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11
Q

Candida albicans is considered an STI

T/F

A

F

is not considered an STI

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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

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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

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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

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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

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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.

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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

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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

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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

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20
Q

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

•The _______ epithelium is (benign or malignant?)

A

Vulvar wart

HPV; 6 & 11

squamous

benign

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21
Q

vulvar wart (_____)

Characterized by
_____osis , _______osis, _________osis.

_______osis is a sign of HPV infection.

A

Condyloma acuminatum

Acanth

Hyperkerat; Parakerat

Koilocyt

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22
Q

Vulva tumours
• __________ —————

• Vulvar _________ ——————- (VIN)

A

Papillary hidradenoma

Vulvar intraepithelial neoplasia (VIN)

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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

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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

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25
Q

Vulva cancers
• (Common or Rare?) .
•___% of the FGT cancers.
• Usually diagnosed in (young or elderly?) women
• Commonest: —————- carcinoma
• Rare forms: ____________ disease, ______-.

A

Rare ; 3%

elderly women

squamous cell carcinoma

extramammary Paget’s disease, melanoma.

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26
Q

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 _________

A

common; carcinoma in situ

Bowen; preinvasive

keratinizing or poorly

inguinal nodes

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27
Q

Squamous cell carcinoma

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

A

multicentric

16

AIDS

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28
Q

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 _______

A

Red, crusted

Intraepithelial

primitive epithelial progenitor cells

mucin ; PAS (periodic acid-Schiff)

epithelium ; dermis

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29
Q

Developmental anomalies

• _______ or _______ vagina/ Double _______ (_______ _______)

• Vaginal __________

• ________ ——— cysts
• _________ cysts
• Endometriosis

A

Septate ; double

uterus ; uterus didelphys

adenosis ; Gartner duct

Mucus

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30
Q

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

A

DES

utero

carcinoma

31
Q

Vagina tumours
• Benign
– __________
– Stromal __________
– __________

• Premalignant
– ______________________

• Malignant
– __________
– __________ carcinoma
– Embryonal __________

A

– Leiomyomas
– Stromal polyps
– Hemangiomas

– Vaginal intraepithelial neoplasm, (VAIN)

– Metastasis
– Squamous cell carcinoma
– Embryonal rhabdomyosarcoma

32
Q

Vagina cancers.
• (Common or Rare?)
•____% of all female genital cancers.
• Most vaginal carcinomas diagnosed in _______ women are of the ______________ type.

A

Rare ; 1%

adult women; squamous

33
Q

Vagina cancers.

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

A

Rare ;young

diethyl stilbestrol(DES)

34
Q

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

A

Sarcoma botryoides

35
Q

Cervicitis

__________ _______cervicitis

________ persistent infection usually _____

________ ________ chronic inflammation of the ___________

A

Mucopurulent acute

Chronic; viral

Mild nonspecific; endocervix

36
Q

Cervicitis

Mucopurulent acute cervicitis
– STI- _________ Or _________
– Endometritis or PID.

Chronic persistent infection usually viral – Caused by viruses ______ and _______

A

Chlamydia and N. gonorrhoeae.

HPV and HSV-2.

37
Q

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 “_______.

A

saprophytic bacteria; no

endocervical polyps ; “spotting.

38
Q

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-_____________ _____________).

A

obligate ; intracellular

DNA and RNA ; larger

Common ; persistence

treatment for gonorrhea

gonococcal

39
Q

Chlamydial Cervicitis

Isolated from the _______ of about _____% of asymptomatic females

Follicular cervicitis subepithelial reactive lymphoid follicles

A

cervices

50%

40
Q

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

A

Cervical Cancer

41
Q

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

A

Cervical Cancer

42
Q

In Nigeria, ______ cancer is second to breast cancer

A

Cervical Cancer

43
Q

Distribution of Cervical Cancer

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

A

3

45

19-75

44
Q

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 __________

A

sexual partners

multiple previous or current sexual partners

Young ; High

HPV 16 or HPV18

HLA subtypes; oral contraceptives

nicotine ; smoking

45
Q

HPV Types

➢ ____ types infect the genitals of males and females
➢ High risk types cause _________
➢ Low-risk HPV types cause _______ , ___________

A

40

invasive
cancer

genital warts, cervical condylomas

46
Q

HPV Types

70.9% of cervical cancers are caused by ________ by __________________________

A

infection

high-risk HPV types 16 and/or 18

47
Q

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

A

superficial ; dysplasia

pre-malignant ; dysplasia

invasive cancer ; outer

48
Q

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 _______

A

sexually transmitted disease (STD)

HPV, Herpes, or cytomegalovirus (CMV).

49
Q

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

A

16, 18,26,31,33,

50
Q

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.

A

6;7 ; immortalization

tumour suppressor protein ; p53

rapid proteolytic degradation.

suppresses cell proliferation

G1 ;suppress

51
Q

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 __________.

A

another human tumour suppressor

the retinoblastoma protein
(pRB)

E2F-1. ; E2F-1

DNA synthesis ; uncontrolled cell growth.

52
Q

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

A

genetic instability.

53
Q

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 ________)-

A

CIN I ; mild dysplasia

CIN ; moderate dysplasia

CIN III ; severe dysplasia

54
Q

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.

A

no ; Pap smear test

probably no SIL or cancer.

not normal.

Colposcopy or biopsy

55
Q

Ovarian surface epithelium

_______ ______ epithelium

_______ layer of cells

Derived from ________ epithelium

A

Simple cuboidal

Single

coelomic epithelium

56
Q

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

A

thoracic and abdominal cavities

outer

57
Q

Epithelial cell tumors: clinical features

Often a “________” disease

Classic presentation: _______

A

silent

Adnexal mass

58
Q

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

A

bilateral
Cyst
watery
Thin

Complex
watery
epithelial
fallopian tube cells

59
Q

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

A

Thin ; mucous

larger ; multiloculated

small cavities

Malignant

60
Q

Brenner Tumor

(Common or Rare?) subtype of epithelial ovarian tumor
Contains _______ epithelial (_______) cells
Usually (benign or malignant?)
Often found incidentally
“_______” nuclei seen on biopsy

A

Rare

bladder ; transitional

benign

“Coffee bean”

61
Q

In epithelial cell tumors,

(More or Less?) ovulation associated with more risk

A

More

62
Q

In epithelial cell tumors,

Nulliparity is associated with (more or less?) risk

A

More

63
Q

Tubal ligation is Protective against epithelial cell tumors

T/F

A

T

Tubal ligation: Protective (↓ risk)

64
Q

Sex cord stromal tumors

___________ , ___________ cells, ___________ cells
Often produce hormones

A

Fibroblasts, theca cells, granulosa cells

65
Q

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)

A

95% ; 50 to 54

estrogen ; puberty

“Sexual precocity”

very early age ; 8 years old

66
Q

Fibroma has no hormone activity

T/F

A

T

67
Q

Ovarian germ cell tumors occurs in ______ women

A

Young

68
Q

Tumors of germ cell derivatives

___________ (Teratoma)
_________ (Dysgerminoma)
___________ (Yolk sac tumors)
______________ (Choriocarcinoma)

A

Germ layers

Germ cells

Yolk sack

Placental tissue

69
Q

Benign form of a teratoma is ??

Malignant form of a teratoma is ??

Rare form of a teratoma is ??

A

Dermoid cyst

Immature teratoma

Monodermal

70
Q

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

A

Mature

peritonitis; Small ; 1

Elements ; Skin

Squamous cell

71
Q

Dysgerminoma

May produce enzymes/hormones (tumor markers)

List 3

A

Lactate dehydrogenase (LDH)
Placental alkaline phosphatase
Β-hCG

72
Q

________ has a friends egg appearance

A

Dysgerminoma

73
Q

_______ tumor has glomeruloid structures

A

Yolk sac

74
Q

HCG in choriocarcinoma mimics _____ and ______

A

LH and TSH

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