Pathoma

Question 0

HPV leads to “______” change, characterized by a “crinkled” nucleus.

Answer 0

koilocytic

Question 1

Genital condylomas are caused by which HPV types?

Answer 1

6 and 11

Question 2

What are the HPV subtypes that are highest risk for the development of carcinoma? What type of carcinoma usually (but not always)?

Answer 2

16, 18, 31, 33. Usually squamous cell carcinoma.

Question 3

What is “lichen sclerosis”?

Answer 3

Thinning of the epidermis and fibrosis of the underlying dermis; seen in postmenopausal women (>70 yo). Benign, but associated with a slightly increased risk of squamous cell carcinoma.

Question 4

What is the difference between lichen sclerosis and lichen simplex chronicus with regards to risk of squamous cell carcinoma?

Answer 4

Lichen sclerosis is associated with a slightly increased risk, but lichen simiplex chronicus is not! Both are benign conditions.

Question 5

What is lichen simplex chronicus?

Answer 5

Hyperplasia of the vulvar squamous epithelium with thick, leather-like vulvar skin, associated with chronic irritation and scratching.

Question 6

An HPV infection takes how long to become carcinoma?

Answer 6

20-30 years to transform (through dysplasia steps)

Question 7

What is the less common non-HPV related vulvar carcinoma caused by?

Answer 7

Long-standing lichen sclerosis (thinning of the epidermis with sclerosis of the dermis)

Question 8

What is different between Paget’s disease of the breast and Paget’s disease of the vulva with regards to underlying carcinoma?

Answer 8

In Paget’s disease of the vulva, there is usually no underlying cancer (vs. Paget’s disease of the breast)

Question 9

What would you expect on PAS, keratin, and S100 stains in a melanoma?

Answer 9

PAS-
keratin-
S100+

Question 10

The lower 1/3 of the vagina is derived from ___________, while the upper 2/3 is derived from __________

Answer 10

1) lower 1/3: urogenital sinus (leading to squamous eptihelium lining)
2) upper 2/3: Müllerian duct (leading to columnar epithelium, that ultimately gets replaced by squamous)

Question 11

What is “adenosis”?

Answer 11

The persistence of columnar epithelium in the vagina (derived from Müllerian duct, upper 2/3 of vagina). Should be replaced by the squamous epithelium of the lower 1/3. This rarely happens in a normal individual, but was seen in females exposed to DES (diethylsylbesterol) in utero. Can lead to clear cell carcinoma (gland cell carcinoma)

Question 12

A bleeding and grape-like mass (“sarcoma batroides”) protruding from the vagina or penis of a child (<5) should make you think of ____________

Answer 12

rhabdomyosarcoma

Question 13

Vaginal carcinoma from the lower 1/3 of the vagina metastasizes to which lymph nodes?

Answer 13

inguinal lymph nodes

Question 14

Vaginal carcinoma from the upper 2/3 of the vagina metastasizes to which lymph nodes?

Answer 14

regional iliac lymph nodes

Question 15

While the exocervix is lined by _______ epithelium, the endocervix is lined by _________ epithelium.

Answer 15

exocervix: squamous
endocervix: columnar

Question 16

What proteins do the viruses that are “high risk” HPV have and what do they do?

Answer 16

E6 and E7
E6 increases the destruction of p53 (tumor suppressor)
E7 increases destruction of Rb (which usually suppresses E2F, which leads to progression of cell cycle)

Question 17

What are the two most common types of cancer caused by HPV?

Answer 17

1) squamous cell carcinoma (exocervix)

2) adenocarcinoma (due to endocervix, columnar cells)

Question 18

What is Ashermann syndrome?

Answer 18

Secondary amenorrhea due to loss of basalia (the regenerative layer) and scarring. A common cause is an overaggressive D&C. Without the basalis, you can’t regenerate the endometrium

Question 19

What are common sites of endometriosis?

Answer 19

1) ovary (chocolate cyst)
2) fallobian tube mucosa (infertility; ectopic)
3) uterine ligaments (pelvic pain)
4) pain of Douglas (pain with defecation)
5) bladder wall (pain with urination)
6) bowel serosa (abdominal pain and adhesions)

Question 20

Involvement of soft tissue by endometriosis creates brown, hemorrhagic areas, known as __________

Answer 20

gunpowder lesions

Question 21

What is “adenomyosis”?

Answer 21

Endometriosis that involves the myometrium