Robbins Ch 22 - Lecture 1 Flashcards by Erin Kretovics

Active HSV infection in mother during delivery usually warrants a

Cesarean section

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HSV2 infection enhances aquisition and transmission of t

HIV-1

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Time period that HSV can be detected and serotyped

48-72 hrs post infection

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MC sexually transmitted strain of molluscum contagiosum

MCV-2

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MC strain of molluscum contagiosum

MCV-1

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Incubation period of molluscum contagiosum

6 wks

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Pearly, dome shared papules with dimpled center

Molluscum contagiosum

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Vulvovaginal puritis, erythema, swelling, curd like vaginal discharge

Yeast infection

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Pseudospores or filament oust fungal hyphae in wet KOH mount or on Pap smear

Yeast infection

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Flange, flagellated ovoid protazoan

Trichomonas vaginalis

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Trichomonas vaginalis infection develops within

4d to 4w

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Yellow, frothy, vaginal discharge

Trichomoas vaginalis

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Fiery-red, “strawberry cervix”

Tri homonyms vaginalis

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Gerdnerella vaginalis morphology

Gram-negative bacillus

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Thin, green gray malodorous discharge

Gardenerlla vaginalis

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Superficial and intermediate squamous cells covered with a shaggy coating coccobacillus

Gardenerla vaginalis

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Main cause of bacterial vaginosis

Gardeneralla vaginalis

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G. Vaginalis in pregnancy can induce

Premature labor

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Implicated in choroamnionitis and premature delivery in pregnancy pts

Ureaplasma urealyticum, mycoplasma hominis

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Infections mainly take form of cervicits but may ascend to result in endometritis and salpingitis

Chalmydia trachomatis

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Most serious complication of gohorrhea in woman

PID

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Infection that begins in the vulva or vagina and spreads upward to involve most structures in the female genial system

PID

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Pelvic pain, adnexal tenderness, fever, vaginal discharge

PID

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PID with less involvement of the mucosa and tube lumen and more inflammation within the deeper tissue layers is cause by

Staph, streptococci, coliforms and cholstridium prefringens (non-gonococcal)

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Multinucleacted cells, intranuclear viral inclusions, "ground-glass" appearance

HSV infection

Smooth white plaques or macules that may coalesce that can cause atrophy or agglutination of the vulva and may cause vaginal orifice constriction

Lichen sclerosus

Marked thinning of vulva epidermis, degeneration of basal cells, hyperkeratosis, sclerotic changes of dermis, bandlike lymphocytic infiltrate underlying the dermis

Lichen sclerosis

Lichen sclerosis sligtly increasea risk of developing

Sq cell carcinoma of the vulva

Result of rubbing or scratching vulva skin w/ leukoplakia, acanthosis, and hyperkeratosis

Sq cell hyperplasia

Benign genital warts cause by low oncogenic risk HPVs

Condylomata acuminatum

MC HPV strains that cause Condylomata acuminatum

6 and 11

Papillary, exophytic treelike cores of stroma covered by thickened squamous epi. ith koilocytic atypia seen on surface epi

Condylomata acuminatum

Nuclear enlargement, hyperchomasia, cytoplasmic perinuclear halo

Koilocytic atypia, characteristic of Condylomata acuminatum

MC histologic type of vulvar cancer

Squamous cell

Vulvular carinoma MCly seen in younger women d/t HPV-16

Basaloid and warty carcinomas

MC vulvar carinoma seen in older women - 70% ass'd with HPV inf

Keratinizing sq cell carcinoma

Classic vulvar intraepithelial neoplasia (VIN)

Basaloid and warty carcinomas

Peak age for basaloid or warty vulvar cancer

6th decade

Ass'd with long standing lichen slerosis or sq cell hyperplasia - not related to HPV

Keratinizing sq cell carcinoma of vulva

Peak age of keratinizing sq cell carcinoma of vulva

8th decade

VIN simplex or differentiated VIN

Keritinizing sq cell carcinoma

scarring and fusion of plicae

chronic salpingitis

acute complications of PID

peritonitis and bacteremia

chronic complications of PID

infertility and tubal obstruction

Nests and cords or small, tightly paked cells that lack matuation and resemble the basal layer of normal epi

Basaloid carcinoma

Exophytic papillary architecture and prominent kiolcytic atypia

Warty carcinoma

Sharply circumscribed nodule, MCly on the labia majora or interlabial folds

Papillary hidradenoma

Papillary projections w/ 2 layers: upper layer of columnar secretory cells, deeper layer of flattened myoepithelial cells

Papillary hidradenoma

Puritic, red, crusted, maplike area, usually on the labia majora

Extramammary paget disease

Immunostain for cytokeratin 7

Paget cells

Failure of mullerian duct fusion leads to

Double vagina and double uterus

Red, granular areas made of up columnar, mucinous epi found in the vagina

Vaginal adenosis

Fluid-filled cysts found on the lateral walls of the vagina that are derived from woffian duct rests

Gartner duct cysts

Virtually all primary carcinomas of the vagina are

Sq cell carcinomas, ass'd with high risk HPV

Greatest risk factor for developing sq cell carcinoma of the vagina

Previous carcinoma of the cervix or vulva

Vaginal intraepithelial neoplasia

Premalignant lesion to sq cell ca of the vagina

Age group of embryonal rhabdomyosarcoma pts

Infants and childre

Grape-like, polypoid mass protruding from the vagina

embryonal rhabdomyosarcoma

Oval nuclei with small protrusions of cytoplasm, look like tennis rackets

embryonal rhabdomyosarcoma

Loose fibromyxomatous stroma covered by mucus-secreting endo cervical glands, often accompanied by inflammation

Endocervical polyps

In the cervix, HPV infects

- immature basal cells of the sq epi in areas of epi breaks | - metaplastic sq cells at the squamocolumnar junction

Viral proteins of HPV responsible for carcinogenic capabilities

E6 and E7

Binds hypophosphorlyated form of RB and promotes its degresdation , and inhibits p21 and p27

Viral protein E7

Binds p53 and promotes it's degradation, upregulates telomerase

Viral protein E6

High level of viral replication, mild alterations in the growth of host cells, most cases regress spontaneously

LSIL

Progressive dysregulation of the cell cycle, increased cellular proliferation, decreased/arrested epi maturation, lower rate of viral replication, high risk of progression to carcinoma

HSIL

Nuclear enlargement, hyperchromasia, coarse chromatin granules, variation in nuclear size and shape

SIL

Ki-67 and p16 staining

areas of high mitotic activity

Nests and tongues of malignant sq epi breaking though the basement membane and invading the underlying cervical stroma

Sq cell carcinoma of the cervix

Proliferation of glandular epi composed of malignant endocervical cells with large, hyperchromatic nuclei with mucin-depleted cytoplasm

Adenocarcinoma of the cervix

Woman >30 yo w/out HPV and normal cytology should be screened

Every 5 yr

Women with normal cytology but are positive for high-risk HPV should have cervical cytology every

6-12 mo

low risk (oncogenic) HPV types

6 and 11

DES exposure

adenosis of the vagina

lymph from vulva and distal 1/3 vagina drains to

inguinal nodes

lymph from proximal 2/3 vagina and uterus drains to

iliac (internal) nodes