Thursday - Vulvular and vag path - Witrak Flashcards
Major cause for abnormal vaginal bleeding
anovulation
- polycystic ovarian syndrome
Post monopausal vaginal bleeding
major cause?
cancer until proven otherwise
endometrial atrophy
adenexal masses
non-neoplastic
- PID
- ectopic gestation
- cyscts
- endometriosis
adenexal masses
neoplastic
epithelial - serous vs mucinous sex steroid - estrogen, test germ cell - dermoid cyst
2 most common STD’s
Dx
Chlamydia and Gonorrhea
PCR
feared complication of STD’s
Pelvic Inflammatory Disease
Fitz-Hugh-Curtis syndrome
infection of liver from PID causing adhesions
Sx of PID
lower abdominal pain, discharge, fever
- many cases are sub-clinical
- first sign can be infertility
Bacterial Vaginosis due to
disturbed vaginal flora –> less lactobacilli –> higher pH
- gardnerella vaginalis
Trichomonas
can be painful, similar to chlamidia
- identify by picture. little red hairs
candida albicans
not usually STD
usually 20-40 y/o
curd-like plaque
Herpes
usually HSV-2
many time sub-clinical
primary infection - ulcers and vessicles, inguinal adenopathy
- recurrent bc is stays in DRG like zoster
transmitted even when asymptomatic
washed out nuclei on smear
no cure
smear to test for hepes
tzanck test. looking for multinucleated giant cells
syphilis
usually painless
solitary lesion
HPV
low risk types
high risk types
usually unaware of infection - leads to cancer.
6, 11 –> warts
16,18 –> carcinoma
Whiteness in perianal area
lichen planus
leukoplakia
no dysplasia, just hyperkeritoses
bartholin gland disease
infectin/abcess –> duct obstruction –> benign neoplasm
hidradenoma
tumor of sweat gland
condyloma
from HPV
90% of vulvar cancer
squamous carcinoma
VIN
2 types
both are precursors to carcinoma
common - HPV - younger woman
differentiated - precursor to post-menopausal women
can present as benign - itchy, pain, discoloration
non-sqamous vulva malignancies
melanoma
- post-menopause, high mortality rate. pigmented
basal cell carcinoma - curable with excision
sarcomas
angiomyxoma
pagets disease of breast - intraepithelial adenomcarcinoma
vulvar carcinoma speards where?
close structures
inguinal/femoral lymph nodes
blood
vagina cancer
very rare, when it happens, HPV related. upper 1/3 of vagina
vaginal cancer in kids
rhabdomyosarcoma
cervcitis
effects all ages
usually from STD
cervical polyp
benign - excise
gland cysts in cervix
nabothian cysts
cervical stenosis
conization
due to instrumentation??
cervical neoplasia
95% HPV related
Why HPV likes the cervix
immature sqamous epithelium
Cervical cancer presentation
heavy vaginal bleeding
pain, stenosis, fistula
ASCUS
atypical squamous cells of undetermined significance
ASC-H
cannot exclude high grade displasia
LSIL
low grade squamous intraepithelial cell lesion - consistent with HPV
HSIL
high grade
