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Repro II > Vulva and Vagina pathology > Flashcards

Vulva and Vagina pathology Flashcards

1
Q

germ cells are from what

A

endoderm

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2
Q

urogenital ridge is from what

A

mesoderm

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3
Q

germ cells migrate to where

A

urogenital ridge to form ovary

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4
Q

what forms the uterus and upper vagina

A

mullerian ducts

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5
Q

all epi surfaces and lining share what origin

A

coelemic (mesothelium)

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6
Q

mesonephric/wolfian duct remnants

A

can create cysts gartner cysts- next to uterus sup to cervix can also form in mesovarium/broad ligament

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7
Q

didelphys

A

when mularian ducts do not fuse -> two uterus’, 2 vaginas different from bicornate bc bicornate only has one vagina slightly higer risk for 2-3rd trimester spontaneous abortions DO NO have higher rate of twins or PID

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8
Q

kelbsiella granulomatous

A

gram neg donovan body

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9
Q

gardnerella vaginalis

A

gram neg clue cells

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10
Q

N. gonorrhoeae

A

gram neg diplococcus

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11
Q

Treponema pallidum

A

syphilis spirochete

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12
Q

HPV

A

koilocyte if low grade koilocyte + nuclear enlargement if high grade

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13
Q

HSV

A

multinucleated giant cell with intranuclear homogenization and inclusion bodies

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14
Q

CMV

A

bulbous intranuclear inclusion body

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15
Q

molluscm contagiosum

A

molluscum body

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16
Q

Trichomonas vaginalis

A

trichomonad

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17
Q

Actinomyces isralii

A

causes PID sulphur granules

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18
Q

M. tuberculosis

A

necrotizing granulomas

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19
Q

C. albicans

A

candida sp

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20
Q

What infections can be seen in vulva

A

herpetic ulcers molluscum lesions HPV (genital warts, intraepi neoplasia, invasive carcinoma) N. gonorrhoeae (skene gland adenitis) Candida trichomonas

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21
Q

what infections can be seen in vagina

A

herpetic ulcers HPV (genital warts, intraepi neoplasia, invasive carcinoma) Gonorrhoeae (vaginitis in kids) candida trichomonas

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22
Q

what infections can be seen in cervix

A

herpectic ulcers HPV (genital warts, intraepi neoplasia, invasive carcinoma) Chlamydia (follicular cervicitis, endometritis, salpingo-oophoritis) Gonorrhoeae (vaginitis in kids) candida trichomonas gardnerella

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23
Q

what infections can be seen in corpus

A

Chlamydia (follicular cervicitis, endometritis, salpingo-oophoritis) Gonorrhoeae (vaginitis in kids)

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24
Q

what infections can be seen in adenxa

A

Chlamydia (follicular cervicitis, endometritis, salpingo-oophoritis) Gonorrhoeae (vaginitis in kids)

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25
Q

Herpes

A

usually HSV-2, but can be 1 DNA virus on PCR test or IgG serology few weeks of red bumps or tiny white blisters -> rupture -> ulcer pain, itchy detrimental to fetal developlment

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26
Q

herpes histo

A

can visualize blisters/ulcers with multinuclear giant cells with nuclear inclusions

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27
Q

test for herpes

A

Tzank test which uses pap stain best way to Dx is to see multinucleated giant cells with intranuclear ground glass viral inclusions

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28
Q

common causes of vaginitis

A

C. albicans (yeast infection) Trichomonas vaginalis Bacterial vaginosis (gardnerella)

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29
Q

C. albicans

A

not considered STD may be normal flora DM, abx, pregnancy, and immunosupressed at risk

Dx with KOH prep or pap

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30
Q

S&S of C. albicans

A

leukorrhea, pruitis, erythema

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31
Q

Trichomoniasis

A

flagellated protozoan STI (4d-4wks) motile

yellow froathy discharge, pruitis, dysurian, dyspareunia, strawberry cervix

32
Q
A

strawberry cervic

seen in trichomonas vaginalis vaginitis

33
Q

mycoplasma

A

vaginitis and cervicitis

implicated in spontaneous abortion and chorioamionitis

34
Q
A

molluscum contagiosum

35
Q
A

molluscum contagiosum

36
Q

molluscum contagiosum

A

pox family virus

painless bumps

if scratch open and can spread via contact (towels)

usually resolves in 6-12 months, keep covered

can be STI in adults

Not a blister, central area of lesion is concave

37
Q
A

mulluscum contagiosum

cytoplasmic pink inclusions representing clusters of large virus with nucleus pushed to the side

central concavity can be seen

38
Q

PID definition

A

infection of pelvic organs beyond the uterine corpus

39
Q

most common causes of PID

A

gonorrhea and chlamydia

most infections are polymicrobial

40
Q

complications of PID

A

rupture of tuboovarian abscess

infertility form scarring of tubes

ectopic pregnancy

intestinal obstruction from fibrous bands and adhesions

41
Q

subclinical PID

A

common cause of serious sequelae

up to 1/3 of infertility women w/o Hx of PID have underlying chlamydia infection

42
Q

fitz-hugh curtis syndrome

A

perihepatitis

infection of liver capsule and peritoneal surfaces

can be complication of PID

43
Q

salpingitis

A

fallopian tube plicae expanded by inflammatory infiltrate and edema

if acute filled with neutrophils, if chronic filled with plasma cells

44
Q

bartholin gland cyst

A

obstuction of duct -> cyst

common

all ages can become infected

may be polymicrobial or gonorrhea or chlamydia

Tx must place catheter or sew open to allow continuous drainage

45
Q
A

lichens planus

pruitic, polygonal, purple, plaques

usually symetrical

ususally goes away in 1-2 yrs, so just tx itch

46
Q
A

wickhams striae of lichen planus

47
Q
A

lichen planus

note band of chronic inflammatory cells at dermal-epidermal jnx

also squamous epi is normal thickness

48
Q
A

lichen sclerosus aka LS&A

elderly and post menopausal females

unknown etiology, maybe autoimmune

atrophic change

not considered precancerous, but 4% increased risk of CA development

49
Q
A

lichen sclerosis

50
Q
A

lichen sclerosis

note white ‘parchment like’ areas

51
Q
A

lichen sclerosis

no band of inflammatory cells, rather a significant band of hylinization

also thickened epi layer

52
Q
A

lichen simplex chronicus

squamous hyperplasia and acanthosis

NO CYTOLOGICAL ATYPIA (if there were is would be VIN)

usually dt chronic scratching

53
Q
A

LSC

54
Q

CONDYLOMA ACUMINATUM

A

venereal warts

90% HPV 6,11 (low risk)

10% HPV 16,18,33 (high risk for VIN 2-3 and carcinoma)

55
Q

gross appearance of Condyloma Acuminatum

A

frequently multiple and papillary warts, occasional flat

56
Q

histo of Condyloma Acuminatum

A

koilicytosis, mitoses

57
Q

Tx of Condyloma Acuminatum

A

cryo, chemical, laser, or excision

58
Q
A

Condyloma Acuminatum

note flat white leukoplakia and multifocal

on histo exam would see hyperkeratosis, thickened epi, and peri-nuclear clearing

59
Q
A

condylomata

warty type

cauliflower multifocal papules

60
Q
A

condylomata

coalescing papules aka bowenoid papulosis

typical in low grade infections

61
Q
A

koilocytosis of Condyloma Acuminatum

radinoid nuclei with surrounding cleared area

low grade infection

if high grade would also see nuclear enlargement

62
Q

VIN

A

vulvar intraepithelial neoplasm

1-3

3 = CIS

63
Q

VIN 1-3 determination

A

determined by what thickness has been invaded with nucelar enlarged cells

moderate (VIN2) = half thickness

if VIN 2 or 3 must be excised

64
Q

invasice SCC of vulva

A

90% of invaseive vulvar CA

usually presents as nodules/masses on background of leukoplakia

an ulcerated mass is CA until proven otherwise

65
Q

type 1 SCC of vulva

A

60%

warty and bowenoid type

HPV 16,18, 33

occurs in reproductive age women

66
Q

type 2 vulvar SCC

A

40% keratinizing type

not HPV associated

may occur in long-standing LS&A or chronic inflammation

67
Q

spread of SCC

A

local invasion with lymphovascular spreas to region nodes followed by mets to lung, liver, etc

68
Q

tx of SCC

A

VULVECTOMY AND LYMPHADECTOMY

69
Q

Glandular lesions of vulva

A

accessory breast tissue along milk line

papillary hidradenoma

extramammary paget disease

70
Q

papillary hidradenoma

A

sharply circumscribed nodule in vulva with normal overlying skin

considered benign

has 2 layers of cells (columnar and myoepithlium)

71
Q

extramammary pagets disease

A

presents as pruitic, red, crusted sharply demarcated area on labia majora of elderly

unlike paget disease of breast, does not have underlying carcinoma tumor mass, but IS malignant

aride form primitive germinal cells of mammary like gland ducts in skin

72
Q

Dx pagets

A

halo cells (epidermal appendages)

PAD, Mucin, CEA, EMA, all postive

usually confined to epi and skin appendages

low potential for mets

73
Q

Tx of pagets

A

wide local excision

may recur

look for synchronous tumors of breast, rectum, bladder, ovary

74
Q

malignant melanoma

A

usuallly poor prognosis

S-100 and Melanin-A +

75
Q

DES

A

given to women with miscarriages 40s-70s

it affects adenosis (process by which glandular epi of embryo is replaced by squamous)

some affected daughters developed CCC of vagina

also have increased risk for CIN and VIN and maybe breast CA

76
Q

generalizations of vaginal neoplasms

A

80% mets

most primary are SCC which arises from Vaginal intraepithelial neoplasm (VaIN)

almost all d/t HPV16

77
Q

Embryonal rhabdomyosarcoma

A

neoplasm of girls <5

presents as polypoid mass or vaginal bleeding

arises in lamina propria

high rate of surgical cure if <3cm

local invasion -> local nodes -> mets

frequently misdiagnosed as inflammatory polyps

can see mm spindle cells w/very small nuclei

Repro II (20 decks)

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