vulva, vagina, cervix Flashcards
Describe endocervical polyps Describe common diagnostic methods for cervicitis Define the T-zone and its impact on cervical pathology Describe PAP smears (how they work and what selected diagnoses look like) Describe HPV and its role in squamous dysplasia \ carcinoma (Applies to vulva and vagina as well) Describe lichen sclerosis and lichen simplex chronicus as it presents in the vulva Describe Paget’s disease and vulvar melanoma as they present in the vulva, and ways to tell them apart D
non-neoplastic growth from the endocervix
endocervical polyp
why endocervical polyps are clinically importanr
can mimic malinancy and cause postcoital bleeding
how to diagnose acute cervicitis
DNA probe tests for gonorrhea or chlamydia, wet mount for trichomonas
how to diagnose chronic cervixitis
biopsy shows lymphoid follicles
normal cause of chronic cervicitis
chlamydia
“transformation zone” def
area where new squamous and mucinous epithelium in the cervix comes from
why the T-zone is important
comminly infected by HPV, giving rise to dysplasia
cause of all squamous dysplasia in the cervix
HPV
risk factors for cervical dysplasia
same as STD (early sex, multiple partners, early pre, smoking, immunosupression, OCP, vit deficiencies)
low risk HPV serotype
6,11
high risk HPV type
16,18
big risk for vulvar, vaginal, penile, anal cancaers
HPV 16,18
HPV E4 gene does what
encodes for protein that binds and disrupts cytokeratin network
HPV E6/E& genes do what
disable tumor supressors - leading to cell immortality
E6 binds to
p53
E7 binds to
RB
proteins in the 16,18 HPV
E6, E7
“raisin” cells
kolilcytes - low grade squamous epithelial lesion (LGSIL)
small cells with enlarged dark nucleus and scant cytoplasm
high grade squamous intraepithelial lesions
important about the appearance of high grade lesions
if they are in a pap smear they have reached the top of the cervical epithelium
atypical mitotic figures, nuclear crowding, near or total lack of maturation
HGSIL CIN III
marked nuclear pleomorphism, dirthy backround, orange keratin cells
squamous cell carcinoma
histological definition of cervical SCC
when cells invade stroma
nests of keratin under the cervical surface
invasive carcinoma of the cervix
cause of 90% of invasive cervical cancers
HPV
most often kind of invasive cervcal cancer
SCC
smooth white “cigarrette paper” plaques,strophic stiff labia, constriction of vaginal orifice
lichen sclerosis
cause of lichen simplex chronicus
itch-scratch cycle
causes of lichen simplex chronicus
dermatitis, infectious processes, other inflammatory
histological charicteristics of lichen simplex chronicus
hyperkeratosis, hypergranulosis, acanthosis
cause of condyloma acuminatum
HPV 6 and 11
branching architecture, koilcytosis, hyper/parakeratosis, aconthosis
condyloma acuminatum
big player in high grade vulvar lesions
HPV 16
def of high grade vulvar intraepithelial neoplasia
SC dysplasia of the vulva affecting most layers of epithelium, but w/o stromal invasion
most common site of extramammary paget’s
vulva
solitary or multiple well demarcated foci of red crusted areas
extramammary paget’s
why extramammary paget’s is hard to excise
microscopically extends past grossly evident lesion
histologic dx of extramammary paget’s
mucin stain
large pleomorphic cells surrounded by abundant pale cytoplasm
extramammary paget’s
ddx of extramammary paget’s
vulvar melanoma
s-100 protein
vulvar melanoma
prognosis of vulvar melanoma
poor
why vulvar melanoma has poor outomes
often lesion is non-pigmented
HPV strain causing vaginal cancer
HPV 16
risk group for vaginal cancer
over 60
most cases of vaginal cancer are from
cervical cancer
“cluster of grapes”, mostly in kids
sarcoma botryoides
DES chemical =
risk for clear cell adenocarcinoma
