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Pathophys > Vulvar, vagina, and cervix patho > Flashcards

Vulvar, vagina, and cervix patho Flashcards

1
Q

what microorganisms usually cause bartholin cysts

A 
usually polymicrobial
E. Coli
Staphylococcus
Streptococci
Sexually transmitted pathogens
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2
Q

what is the mesonephric duct

A

AKA wolffian duct becomes the vas deferens in men

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3
Q

what is the paramesonephric duct

A

AKA the Müllerian ducts- become the fallopian tubes

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4
Q

what abx should be used for bartholin cyst tx

A

Cefixime (strep and e.coli)

Clindamycin (Staph)

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5
Q

does a asymptomatic bartholin cyst need to be tx?

A

only if >=40yo.

need to biopsy to exclude carcinoma

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6
Q

what can cause white plaques of the vulva

A
  • Inflammatory dermatoses: psoriasis
  • Vulvar intraepithelial neoplasia (Paget’s or carcinoma)
  • Lichen sclerosus
  • Squamous cell hyperplasia (lichen simplex chronicus)
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7
Q

what are characteristics of lichen sclerosus

A 
Thinning of epidermis
Disappearance of rete pegs
Hydropic degeneration of basal cells
Superficial hyperkeratosis
Dermal fibrosis
Scant perivascular mononuclear infiltrate
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8
Q

what are rete pegs

A

epithelial extensions that project into the underlying connective tissue in both skin and mucous membranes.

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9
Q

lichen sclerosus has a inc risk of developing what

A

SCC

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10
Q

what is the pathogenesis of lichen sclerosus

A

Autoimmune disorder with activated T cells

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11
Q

what other diseases may be seen with lichen sclerosus

A

other autoimmune disorders:DM, thyroid, vitiligo, pernicious anemia

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12
Q

what are characteristics of squamous cell hyperplasia(hyperplastic dystrophy, lichen simplex chronicus)

A

Hyperkeratosis
Expansion of stratum granulosum
Epithelial thickening:

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13
Q

does squamous cell hyperplasia have a inc risk to Ca

A

no

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14
Q

what are benign exophytic lesions

A 
raised, wart-like
Condyloma latum:(syphilis)  
Fibroepithelial polyps (Skin Tags)
Condyloma acuminatum (HPV 6/11)
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15
Q

what is kailocytic atypia? what is it characteristic of

A

squamous epithelial cell that has undergone a number of structural changes from HPV. It is characteristic of ASCUS

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16
Q

what are characteristics of condyloma acuminatum

A

Verrucous gross appearance
Solitary or multifocal
May involve vulvar, perineal and perianal regions as well as vagina.

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17
Q

is condyloma acuminatum a precancerous lesion

A

typically not

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18
Q

what are the VIN usual types

A

VIN warty type
VIN basaloid type
VIN mixed type (warty & basaloid)

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19
Q

what are the VIN differentiated types

A

Simplex type
High grade squamous lesions
Progresses to cancer

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20
Q

what are characteristics of VIN basaloid type

A 
Thickened epithelium
Relatively flat, smooth surface
Atypical immature parabasal type cells
Hyperchromatic nuclei
Increased mitosis
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21
Q

what are characteristics of VIN warty type

A

Spiking surface
Condylomatous appearance
Abnormal maturation
Increased mitosis

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22
Q

what is VIN a precursor for

A

vulvar SCC

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23
Q

what are characteristics of VIN mixed type (warty & basaloid)

A

HPV 16, 18, 31:
Multifocal and multicentric
-Interlabial folds, posterior fourchette, perineum
Lack of cellular maturation
Analogous to cervical squamous intraepithelial lesions
10-30% have vaginal or cervical HPV related lesions

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24
Q

what are characteristics of VIN differentiated

A

Common in post menopausal women:
Usually unifocal and unicentric
Associated with lichen sclerosus
NOT associated with HPV
Found adjacent to keratinizing squamous cell carcinoma
Differentiated (simplex) type; little or no atypia above the basal layers
-Precursor of HPV-negative vulvar cancer

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25
Q

what are the subtypes of SCC following VIN

A

Keratinizing, differentiated (simplex type)

  • not related to HPV
  • History of long standing lichen sclerosus or squamous cell hyperplasia
  • Precurser is VIN differentiated

Classic warty, or Bowenoid type

  • HPV related
  • precursor is VIN usual type
26
Q

Keratinizing squamous cell carcinoma have atypia of which layer

A

basal layer of squamous epithelium

27
Q

what ages are associated with keratinizing and bowenoid types of SCC

A

keratinizing-older women

bowenoid-younger

28
Q

what is verrucous carcinoma

A 
Variant of squamous cell cancer
Condyloma-cauliflower in appearance
Does not respond to treatment of HPV
Grow  slow
Rarely metastasize to nodes
29
Q

what are glandular neoplastic lesions

A

Arise from tissue closely resembling breast tissue: ectopic breast

30
Q

what is papillary hidradenoma

A

Identical in appearance to intraductal papillomas of the breast
Papillary projections with 2 layers of cells
-Columnar secretory cells (top layer)
-Myoepithelial cells: characteristic of sweat glands and sweat gland tumors

31
Q

where is extramammary pagets disease usually located

A

labia majora -Confined to epidermis of skin, hair follicles and sweat glands

32
Q

how does extramammary pagets disease present

A

pruritic, red, crusted, sharply demarcated, maplike area

33
Q

what is vaginal adenosis? how does it present

A

Remnant of columnar endocervical epithelum migrates to vaginal wall
Presents as red granular areas: vaginal mucosa is usually pale pink

34
Q

Vaginal adenosis is liked to exposure of what

A

DES

35
Q

what are Gartner duct cysts

A

Derived from wolffian duct rests forming 1-2 cm fluid filled cysts in cervical submucosa

36
Q

how are Gartner duct and mullerian duct cysts different

A

Gartner- in cervix

Mullerian Duct- occur in proximal vagina

37
Q

what are the 3 most common causes of vaginitis

A

Bacterial Vaginitis-Most common cause (50% of cases)
Candida-2nd most common
Trichomonas Vaginalis-3rd most common cause

38
Q

how can abx cause inc risk for trich and bact vaginosis? what else can inc this risk

A

Abx that kill lactobacillus acidophilus cause inc ph of vagina= inc risk of trich and bact vaginosis

DM can also inc risk bc inc glycogen= inc pH

39
Q

what age range has greatest risk of vaginitis

A

10-24

40
Q

what epithelial thickness is affected by VAIN I/II/III

A

VAIN I: lower 1/3
VAIN II: lower 2/3
VAIN III: full thickness

41
Q

What prior conditions is VAIN assoc. with

A

HPV
Immunosuppression
prior or concurrent neoplasia elsewhere in lower genital tract
50-90% have intraepithelial neoplasia or carcinoma of cervix or vulva

42
Q

what type of tumors can be caused by SCC

A

Tumors may be nodular, ulcerative, indurated, endophytic or exophytic

43
Q

overall is CIN or VAIN typically worst

A

CIN-Vaginal epithelium more stable than cervical epithelium

44
Q

where is mets in vaginal SCC

A

Lesions in lower 2/3rds of vagina mets to inguinal nodes

45
Q

what is embryonal rhabdomyosarcoma

A

highly malignant sarcoma grows as polypoid rounded bulky masses that fill and project out of vagina
Appearance: grape like structure

46
Q

what is embryonal rhabdomyosarcoma AKA

A

Sarcoma botryoides

47
Q

what is vaginal adenocarcinoma assoc with

A

DES

48
Q

how does the squamocolumnar junction change with time

A

There is a clear squamocolumnar junction at puberty. With age/trauma the squamous cells extend up the endocervix extending the squamocolumnar junction and creating the transformation zone(which inc risk for HPV to cause Ca)

49
Q

what is the relationship between lactobacilli and H202

A

Direct-Decreasing Lactobacilli =decreasing H2O2 production

50
Q

is amniotic fluid acidic or basic

A

acidic

51
Q

what is the single most important factor in cervical oncogenesis

A

the oncogenic risk of the HPV subgroup
HPV 16 accounts for 60% of cervical cancers
HPV 18 accounts for 10% of cervical cancers

52
Q

how do oral contraceptives inc risk for cervical neoplasms

A

it affects the natural pH changes with cycling

53
Q

what type of cells do HPV affect

A

Infects immature basal cells of squamous epithelium
Areas of epithelial breaks, immature metaplastic squamous cells
Cannot infect mature superficial squamous cells (cover ectocervix)
Therefore, there has to be damage to the surface epithelium allowing access to immature cells.

54
Q

how does HPV activate the cell cycle

A

interfering Rb (E7) and p53(E6).

55
Q

what does premalignant cervical neoplasms refer to

A

precancerous dysplasia or cervical intraepithelial carcinoma (CIN)

56
Q

what type of CIN is considered true precancer

A 
CIN II and III (both HSIL= high grade)
CIN I (LSIL) is not
57
Q

what are HPV assoc rates with LSIL and HSIL

A 
LSIL= >80%
HSIL= 100%
58
Q

what are the rates of regression, persit, and progression for LSIL and HSIL

A

LSIL-60% regress, 30% persist, 10% progress to HSIL
HSIL-30% regress, 60% persist, 10% progress to carcinoma
*depends also on immune status and environmental factors

59
Q

why does cervical adenocarcinoma have a worse prognosis than cervical SCC

A

diagnosed at a higher stage

60
Q

where is carcinoma in situ most likely to occur and why

A

Most likely at the squamous-columnar junction bc
Columnar epithelium constantly being replaced by squamous epithelium via metaplasia
Metaplasia affected by hormonal levels
Metaplastic cells increased risk of incorporating foreign or ab normal genetic material

61
Q

how common is Spontaneous regression of carcinoma in situ

A

rare

Pathophys (15 decks)

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