Vulvar, vagina, and cervix patho Flashcards by Tyler VanNoord

what microorganisms usually cause bartholin cysts

usually polymicrobial
E. Coli
Staphylococcus
Streptococci
Sexually transmitted pathogens

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what is the mesonephric duct

AKA wolffian duct becomes the vas deferens in men

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what is the paramesonephric duct

AKA the Müllerian ducts- become the fallopian tubes

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what abx should be used for bartholin cyst tx

Cefixime (strep and e.coli)

Clindamycin (Staph)

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does a asymptomatic bartholin cyst need to be tx?

only if >=40yo.

need to biopsy to exclude carcinoma

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what can cause white plaques of the vulva

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

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what are characteristics of lichen sclerosus

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

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what are rete pegs

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

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lichen sclerosus has a inc risk of developing what

SCC

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what is the pathogenesis of lichen sclerosus

Autoimmune disorder with activated T cells

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what other diseases may be seen with lichen sclerosus

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

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

Hyperkeratosis
Expansion of stratum granulosum
Epithelial thickening:

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does squamous cell hyperplasia have a inc risk to Ca

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what are benign exophytic lesions

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

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what is kailocytic atypia? what is it characteristic of

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

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what are characteristics of condyloma acuminatum

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

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is condyloma acuminatum a precancerous lesion

typically not

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what are the VIN usual types

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

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what are the VIN differentiated types

Simplex type
High grade squamous lesions
Progresses to cancer

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what are characteristics of VIN basaloid type

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

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what are characteristics of VIN warty type

Spiking surface
Condylomatous appearance
Abnormal maturation
Increased mitosis

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what is VIN a precursor for

vulvar SCC

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

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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what are characteristics of VIN differentiated

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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what are the subtypes of SCC following VIN

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

Keratinizing squamous cell carcinoma have atypia of which layer

basal layer of squamous epithelium

what ages are associated with keratinizing and bowenoid types of SCC

keratinizing-older women | bowenoid-younger

what is verrucous carcinoma

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

what are glandular neoplastic lesions

Arise from tissue closely resembling breast tissue: ectopic breast

what is papillary hidradenoma

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

where is extramammary pagets disease usually located

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

how does extramammary pagets disease present

pruritic, red, crusted, sharply demarcated, maplike area

what is vaginal adenosis? how does it present

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

Vaginal adenosis is liked to exposure of what

DES

what are Gartner duct cysts

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

how are Gartner duct and mullerian duct cysts different

Gartner- in cervix | Mullerian Duct- occur in proximal vagina

what are the 3 most common causes of vaginitis

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

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

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

what age range has greatest risk of vaginitis

10-24

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

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

What prior conditions is VAIN assoc. with

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

what type of tumors can be caused by SCC

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

overall is CIN or VAIN typically worst

CIN-Vaginal epithelium more stable than cervical epithelium

where is mets in vaginal SCC

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

what is embryonal rhabdomyosarcoma

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

what is embryonal rhabdomyosarcoma AKA

Sarcoma botryoides

what is vaginal adenocarcinoma assoc with

DES

how does the squamocolumnar junction change with time

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)

what is the relationship between lactobacilli and H202

Direct-Decreasing Lactobacilli =decreasing H2O2 production

is amniotic fluid acidic or basic

acidic

what is the single most important factor in cervical oncogenesis

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

how do oral contraceptives inc risk for cervical neoplasms

it affects the natural pH changes with cycling

what type of cells do HPV affect

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.

how does HPV activate the cell cycle

interfering Rb (E7) and p53(E6).

what does premalignant cervical neoplasms refer to

precancerous dysplasia or cervical intraepithelial carcinoma (CIN)

what type of CIN is considered true precancer

``` CIN II and III (both HSIL= high grade) CIN I (LSIL) is not ```

what are HPV assoc rates with LSIL and HSIL

``` LSIL= >80% HSIL= 100% ```

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

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

why does cervical adenocarcinoma have a worse prognosis than cervical SCC

diagnosed at a higher stage

where is carcinoma in situ most likely to occur and why

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

how common is Spontaneous regression of carcinoma in situ

rare