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Repro 2 Midterm > Whitaker: Pathology of femal genital tract > Flashcards

Whitaker: Pathology of femal genital tract Flashcards

1
Q

With HSV, what are the intranuclear inclusion bodies called?

A

Cowdry bodies

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2
Q

What is TORCH?

A
  • the infections that pass through the infected birth canal:
  • Toxoplasma
  • Rubella
  • Cytomegalovirus
  • Herpes
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3
Q

How many males and females are symptomatic for HSV?

A
  • 1/3 of females

- all males

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4
Q

Molluscum contagiosum

A
  • Poxvirus
  • Only DNA virus that replicates in the cytoplasm and has own RNA polymerase and everything it needs to replicate outside the nucleus
  • Pearly, dome-shaples papules with a dimpled center…
  • Cytoplasmic viral inclusion bodies
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5
Q

Candida (Moniliasis)

A
  • mold in heat
  • yeast in cold
  • forms pseudohyphae and budding yeast at 20degrees C and germ tubes-hypae molds at 37 degrees C
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6
Q

Clinical symptoms of Candida (Moniliasis

A
  • vulvovaginal pruritus, erythema, swelling, and curd-like vaginal discharge… AIDS defining illness
  • not STI
  • Pseudospores of filamentous fungal hyphae in wet KOH
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7
Q

Trichomonas Vaginalis

A
  • Potozoan!
  • Strawberry Cervix
  • Motile trophozoites in methylene blue wet mount; present with corkscrew motility
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8
Q

Gardnerella vaginalis

A
  • gram negative bacillus
  • Green-gray, malodorous (fishy) vaginal discharge
  • superficial and intermediate squamous cells covered with a shaggy coating coccobacilli… pH 4.5 and “CLUE CELLS
  • Whiff test: add KOH to sample and it produces the fishy amine odor
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9
Q

Mycoplasma hominis and UReaplasma urealyticum

A
  • Mycoplasma: no cell wall
  • Ureaplasma: Urease positive
  • Both: Chorioamnionitis and premature delivery in preggo pts….. urethritis
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10
Q

Chlamydia trachomatis

A
  • most common STD in world
  • causes PID
  • 2 forms: elementary body… metabolically inactive infections form in endosome, reticulate body… metabolically active form
  • Nucleic acid amplification test (NAAT’s)
  • lymphogranuloma venereum
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11
Q

Treponema pallidum

A
  • thin spirochete THIS IS SYPHILIS
  • obligate pathogen… but not intracellular
  • Sexual or transplacental transmission
  • endarteritis resulting in lesions; strong tendency to chroncitiy
  • Jarisch-Herxheimer reaction starts generally during the first 24 hrs of antibiotic tx: increase in temp, decrease in BP, rigors, and leukopenia
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12
Q

is the chancre with T. pallidum painful?

A

no!

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13
Q

What are argyll robertson pupils?

A

accomodating but unreactive

  • tertiary syphilis
  • tabes dorsalis can happen too
  • mulberry molars… etc
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14
Q

Neisseria gonorrhea

A
  • most common cause of PID
  • Acute suppurative salpingitis
  • Salpingo-oophoritis
  • Tubo-ovarian abscess
  • pyosalpinx
  • chronic salpingitis
  • hydrosalpinx
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15
Q

What is PID anyways?

A

-an infection that befins in the vulva or vagina and spreads upward to involve most of the structures in the female genital system, resulting in pelvic pain, adnexal tenderness, fever, and vaginal discharge

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16
Q

Human Papillomavirus

A
  • non-enveloped, Ds DNA virus w. icosahedral capsule
  • Binding to cells is dependent only on capsid protein L1 (not L2)
  • HPV’s are generally internalized via a clatherin-dependent endocytic mechanism
  • infects stems cells basal keratinocytes of the mucosal epithelium and delivers the genome to the nucleus
  • the immune system is largely unaware oft he infection … we don’t recognize it sometimes i guess
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17
Q

What is responsible for the oncogenic effect of HPV?

A
  • E6 and E7 proteins
  • E6: degrades p53… stimulates expression of TERT
  • E7: binds to RB ptn and displaces the E2F transcription factors that are normally sequestered by RB, promotion progression through the cell cycle
  • E7 also inactivates the CDK inhibitors p21 and p27
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18
Q

What is unique about the condyloma acuminatum nucleic changes?

A

-Kolicytic atypia: enlarged hyperchromatic nuclei with perinuclear halo

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19
Q

Bartholin Cyst

A
  • plug a tube… causes abscess
  • common occur in all ages
  • obstruction of duct
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20
Q

Lichen sclerosus

A
  • postmenopausal smooth white plaque, thinning the skin to resemble parchment paper
  • T cells cause subendothelial inflammatory infiltrate
  • slightly inccreased risk of squamous cell carcinoma
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21
Q

Squamous cell hyperplasia

A
  • small flat papule, due to chronic rubbing or scratching to relieve pruritus
  • hyperkeratosis and thickened epidermis (acanthosis)
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22
Q

Which vulvar carcinoma is related to HPV infection and is less common and occurs at younger ages?

A
  • Basaloid and warty carcinomas

- HPV16 is usually the culprit

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23
Q

Is Keratinizing squamous cell carcinomas related to HPV?

A

no

  • more common and occur in older women
  • due to long standing lichen sclerosus or squamous cell hyperplasia
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24
Q

Papillary Hidradenoma

A
  • sharply circumscribed nodule.. most commonly on the labia majora or interlabial folds
  • can ulcerate
  • histologically identical to the breast
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25
Q

Extramammary Paget Disease

A

-Pruritic, red, crusted, maplike area, usually on the labia majora

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26
Q

What exposure in utero is associated with Septation?

A

DES: diethylstilbestrol

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27
Q

What is Adenosis?

A

-embryologic epithelium of the vagina is endocerval type, but changes to squamous

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28
Q

Gartner duct cyst

A

-common along the lateal wall derived from the wolffian duct rests in the proximal vagina

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29
Q

What do we get if we block the mucosal glands in the simple columnar epithelium of the endocervix?

A

-Nabothian cysts

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30
Q

What will endocerviocal polyps cause in postmenopausal women?

A

-bleeding or spotting

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31
Q

Is HPV alone sufficient for carcinogenesis?

A
  • No!

- Immune status and co-carcinorgens are influencers

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32
Q

What’s the most common type of cervical carcinoma?

A

-squamous cell (80%)

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33
Q

What proliferation marker are we looking for with Cervical cancer?

A
  • Ki-67

- usually restricted to the basal layer, but E6+7 prevent cell cycle arrest so seen in upper levels

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34
Q

What is the mullerian duct also called?

A

paramesonephric duct

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35
Q

What is the mesonephric duct called as well?

A

-wolffian duct

36
Q

What are gartner duct cysts remnants of?

A
  • the mesonephric duct

- it was kinda by the cervix/uterus part

37
Q

What are the paratubal cysts remnants of?

A

-also the mesonephric duct

38
Q

What will HSV present as?

A

painfull genital warts

39
Q

What is the thing that HSV has (buzzword)?

A
  • Cowdry bodies

- intranuclear inclusion bodies

40
Q

How many females and males will be symptomatic if they have herpes?

A
  • 1/3 of females..

- all the males

41
Q

What is does molluscum contagiosum?

A
  • a poxvirus
  • cytoplasmic viral inclusion bodies
  • pearly dome-shaped papules with a DIMPLED center
  • MSV
42
Q

Is candida normal in the vaginal tract?

A

-yes

43
Q

What will candida look like?

A
  • curd like vaginal discharge
  • … burns
  • filamentous fungal hyphae in wet KOH
44
Q

What is the buzz word for Gardnerella?

A
  • clue cells

- green-gray malodorous vaginal disharge

45
Q

Trichomonas Vaginalis

A
  • Strawberry cervix
  • large, flagellated ovoid protozoan
  • motile trophozoites in methylen blue wet mount
  • present with corkscrew motility
46
Q

Describe Mycoplasma and ureaplasma?

A
  • no cell wall

- urease positive

47
Q

Chlamydia trachomati

A
  • elementary body… metabolically inactive infectious form
  • reticulate body.. metabolically active form
  • NAAT is diagnostic
  • PID!
48
Q

What is the weird reaction that starts after the first abx tx for T. pallidum?

A
  • Jarisch-Herxheimer rxn

- presents with increase in temp, derease in bp, rigors, and leukopenia

49
Q

how will T pallidum present?

A
  • nontender chancre: primary
  • diffuse copper rash: secondary
  • Gummas or granulomas: tertiary
50
Q

What are we most worried about with syphillis?

A

-aneurysm of the ascending aorta with tree-barking appearance

51
Q

How will congenital syphillis present with the newborn?

A
  • Saber shins

- mullberry molars

52
Q

What was the boded word on the chlamydia trachomatis PID slid?

A

-lymphogranuloma venereum

53
Q

What is the most common cause of PID?

A

-N. gonnorhoea

54
Q

What are the buzzwords for Neisseria?

A
  • acute suppurative salpingitis
  • salpingo-oophoritis
  • tubo-ovarian abscess
  • pyosalpinx
  • chronic salpingitis
  • hydrosalpinx
55
Q

in what direction does PID spread?

A
  • starts on outside

- goes towards inside

56
Q

What is HPV binding to its cellular receptor dependent on?

A

-capsid protein L1

57
Q

How are HPVs generally internalized?

A

-via clatherin-dependent endocytic mechanism

58
Q

How does HPV infection travel?

A
  • starts at stem cells BASAL keratinocytes of the mucosal epithelium
  • spreads apically
59
Q

What is the buzz word for HPV?

A

-Koilocytes

60
Q

What is it called when a PID reaches all the way to the liver?

A

-Fitz Hugh Curtis syndrome

61
Q

So what are the two organisms that will give us PID and how do we tell the difference between them?

A
  • N. gonorrhoeae (most common): gram -
  • C. trachomatis: gram -
  • you’d also just do a NAAT for both of them and see what shows up
62
Q

What does E6 in HPV do?

A

-degrades P53

63
Q

What does E7 do?

A
  • binds RB protein and displaces E2F

- promotes progression through the cell cycle

64
Q

Buzz word for lichen sclerosis of the Vulva?

A

-parchment paper

65
Q

Buzz word for squamous cell hyperplasia?

A
  • chronic rubbing or scratching to relieve pruritus

- THICKENED epidermis

66
Q

What are the bumps on the vulva from low risk HPV called?

A

-condyloma Acuminatum

67
Q

What viral cytopathic change will there be in HPV 6 and 11 on vulva?

A

-koilocytic atypia

68
Q

What can arise in older women with long standing lichen sclerosus or swaumous cell hyperplasia?

A

-Keratinizing squamous cell carcinomas

69
Q

What is a Papillary Hidradenoma?

A
  • sharply circumscribed nodule
  • most commonly on labia majora or interlabial folds
  • can ulcerate
  • histologically identical to the breast
70
Q

What is extramammary paget disease (like in the vulva)

A
  • pruritic red, crusted, maplike area, usually on the labia majora
  • DOES NOT MEAN THAT THERE IS CANCER SOMEWHERE!!!!
  • paget disease of the nipple= definite underlying cancer
71
Q

What is that really important thing that DES causes?

A

-Clear cell adenocarcinoma

72
Q

Whwere does a gartner duct cyst come from?

A
  • common along the lateal wall
  • derived from wolffian (mesonephric) duct
  • rests in proximal vagina
73
Q

Grapelike clusters in children, what do we think of?

A
  • Embryonal Rhabdomyosarcoma
  • rare
  • small tumors with oval nuclei, small protrusions of cytoplasm from one end… resembling a TENNIS RACKET
74
Q

What kind of HPVs are basaloid and warty carcinomas associated with?

A

-the high risk kinds

75
Q

Is HPV related to Keratinizing squamous cell carcinomas ?

A
  • NO!
  • those are more common in older women
  • due to long standing lichen sclerosus or squamous cell hyperplasia
76
Q

How does Classic VIN present?

A
  • discrete white or a slightly raised, pigmented lesion

- epidermal thickening, nuclear atypia, increased mitoses, and lack of cellular maturation

77
Q

How does Differentiated VIN present?

A
  • marked atypia of the basal layer of squamous epithelium and normal-appearing differentiation of the more superficial layers
  • “nests and tongues”
78
Q

If there is residual glandular epithelium, what’s that called?

A

-Vaginal Adenosis

79
Q

If there is blockage of mucosal glands in the cimple columnar epithelium of the cervix, what’s that called?

A

-Nabothian cyst

80
Q

Are lactobacilli enogenous to the vagina?

A

-yes

81
Q

If a woman is spotting after sex, what do we think of?

A

-some kind of carcinoma

82
Q

If a woman is spotting any other time than after sex, what do we think of?

A
  • endocervical polyps
  • fibromyxomatous
  • tx with just surgical excision
83
Q

Is HPV alone sufficient for carcinogenesis?

A

-NO! GOD NO!

84
Q

What age does cervical carcinoma present at?

A
  • 45 y.o

- takes a while to develop

85
Q

What tumor marker is usually restricted to the basal layer of the cervix?

A
  • Ki-67

- we can use this

86
Q

What is the main difference between classic and differentiated VIN in regards to HPV?

A
  • classic is HPV+

- Differentiated is HPV negative!

Repro 2 Midterm (9 decks)

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