Whitaker: Pathology of femal genital tract Flashcards
1
Q
With HSV, what are the intranuclear inclusion bodies called?
A
Cowdry bodies
2
Q
What is TORCH?
A
- the infections that pass through the infected birth canal:
- Toxoplasma
- Rubella
- Cytomegalovirus
- Herpes
3
Q
How many males and females are symptomatic for HSV?
A
- 1/3 of females
- all males
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
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
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
7
Q
Trichomonas Vaginalis
A
- Potozoan!
- Strawberry Cervix
- Motile trophozoites in methylene blue wet mount; present with corkscrew motility
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
9
Q
Mycoplasma hominis and UReaplasma urealyticum
A
- Mycoplasma: no cell wall
- Ureaplasma: Urease positive
- Both: Chorioamnionitis and premature delivery in preggo pts….. urethritis
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
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
12
Q
is the chancre with T. pallidum painful?
A
no!
13
Q
What are argyll robertson pupils?
A
accomodating but unreactive
- tertiary syphilis
- tabes dorsalis can happen too
- mulberry molars… etc
14
Q
Neisseria gonorrhea
A
- most common cause of PID
- Acute suppurative salpingitis
- Salpingo-oophoritis
- Tubo-ovarian abscess
- pyosalpinx
- chronic salpingitis
- hydrosalpinx
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
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
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
18
Q
What is unique about the condyloma acuminatum nucleic changes?
A
-Kolicytic atypia: enlarged hyperchromatic nuclei with perinuclear halo
19
Q
Bartholin Cyst
A
- plug a tube… causes abscess
- common occur in all ages
- obstruction of duct
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
21
Q
Squamous cell hyperplasia
A
- small flat papule, due to chronic rubbing or scratching to relieve pruritus
- hyperkeratosis and thickened epidermis (acanthosis)
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
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
24
Q
Papillary Hidradenoma
A
- sharply circumscribed nodule.. most commonly on the labia majora or interlabial folds
- can ulcerate
- histologically identical to the breast
25
Extramammary Paget Disease
-Pruritic, red, crusted, maplike area, usually on the labia majora
26
What exposure in utero is associated with Septation?
DES: diethylstilbestrol
27
What is Adenosis?
-embryologic epithelium of the vagina is endocerval type, but changes to squamous
28
Gartner duct cyst
-common along the lateal wall derived from the wolffian duct rests in the proximal vagina
29
What do we get if we block the mucosal glands in the simple columnar epithelium of the endocervix?
-Nabothian cysts
30
What will endocerviocal polyps cause in postmenopausal women?
-bleeding or spotting
31
Is HPV alone sufficient for carcinogenesis?
- No!
| - Immune status and co-carcinorgens are influencers
32
What's the most common type of cervical carcinoma?
-squamous cell (80%)
33
What proliferation marker are we looking for with Cervical cancer?
- Ki-67
| - usually restricted to the basal layer, but E6+7 prevent cell cycle arrest so seen in upper levels
34
What is the mullerian duct also called?
paramesonephric duct
35
What is the mesonephric duct called as well?
-wolffian duct
36
What are gartner duct cysts remnants of?
- the mesonephric duct
| - it was kinda by the cervix/uterus part
37
What are the paratubal cysts remnants of?
-also the mesonephric duct
38
What will HSV present as?
painfull genital warts
39
What is the thing that HSV has (buzzword)?
- Cowdry bodies
| - intranuclear inclusion bodies
40
How many females and males will be symptomatic if they have herpes?
- 1/3 of females..
| - all the males
41
What is does molluscum contagiosum?
- a poxvirus
- cytoplasmic viral inclusion bodies
- pearly dome-shaped papules with a DIMPLED center
- MSV
42
Is candida normal in the vaginal tract?
-yes
43
What will candida look like?
- curd like vaginal discharge
- ... burns
- filamentous fungal hyphae in wet KOH
44
What is the buzz word for Gardnerella?
- clue cells
| - green-gray malodorous vaginal disharge
45
Trichomonas Vaginalis
- Strawberry cervix
- large, flagellated ovoid protozoan
- motile trophozoites in methylen blue wet mount
- present with corkscrew motility
46
Describe Mycoplasma and ureaplasma?
- no cell wall
| - urease positive
47
Chlamydia trachomati
- elementary body... metabolically inactive infectious form
- reticulate body.. metabolically active form
- NAAT is diagnostic
- PID!
48
What is the weird reaction that starts after the first abx tx for T. pallidum?
- Jarisch-Herxheimer rxn
| - presents with increase in temp, derease in bp, rigors, and leukopenia
49
how will T pallidum present?
- nontender chancre: primary
- diffuse copper rash: secondary
- Gummas or granulomas: tertiary
50
What are we most worried about with syphillis?
-aneurysm of the ascending aorta with tree-barking appearance
51
How will congenital syphillis present with the newborn?
- Saber shins
| - mullberry molars
52
What was the boded word on the chlamydia trachomatis PID slid?
-lymphogranuloma venereum
53
What is the most common cause of PID?
-N. gonnorhoea
54
What are the buzzwords for Neisseria?
- acute suppurative salpingitis
- salpingo-oophoritis
- tubo-ovarian abscess
- pyosalpinx
- chronic salpingitis
- hydrosalpinx
55
in what direction does PID spread?
- starts on outside
| - goes towards inside
56
What is HPV binding to its cellular receptor dependent on?
-capsid protein L1
57
How are HPVs generally internalized?
-via clatherin-dependent endocytic mechanism
58
How does HPV infection travel?
- starts at stem cells BASAL keratinocytes of the mucosal epithelium
- spreads apically
59
What is the buzz word for HPV?
-Koilocytes
60
What is it called when a PID reaches all the way to the liver?
-Fitz Hugh Curtis syndrome
61
So what are the two organisms that will give us PID and how do we tell the difference between them?
- 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
What does E6 in HPV do?
-degrades P53
63
What does E7 do?
- binds RB protein and displaces E2F
| - promotes progression through the cell cycle
64
Buzz word for lichen sclerosis of the Vulva?
-parchment paper
65
Buzz word for squamous cell hyperplasia?
- chronic rubbing or scratching to relieve pruritus
| - THICKENED epidermis
66
What are the bumps on the vulva from low risk HPV called?
-condyloma Acuminatum
67
What viral cytopathic change will there be in HPV 6 and 11 on vulva?
-koilocytic atypia
68
What can arise in older women with long standing lichen sclerosus or swaumous cell hyperplasia?
-Keratinizing squamous cell carcinomas
69
What is a Papillary Hidradenoma?
- sharply circumscribed nodule
- most commonly on labia majora or interlabial folds
- can ulcerate
- histologically identical to the breast
70
What is extramammary paget disease (like in the vulva)
- 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
What is that really important thing that DES causes?
-Clear cell adenocarcinoma
72
Whwere does a gartner duct cyst come from?
- common along the lateal wall
- derived from wolffian (mesonephric) duct
- rests in proximal vagina
73
Grapelike clusters in children, what do we think of?
- Embryonal Rhabdomyosarcoma
- rare
- small tumors with oval nuclei, small protrusions of cytoplasm from one end... resembling a TENNIS RACKET
74
What kind of HPVs are basaloid and warty carcinomas associated with?
-the high risk kinds
75
Is HPV related to Keratinizing squamous cell carcinomas ?
- NO!
- those are more common in older women
- due to long standing lichen sclerosus or squamous cell hyperplasia
76
How does Classic VIN present?
- discrete white or a slightly raised, pigmented lesion
| - epidermal thickening, nuclear atypia, increased mitoses, and lack of cellular maturation
77
How does Differentiated VIN present?
- marked atypia of the basal layer of squamous epithelium and normal-appearing differentiation of the more superficial layers
- "nests and tongues"
78
If there is residual glandular epithelium, what's that called?
-Vaginal Adenosis
79
If there is blockage of mucosal glands in the cimple columnar epithelium of the cervix, what's that called?
-Nabothian cyst
80
Are lactobacilli enogenous to the vagina?
-yes
81
If a woman is spotting after sex, what do we think of?
-some kind of carcinoma
82
If a woman is spotting any other time than after sex, what do we think of?
- endocervical polyps
- fibromyxomatous
- tx with just surgical excision
83
Is HPV alone sufficient for carcinogenesis?
-NO! GOD NO!
84
What age does cervical carcinoma present at?
- 45 y.o
| - takes a while to develop
85
What tumor marker is usually restricted to the basal layer of the cervix?
- Ki-67
| - we can use this
86
What is the main difference between classic and differentiated VIN in regards to HPV?
- classic is HPV+
| - Differentiated is HPV negative!
