Witrak Part 1: OBGYN Pathology Flashcards
What are some causes of abnormal vaginal bleeding?
Endometrial atrophy (post-menopausal), endometrial hyperplasia/carcinoma, structural disorders of endometrium/myometrium: endometrial polyps, abnormal gestation
what are the most malignant primary ovarian neoplasms?
epithelial: serous vs. mucinous
are germ cell tumors in men benign or malignant? what about women?
malignant for men. benign for women.
adnexal mass in post-menopausal female = ______ until proven otherwise?
CANCER
what is an early trimester gestational disorder example
?
miscarriage, ectopic gestation
post-menopausal vaginal bleeding is _____ until proven otherwise?
cancer
almost all of the infections of the vulva and vagina are _____________, except ____.
largely sexually transmitted, except candidiasis and post-partum types.
infections with clinical manifestations typically limited to _______ genital tract
lower (vulva, vagina, cervix).
candidiasis, trichomonas, gardnerella (bacterial
vaginosis), HSV, HPV, molluscum, and tropical
STDs (lymphogranuloma venereum, granuloma
inguinale, chancroid)
what two bugs can progress to Pelvic Inflammatory Disease (asymptomatic usually) and what does it put the female at risk for?
Chlamydia and gonococcus. Ectopic pregnancy and infertility.
What infectious agents are potentially fatal sequelae?
HIV, Syphillis, viral hepatitis.
What STDs are notable for risk to fetus/newborn?
HSV, Chlamydia, gonorrhea, syphilis, HIV,
hepatitis B and C
what is a common complication leading to obstetrical infection in the third world? from what organism?
retained placenta doesnt allow uterus to contract. Group B strep.
Classically, but can be subclinical: Sexually active female with lower abdominal pain, purulent endocervical discharge, chandelier sign (pain with movement of cervix). Name that disorder!
PID. subclinical could be first evidence of tubal infertility.
Dx is largely a clinical one:
one recommendation: sexually active young women with lower abdominal, adnexal, and cervical motion tenderness – should receive WHAT?
receive empiric antibiotic RX.
what is the commonest cause of vaginal discharge (40-50%) in reproductive age women?
Bacterial vaginosis- results from disturbed vaginal flora (Gardnerella vaginalis)
How does Gardnerella vaginalis present? Inflammation?
malodorous (fishy), gray-white discharge usually WITHOUT signs of INFLAMMATION. Clue CELLS
What is the commonest curable STD in the world?
Trichomoniasis due to flagellated protozoan T. vaginalis
Are Candida albicans usually sexually transmitted?
NO. often normally present as a commensal in small numbers, due to IMMUNOSUPPRESSION (antibiotics, HIV)
Sexually active female presents with multiple, shallow, painful genital ulcers (preceding vesicles), inguinal adenopathy. What is this infection?
HSV-2
T or F: HSV is sexually transmitted and may occur during asymptomatic/sub-clinical viral shedding (even without genital lesions)
True!
HSV-2 is the most common cause of sporadic _______
MENINGITIS!!!
Tzanck smear is used to see what infectious agent? what would you see?
HSV. multinucleated giant cells, intranuclear inclusions.
what do you see on a histologic slide for HPV?
papillomatous proliferation w/ koilocytotic atypia/mild dysplasia (low grade squamous intraepithelial lesion).
what type of cervical cancer, due to HPV, is the most common?
Squamous cell carcinoma! Adenocarcinoma is the next (if it infects endocervical glandular mucosa).
______ disease usually presents with non-specific pruritus, soreness, or dyspareunia
non-neoplastic
what is the commonest tumefaction of vulva (either infection with abscess or inflammatory duct obstruction with cyst formation)?
Bartholin gland disease
90% of vulvar malignancies are ________
squamous carcinoma
what is the principal cause of vulvar carcinoma in older/post-menopausal women?
‘differentiated type’: typically seen arising in relation to LICHEN SCLEROSUS or LICHEN SIMPLEX CHRONICUS
what can present as abnormal coloration: usually white but also may be red or dark/pigmented. symptomatically: vulvar itch, burning, pain
Squamous vulvar neoplasia
what does the whiteness of the vulvar skin represent?
- lichen simplex chronicus – chronically irritated/hyperplastic skin.
- lichen sclerosus et atrophicus = atrophic epidermis with subepidermal edema
OR Pre-invasive cancer. -> NEED BIOPSY TO TELL THE DIFFERENCE
what benign lesion is associated with the ‘milk line’ and a lump of the vulva?
Papillary hidradenoma. benign labial neoplasm which may ulcerate- hypothesized as originating from ectopic-breast tissue (axilla to groin = milk line)
can have cancer have condyloma like features?
YES. biopsy to make sure. 90% benign condylomatous disease
a post-menopausal white woman has a non-squamous malignancy on her clitoris, what type of cancer is it?
melanoma (5-10%). HIGH mortality rate if > 1 mm thickness. favors clitoris and labia minora
what vulvar carcinoma presents as a ‘rodent’ ulceration, usually non-metastasizing?
Basal Cell Carinoma (2% of vulvar CA)