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Pathology > Cervix, Vagina, Vulva > Flashcards

Cervix, Vagina, Vulva Flashcards

1
Q

What are the structures that provide vaginal lubrication?

A

Transudate from BVs
Secretions of the Bartholin’s & Skene’s glands

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2
Q

WHat are the 5 congenital anomlies of the vagina & vulva?

A
  1. Imperforate hymen (Hematocolpos)
  2. Vaginal atresia
  3. Vaginal agenesis
  4. Septate vagina
  5. Double uterus didelphys
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3
Q

What congenital anomaly of the uterus has double uterus with 2 separate cervices & possibly double vagina?

A

Double uterus (Didelphys)

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4
Q

What is the cause of Didelphys?

A

Embyronic fusion of the Mullerian ducts fail to occr

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5
Q

What is the most common and most distal form of vaginal outflow obstruction that is a congenital anomaly w/ hymen completely obstructing the vaginal opening?

A

Imperforate. Hymen/Hematocolpos

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6
Q

When is Hematocolpos diagnosed in adolescent girls?

A

When menstrual blood accumulated in the vagina & can backflow in the uterus

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7
Q

What congenital anomaly has total absence of the vaginal canal?

A

Vaginal agenesis

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8
Q

What other conditions are associated with vaginal agenesis?

A

assoc w/ renal hypoplasia or agenesis & middle ear abnormalities in px w/ Winter syndrome

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9
Q

What congenital anomaly of the vagina is found at the lower portion of the vagina replaced by 2-3cm of fibrous tissue?

A

Vaginal atresia

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10
Q

Whaat is the cause of Vaginal atresia?

A

Failure of urogenital sinus to contribute to the formation of the caudal portion of the vagina -> ABsence of Mullerian derivatives

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11
Q

What is a rare congenital anomaly of the vagina where it is divided to create a double vagina?

A

Septate vagina

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12
Q

What is the cause of septate vagina? What other structures are doubled?

A

incomplete fusion of the lower parts of the 2 Mullerian ducts

Doubled: cervix, uterine septum

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13
Q

What are the diff causative agents of lower genital tract infections in females?

A

Gardnerella vaginalis
Trichomonas vaginalis
Candidasis albicans, C. Glabiata,, C tropicales
HSV type 2
HPV
Molloscum Contagiosum
Syphilis

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14
Q

What structures are affected in the upper & lower reproductive tract of females in cases of infections?

A

URT: Fallopian tube, ovary, uterus
LRT: Vagina cervix, and vulva

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15
Q

What are the diff types of repro tract infectionss?

A

Endogenous infections
Iatrogenic infections
STIs

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16
Q

What are the S/Sx & Dx of Gardnerella vaginalis?

A

S/Sx: thin, milky, Malodorous (FISHY) ginal discharge, pH >4.5
Dx: Clue cells in PAP smear —> Shaggy coat of coccobacilli in cytoplasm

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17
Q

What are the risk factors in developing bacterial vaginosis?

A

Higher incidence of preterm labor
PID
Concomitant HIV, HSV, GC, and chlamydial infection & transmission
Premature rupture of membranou & chorioamnionitis

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18
Q

What are the risk factors in developing Candidiasis?

A

recent antibiotic use
Uncontrolled DM
HIV/AIDS
Other immunocompromised states

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19
Q

What are the S/Sx & Dx of Candidiasis?

A

Dx: Pap smear, KOH mount: spaghetti & balls
S/Sx:
Pruritus
Thick, white, curd-like cervical discharge
Edema
Dysuria
Vulvovaginal erythema

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20
Q

What are the S/Sx & Dx of Trichomoniasis ?

A

S/Sx:
- strawberry spot cervix
- yellow, frothy, foul smelling vaignal discharge
- duspareunia (painful intercourse)
- dysuria, vulvovaginal discomfort

Dx:
- Oval, flagellated single-celled organisms w/ v small round nucleus

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21
Q

What is the leading cause of genital ulcer dis that has an INC risk of HIV acquisition & neonatal herpes?

A

HSV-2

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22
Q

What reproductive tract structures of females are affected in HSV-2 infections?

A

Cervix
Vagina
VUlva
Sacral nerves

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23
Q

What is produced by nerve involvement during acute, latent, chronic phase of HSV-2 to allow persistence of infection?

A

Retrograde axonal transport

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24
Q

What are complications of HSV-2?

A

Neonatal transmission
Malignant transformation

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25
Q

What are the gross features & histologic features of HSV-2?

A

Gross: crops of vesicles, pustules, and painful shallow ulcers

Histo:
1. Synctial multinucleated giant cells containing ground glass nuclei
2. Nuclear MOLDING
3. MARGINATION of chromatin at the periphery of the nculear membrane

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26
Q

What are inclusion bodies pathognomonic for HSV-2? WHat test is done to detect the virus?

A

Cowdry A inclusion bodies

Tzanck test

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27
Q

WHat strains of HOV are low risk and high risk?

A

High risk HPV: 16, 18, 31, 33

Low risk HPV 6, 11, 42, 44

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28
Q

What HPV serological type causes Condylomata acuminatum?

A

HPV type 6

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29
Q

What are the gross & histo featuers of Condylomata acuminatum?

A

Gross: Verrucuous papillary exophytic outgrowth (flat on the perineal surface of the vagina & vulva)

Histo: Acanthosis, hyperkeratosis, parakeratosis, papillomatosis & koilocytosis (perinuclear halo)

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30
Q

WHat is an intermediate cell w/ perinuclear halo associated with COndylomata acuminatum?

A

Koilocytes

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31
Q

What are the 4 serologic types of Molloscul contagiosum?

A

MCV 1, 2, 3, 4

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32
Q

What strain of Molloscum contagiosum is the most common and which one is assoc with STI?

A

MCV 1 = most common
MCV 2 = STI

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33
Q

What are the gross & histo features of Molloscum contagiosum?

A

Gross: multiple, umbilicated, highly pruritic, small papular lesions (dome-shaped) found on the trunk & anogenital areas

Histo:
- Molloscum contagiosum lesion = dome-shaped lesion of the skin with a central umbilicated crater
- Molloscum bodies = shows densely eosinophilic, round intracytoplasmic inclusion bodies

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34
Q

WHat are the lesions seen in primary & secondary syphilis?

A

Primary syphilis - chancre
SEcondary syphilis - condylomata lata

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35
Q

What kind of infection begins in the vulva/vagina & spreads upwards to involve the uterus, fallopian tubes, ovaries, and pelvic peritoneum?

A

Pelvic inflammatory disease

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36
Q

What are the most common sites of PID (pelvic inflammatory dis)? WHat are the causative agents?

A

Fallopian tubes & ovaries

CAs: N gonorrheae, Chlamydia, Enteric bacte, polymicrobial orgnanisms

But most common is Neisseira gonorrhoeae

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37
Q

What are acute & chronic complications of PID?

A

Acute: Peritonitis, Bacteremia
Chronic: Salpingitis, Tubo-ovarian abscess, Intestinal osbtructions, Infertility

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38
Q

What are the 3 benign cystic lesions of the vulva?

A

Epidermoid cyst of the vulva
Bartholin’s duct cyst
Epithelial tumors of the vulva

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39
Q

What benign cystic lesion of the vulva is lined by stratified squamous epithelium that contains keratin of amorphous material in the lumen?

A

Epidermoid cyst of the vulva

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40
Q

What benign cystic lesion is found in the posterior wall of the vulva and causes “fist formation” where there is inflammation/obstruction of Bartholin’s gland?

A

Bartholin’s duct cyst

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41
Q

What is the cause of Bartholin’s duct cyst?

A

Scaring & obstruction of the duct & eventual cystic dilations of the duct

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42
Q

How do u tx Bartholin’s duct cyst?

A

Marsupialization: surgery to remove the cyst

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43
Q

What are the 2 types of epitheliam tumors of the vulva?

A
  1. Fibro-epithalial polyp
  2. Papillary/nodular hidradenoma
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44
Q

What are the gross & histo features of Acrochordon/Fibro-Epithelial polyp?

A

Gross: Papillomatous pedunculated outgrowth of the mucosa of the vulva & vagina

Histo:
- Elevated, dome-shaped, pedunculated, polypod outgrowth

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45
Q

What are the gross & histo features of Papillary/Nodular Hidradenoma?

A

Gross: Small brown nodules on vulva
Histo: Benign proliferative glands that have Aprocirin features lined by columnar/cuboidal pink cytoplasm

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46
Q

What are groups of non-neoplatic disorders of the mucosa of the vulva and the skin seen in post-menopausal women?

A

Vulvar dystrophies

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47
Q

What are the common presentations of Vulvar dystrophies?

A

Assoc with Pruritus

Presents w/ white, scaly, plaque-like mucosal thickening

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48
Q

What are 2 types of vulvar dystrophies?

A

Lichen sclerosus
Squamou hyperplasia

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49
Q

what type of vulvar dystophy is aka Hyperplastic hystrophy or LIchen simplex chronicus?

A

Squamous hyperplasia

50
Q

What is the cause of squamous hyperplasia or LIchen simplex Chornicus?

A

Rubbing/scratching/chronic irritation of the skin to relive pruritus

51
Q

What is the clinical presentation of Hyperplastic dystrophy?

A

Leukoplakic lesion

52
Q

What are the histo & gross features of Lichen Simplex Chronicus?

A

Gross:
- irregular map-like white thickeing of the vulva

Histo:
- Thickening of the epidermis (Acanthosis), Hyperkeratosis and dermal inflammation
- Lymphocytic infitlration of the dermis

53
Q

What type of vulvar dystrophy is aka Chronic Atrophic Vulvitis caused by an autoimmune rxn of activated T cells in the sub-epithelium?

A

Lichen Sclerosus

54
Q

What is the clinical presetation of LIchen Sclerosus? IN what age grp does this commonly seen?

A

Porcelain or parchment surface of the vulva

Age grp: Post-menopausawomen

55
Q

What are the histo & gross features of Lichen Sclerosis?

A

Gross:
- everted labia majora with white patchent-like smooth thickening of the mucosa
- vaginal introitus is narrowd & obliterated
(Trisha mukha siyang loob ng oyster)

Histo:
- Rete pegs are lost
- marked thinning & hypoplasia of the pidermis + hyperkeratosis
- scattered mononuclear inflammaotry responses

56
Q

What are the 3 categories of vulvar intraepithelial neoplasia (VIN)?

A

VIN I - mild dysplasia
VIN II - moderate dysplasia
VIN III - Severe dysplasia

57
Q

Are px w/ VIN lesions less susceptible to HPV sero type 16?

A

No, they are MORE susceptible

58
Q

What are the gross & histo features of VIN lesions?

A

Gross; Irregular map-like white parchment leukoplakic lesion
(Mukha ngang parchment paper)

Microscopic:
- R side affected (w/ VIN lesion)
- irregular thickening, acanthosis, papillomatosis of strat squamous mucosa

59
Q

What type of VIN has 1/3 epithelial thickness from the basement membrane up to the surface?

A

VIN I - Mild dyplasia

60
Q

What are the causes of VIN I?

A

Disordered maturation
Nuclear enlargement
Hyperchromasia
Mitosis

61
Q

What VIN has atypical proliferation exceeding 1/3 of the epithelium but does not exceed 2/3 of it?

A

VIN II = moderate dysplasia

62
Q

WHat VIN type exceeds 2/3 of the epithelial thickness but does not involve the full thickness of the epithelium?

A

VIN III - severe dysplasia`

63
Q

What are the caues of ViN II?

A

Disordered maturation of squamosu cells
Hyperchromatic large nuclei
Mitotic figures

64
Q

What is an important sign of maturation in VIN III?

A

Top of the epidermis that appear longitudinally parallel to the basement membrane

65
Q

What are the most common type of vulvar carcinoma?

A

Squamous cell carcinoma:
- Keratinizing SCCA
- Warty basaloid SCCA

66
Q

What are the causes of vulvar carcinoma?

A
  • Lichen sclerosus
  • VIN lesions or VIN simplex: carried a high risk of cancer devt
  • HPV-associated warty and basaloid carcinoma
67
Q

What are the gross features of Vulvar carcinoma?

A

Exophytic, ulcerative, infiltrative
Slow growing mass w/ surface extension to contiguous skin, vagina, and rectum

68
Q

What are the 2 grps of vulvar carcinoma?

A

Assoc w/ HPV
Assoc w/ VIN, Squamous cell hyperplasia, Lichen sclerosus

69
Q

What type of vulvar carcinoma represents the tumor that has invaded the underlying connective tissue trauma?

A

Invasive SCCA vulva

70
Q

What are the gross & histo features of Invasive SCCA vulva?

A

Gross:
- large, whitish, exophytic, fungating mass
- endophytic ulcerating lesion

Histo
- Nests and islands of malignant squamous cells
- Keratinizing and intracellular bridges –> Keratin pearls

71
Q

What is aka Extramammary Paget Disease where it is assoc with carcinoma of the skin adnexa?

A

Paget’s disease of the vulva

72
Q

What are the gross & histo features of Extramammary Paget dis?

A

Gross:
- Large, red, moist, sharply demarcated encrusted lesion in the labia

Histo
- Piaget cell: + Mucopolysaccharide stain

73
Q

What are the 3 pathologies of the vagina?

A

Mesonephric cyst/Gartner’s duct cyst
Squamous papilloma
Vagina intraepithelial Neoplasia

74
Q

Where is Gartner’s duct cyst located?

A

Anterolateral wall of the vagina, ff the route of mesonephric duct

75
Q

What is the histologic feature of Gartner’s duct cyst?

A

Simple cuboidal, non-mucin-secreting cells that is reminiscent from mullerian cell derivative

76
Q

What benign lesion of the vagina is commonly seen in reproductive-age women and includes Stromal tumors, Leiomyomas, and Hemangiomas?

A

Squamous papilloma

77
Q

What are the gross & histo features of squamous papilloma?

A

Gross: Shows exophytic small, pedunculated lesions

Histo:
- benign squamous epithelium arranged in complex papillary frond
- single papillary front around a central fibrovascular core

78
Q

What is the location of squamous papilloma?

A

near the hymenal ring

79
Q

What are the group of spectrum epithelium lesions of atypia involving the vaginal mucosa?

A

Vaginal intraepithelial neoplasia

80
Q

What is the Bethesda system of vaginal intraepithelial neoplasia?

A

Low grade squamous epithelial lesion: VaIN 1 (Mild dysplasia)

High grade squamous epithelia lesion: VaIN 2 and VaIN3

81
Q

What are the gross & histo features of Vaginal Intraepithelial neoplasia?

A

Gross: raised, flat white or pink, eroded
Histo:
- loss of normal maturation
- nuclear atypia
- INC mitotic activity
- abnormal mitotic figures
- acanthosis & dyskeratosis

82
Q

What are the characteristics of Bethesda system?

A

LG SQEL: N I).
- Atypical changes are confined within the inner 1/3 of vaginal mucosa.
- hyperchromasia of the nuclei, presence of abnormal mitotic figures, disordered
maturation.

HGSEL: atypia > 2/3 of epithelial linings -> full thickness in carcinoma situ

83
Q

What are the risk factors of vaginal carcinoma?

A
  • high risk HPV: detected via vaginal testing
  • premalignant lesion
  • assoc with cervical and vulvar carcinoma
84
Q

What is the pattern of spread of vaginal carcinoma?

A

Upper vaginal tumor -> Iliac lymph node
Lower vaginal tumor -> inguinal lymph node

85
Q

What is an important histo feature of vaginal carcinoma?

A

keratinization forming laminated pink keratin pearls

86
Q

What are the 2 types of vaginal adenocarcinoma?

A

Clear cell adenocarcinoma
Embryonal rhabdomyosarcoma

87
Q

What are histological features of clear cell adenocarcinoma?

A
  1. Hobnail = cell pattern that presents a nucleus protruding out of their lumen
  2. Solid, Tubulocystic pattern
  3. Clear cells due to glycogen
88
Q

What is the risk factor of developing vaginal adenocarcioma?

A

Vaginal adenosis (precursor lesion)

89
Q

What is the most common malignant tumor of the vagina in infants & children?

A

Embryonal rhabdomyosarcoma/Sarcoma botryoides

90
Q

What are the gross & histo features of Embryonal Rhabdomyosarcoma?

A

Gross:
“bunch of grapes” - large, soft, polypoid mass

Microscopic:
- Rhabdomyoblasts = racket-shaped. tadpole-shaped cells
- Cambium layer = condensed layer beneath the benign squamous epithelium of the vagina

91
Q

What condition presents with inflammation of the cervical mucosa and stroma?

A

Cervicitis

92
Q

What are the histological features of Cervicitis?

A
  • Glycogenated squamopus cells
  • inflammation of the stroma
93
Q

What is the common cause of Cervicitis?

A

Chlamydial infection

94
Q

What are the clinical features of Cervicitis?

A
  • freq asymptomatic
  • mucosal changes: erosion, superficial ulceration
  • vaginal discharge
95
Q

What are the 3 important hallmarks of Chronic Cervicitis?

A
  1. Squamous metaplasia of the endocervix
  2. Nabothian cysts
  3. Endocervical polyp
96
Q

What are the histo findings of Nabothian cysts?

A
  • cystic dilation of endocervical glands w/ accumulation of secretory material in the lumen
  • scarring, securitization
97
Q

What cells line the Endocervical polyp

A

Mucous columnar cells
Squamous metaplastic cells

98
Q

What sero typeof HPV is assoc w/ higher risk of LSIL?
What viral oncogene interferes with tumor suppressor proteins and DNA repair mechanisms?

A

sero type: HPV-16

Viral oncogene E6&E7

99
Q

What structures are affected in Cervical intraepithlial lesion & invasive squamous neoplasia?

A

Intraepithelial atypia to invasive squamous cell carcioma

100
Q

What are the risk factors of Cervical Intraepithelial lesion & invasive squamous neoplasia?

A
  • early age of 1st intercourse
  • multiple sexual partners (HIGHER in males)
  • immunosuppression
  • HPV 16, 18, 31, 33
101
Q

What are atypical changes in the cervix causing Cervical Intraepithelial Neoplasia?

A

Atypical changes:
- dyskeratosis
- nuclear pleomorphism
- mitoses
- koilocytosis

102
Q

Where does Cervical Intraepithelial Neoplasia commonly occur?

A

Squamo-columnar junction

103
Q

what are the 3 significant biomarkers of squmaous intraepithelial lesions?

A

p16, Ki67 & high-risk HPV

104
Q

what biomarker distinguishes from benign mimics? What is indicated if it is negative for thsi biomarker?

A

P16

Neg P16 - focal positivity that are patchy & distributed all throughout epithelium

105
Q

What biomarker is expresses in SIL and correlates with the extend of disordered maturation?

A

Ki-67

106
Q

What are the clinical presentation of Cervical carcinoma?

A
  • Nodular, infiltrative & fungating lesions
  • advanced spread & metastasis
  • vagina bleeding/discharge
107
Q

What are the gross & histo features of Cervical caricnoma?

A

Gross:
- fungating or exophytic, ulcerating & infiltrative/endophytic

histo
- SCC, adenocarcinoma, adenosquamous carcinoma & neuroendocrine carcinoma

108
Q

What are the 5 types of cervical carcinoma?

A

Cervical squamous cell carcinoma
Cervical adenocarcinoma
Cervical adenosquamous carcinoma
Clear cell adenocarcinoma
Neuroendocrine carcinoma

109
Q

At what age should males & females have their HPV vax?

A

11-12yr - 26 y/o

110
Q

When should the 1st screening for cervical cancer be? How often should px 21-29 yo undergo cytologic testing?

A

21 yrs or 3 yrs after onset of sex

Cyto test: every 3 yrs

111
Q

What is px 30-65 yo test negative for HPV, when should they have their next test?

A

After 5 yrs

112
Q

If a px is + for HPV, what should be advised to the px?

A

Cotesting every 6-12 mons

113
Q

What should we do if there is a + abnormal pap smear?

A

Colposcopoc biopsy

114
Q

What are the 3 morphologic variants of Cervical SCC/

A

Large cell keratinizing
Large cell non-keratiniizing
Small cell

115
Q

WHat are the morphological clues of squamous differentiation?

A

Keratin pearls
Intracellular bridges
Intracytoplasmic keratin

116
Q

What are the most common morphological var of cervical SCC?

A

Large Cell, Nonkeratinizing - presence of iNTRACELLULAR BRIDGES

117
Q

What are clues of Large Cell Keratinizing variant?

A

Sheaths, islands & nests of malignant polygonal cells w/ KERATIN PEARLS

118
Q

What are clues of small cell var of cervical SCC?

A

NO KERATINIZATION
NO INTRACELLULAR BRIDGES

119
Q

What are the gradings of cervical SCC?

A

G1 = well-diff
G2 = moderately diff
G3 = poorly diff

120
Q

What type of cervical carcinoma may present w/ Cushings & Carcinoid syndromes?

What are its histological features?

A

Neuroendocrine carcinoma

Histo features:
- fine chromatin pattern
- nuclear molding
- signs of apoptosis positive for Chromogranin & Synaptophysin

Pathology (8 decks)

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