13.1 - 13. 4: Vulva, vagina, cervix, and Endometrium Flashcards
(122 cards)
1
Q
What are the boundaries of the vulva?
A
Vagina external to the hymen
2
Q
What is a Bartholin cyst? Who do they usually occur in?
A
- Inflammation/infection of the vestibular glands in the vagina (located in the posterolateral corners) 2/2 obstruction
- Women of reproductive age
3
Q
What is a Condyloma accumata, and what causes it? What are the histological characteristics? Does it progress to carcinoma?
A
- Wart
- HPV 6 or 11
- Koilocytic change on histo
- Rarely progresses to CA
4
Q
What are the HPV strains that cause warts? Cervical cancer?
A
- 6, 11 cause warts
- 16, 18, 31, 33, 35 cause CA
5
Q
Where in the female genitalia are the three locations where HPV classically infects?
A
- Vaginal canal
- Cervix
- Vulva
6
Q
How does koilocytic change appear? What pathology does this occur in?
A
- Crumpled raisins nuclei
- HPV infections
7
Q
What is the viral family and genetic content of HPV? Enveloped?
A
- Papillomaviridae
- dsDNA
- Non-enveloped
8
Q
What are CIN, VaIN, and VIN, respectively?
A
Cervical CA in situ
- Vaginal carcinoma in situ
- Vulvar carcinoma in situ
9
Q
True or false: the koilocytic change that is characteristic of HPV infection occurs regardless of in the cell in cancerous or just a wart
A
True
10
Q
What is Lichen Sclerosis? What are the clinical characteristics of this? In whom is this seen in?
A
- Thinning of the epidermis and fibrosis of the underlying dermis
- White, Parchment-thin paper
- Postmenopausal women
11
Q
Is Lichen Sclerosis malignant or benign? If benign, does it have a risk of developing to SCC?
A
Benign, but has a slightly increased risk for developing into SCC
12
Q
What is Lichen Simplex Chronicus? What are its clinical features?
A
- Hyperplasia of the vulvar squamous epithelium, that is associated with chronic scratching
- Leukoplakia with thick, leathery vulvar skin
13
Q
Is Lichen simplex chronicus malignant or benign? If benign, does it have a risk of developing to SCC?
A
Benign with NO increased risk for the development of SCC
14
Q
What are the major differences between lichen sclerosus and Lichen simplex? What is the treatment, generally, for both of them?
A
Sclerosis = thinning of the epidermis with white plaques
Simplex = hyperplasia with red, velvety lesions
Steroids to treat
15
Q
What type of cancer arises in the vulva? How common is this?
A
SCC
Relatively rare
16
Q
SCC of the vulva presents are what? What, generally, does this appear similar to? How can you differentiate?
A
Leukoplakia, which looks similar to the lichen lesions
Bx to confirm
17
Q
What is Lichen planus?
A
Inflammatory, desquamative lesions of the skin
18
Q
What are the two general etiologies of SCC of the vulva? In whom are each of these seen?
A
- HPV related (40-50 yo)
- Non-HPV related (postmenopausal woman)
19
Q
What is Non-HPV related SCC? Who is this usually seen in?
A
- Arises from the inflammation caused by chronic lichen sclerosis
- Older women
20
Q
What is the cause of extramammary Paget’s disease? How does this present?
A
Malignant epithelial cell in the epidermis of the vulva
-Presents as erythematous, pruritic, ulcerated skin
21
Q
True or false; Extramammary Paget’s disease represents underlying carcinoma
A
False- represents carcinoma in situ, not underlying carcinoma
22
Q
What are the histological characteristics of Paget’s disease?
A
Cells with clear halos about the nucleus
23
Q
What are the two things that HAVE to be in your differential when Paget’s disease of the vulva presents?
A
Carcinoma vs melanoma
24
Q
Paget’s cells and melanoma are distinguished using stains. For each, what are the results of the following stains:
- PAS
- Keratin
- S100
A
Paget’s:
- PAS(+)
- keratin (+)
- S100 (-)
Melanoma:
- PAS (-)
- Keratin (-)
- S100 (+)
25
What is Keratin? Why is this seen with Paget's cells?
Intermediate filament that is present in epithelial cells. Why is this seen with Paget's cells?
-Keratin means it comes from the epidermis, of which means it's carcinoma (Paget's)
26
Why are Paget's cells PAS +?
PAS stains mucus, and only epithelial cells produce mucus (as Paget's is a carcinoma)
27
---What is the major difference between Paget's disease of the nipple, vs Paget's disease of the vulva?----
-----
Nipple = there is an underlying CA
Vulva = not
------
28
What is the epithelial type that lines the vagina?
Non-keratinized stratified squamous epithelium
29
The lower 1/3 of the vagina is derived from what? Upper 2/3?
- Urogenital sinus = lower 1/3
| - Mullerian duct = upper 2/3
30
What are the derivatives of the mullerian ducts?
Upper 2/3 of the vagina and all the way up to the tubes
31
What is the epithelium of the upper 2/3 of the vagina during development? What changes occurs?
Initially simple columnar, but becomes stratified squamous by ascending growth of the stratified squamous epithelium of the lower 1/3
32
What is adenosis of the vagina?
Failure of the upper 2/3 of the vagina to transform to stratified squamous epithelium
33
Increased exposure to DES in utero leads to what two *developmental* pathologies? Why?
-Adenosis of the vagina
disrupts the development of the vaginal epithelium
-lack of development of the uterine muscle wall
34
Increased exposure to DES in utero leads to what two *neoplastic* pathologies?
- Clear cell adenocarcinoma
| - Smooth muscle formation issues in smooth muscles
35
Are there any significant complications of DES use in male pregnancies? How about for mom?
- None for sons
| - Breast cancer in women
36
What is embryonal rhabdomyosarcoma (sarcoma botryoides)? How common is this? What age does this occur in?
- Malignant mesenchymal proliferation of immature skeletal muscle
- Rare
- Less than 5 yo
37
What are the clinical features of embryonal rhabdomyosarcoma?
Bleeding and grape-like mass protruding from the vagina or the penis
38
What is the classic cell on histology for rhabdomyosarcoma? Features? What are the two stains that this is positive for?
- Rhabdomyoblast
- Cytoplasmic cross-striation
- Positive IHC staining for desmin and myogenin
39
Cytoplasmic cross-striation = ?
Rhabdomyoblast of rhabdomyosarcoma
40
What is desmin?
Intermediate filament that is present in muscle cells
41
What is myogenin?
Nuclear transcription factor that is present in immature skeletal muscle
42
What causes vaginal carcinoma?
Usually related to high risk HPV
43
What is the precursor lesion to vaginal carcinoma?
Vaginal intraepithelial neoplasia
44
Cancer from the lower 1/3 of the vagina goes to what lymph nodes?
Inguinal nodes
45
----
Cancer from the upper 2/3 of the vagina goes to what lymph nodes?
-----
-------
Regional iliac nodes
-------
46
What is the epithelium of the endocervix? Exocervix?
```
Endo = columnar
Exo = stratified squamous epithelium
```
47
Where in the cervix in particular is at risk for the development of cervical CA from HPV?
Transformation zone
48
True or false: most of the time HPV infections clear on their own, and thus does not usually present as a risk factor for cervical cancer
True--it is the PERSISTENT infection that is a risk
49
What are the two proteins in HPV that cause cervical cancer? What is the function of each? (2)
```
E6 = destroys p53
E7 = destroys Rb
```
50
What is the major function of p53
Regulates the transition between G1 to S phase of the cell cycle
51
What is the molecule that is recruited if p53 senses too much DNA damage? What does this do? What is the cascade of events that follows this to kill the cell?
Bax, knockout Bcl-2, destabilizing the mitochondria, and causing apoptosis
52
What is the molecule that Rb holds, in order to prevent progression of the cell into the G1/S phase? What must be done in order for Rb to release this?
E2F
Rb must be phosphorylated
53
What are the histological characteristics of CIN? (3)
- Koilocytic change
- Nuclear atypia
- Increased mitotic activity
54
What is the key difference between carcinoma and dysplasia?
Dysplasia is reversible
55
What are the four grades of CIS? At what point is it no longer reversible?
- I
- II
- III --last stage at which it is reversible
- CIS
56
True or false: Stages I, II and III of dysplasia and CIS are not inevitable--they may regress
False--I, II, and III are reversible, but once at CIS, not reversible
57
What is the distinguishing factor between cervical carcinoma, and cervical CIS?
Invasion of the BM = carcinoma
58
How does cervical carcinoma usually preset?
- Vaginal bleeding
| e. g. Postcoital bleeding
59
What general age range of women usually develop cervical carcinoma?
Middle aged women
60
What are the two major risk factors for the development of cervical CA?
- Smoking
| - Immunodeficiency
61
What are the two organ systems that smoking can cause cancer in, that is not immediately obvious (doesn't touch)?
Pancreas
| Cervix
62
True or false: cervical carcinoma is an AIDS-defining illness
True
63
What are the two subtypes of cervical cancer that can develop from HPV infection?
- Squamous cell carcinoma
| - Adenocarcinoma
64
What is the classic finding associated with advanced cervical cancer? Why?
Hydronephrosis--invasion through the anterior uterine wall into the bladder
65
True or false: cervical carcinoma metastasizes early, and often
False-- rarely and late
66
What is the gold standard for screening for cervical carcinoma?
Pap smear
67
What are the histological findings on a pap smear that are suggestive of cervical carcinoma? (2)
- Cells with low nuclear:cytoplasm ratio
| - hyperchromatic nuclei
68
What is the next step with an abnormal pap smear?
Colposcopy and bx
69
What is the major reason for a false negative with a pap smear?
Sample does not reach the transformation zone
70
Pap smears has limited efficacy for screening cervical carcinoma or adenocarcinoma
Adenocarcinoma
71
What are the four subtypes of HPV that are protected against with he gardasil vaccine? Which cause condyloma, and which cause carcinoma?
6, 11 = condyloma
| 16, 18 = carcinoma
72
True or false: pap smears are no longer necessary, with the gardasil vaccine
False--still need to assess for other subtypes
73
----
What is the hormone that causes the endometrium to grow? To mature?
------
```
Grow = estrogen
Mature = progesterone
```
74
What type of muscle comprises the myometrium?
Smooth muscle
75
What is asherman syndrome? Usual cause?
Secondary amenorrhea due to a loss of *basalis* and scarring
-usually caused by overaggressive D and C
76
What is the layer of the endometrium that is lost with asherman syndrome, and is the layer of stem cells in the uterus?
Stratum basalis
77
What is the layer of the uterine endometrium that regenerates the stratum functionalis?
Stratum basalis
78
What is the pathophysiology behind the abnormal uterine bleeding in an anovulatory cycle?
No ovulation means there's no corpus luteum to secrete progesterone. No loss of progesterone = no shedding, so sheds is small amounts
79
What are the two time periods where anovulatory cycles are usually seen?
Menarche
| Menopause
80
What usually causes acute endometritis?
-Bacterial infection of the endometrium, 2/2 retained products of conception
81
What are the s/sx of acute endometritis? (3)
- Fever
- Abnormal uterine bleeding
- Pelvic pain
82
True or false: lymphocytes are usually found in a normal uterine lining
True
83
What is the classic cell that is found with chronic endometritis, and is needed to diagnose it?
Plasma cells
84
What are the common causes of chronic endometritis?
- Retained POC
- PID
- IUD
- TB
85
What are the s/sx of chronic endometritis?
- Abnormal uterine bleeding
- Pelvic pain
- Infertility
86
What, generally, is an endometrial polyp?
Hyperplastic protrusion of endometrium
87
What is the classic presentation of an endometrial polyp? Why?
Abnormal uterine bleeding--polyp stretches away from its BM
88
What drug can produce an endometrial polyp? Why?
Tamoxifen--has pro-estrogen effects on the uterus
89
What, generally, is endometriosis?
Abnormal placement of endometrial glands and stroma outside the uterine endometrial lining
90
What is the classic presentation of endometriosis? (3)
- Dysmenorrhea
- Pelvic pain
- Deep Dyspareunia
91
What are the three theories of endometriosis?
1. Retrograde menstruation
2. Metaplastic (mullerian duct)
3. Lymphatic dissemination theory
92
What is the most common site of endometriosis? What does this form, once there?
Ovary
| Chocolate cysts
93
If the uterine ligaments are involved in endometriosis, what is the usual presentation?
Pelvic pain
94
If the pouch of douglas is involved with endometriosis, what is the usual presentation?
dyschezia
95
If the bladder wall is involved with endometriosis, what is the usual presentation?
Dysuria
96
If the bowel serosa is involved with endometriosis, what is the usual presentation?
Abdominal pain and adhesions
97
If the fallopian tube is involved with endometriosis, what is the usual presentation?
Scarring and thus infertility or ectopic tubal pregnancy
98
How can endometriosis cause an ectopic pregnancy?
Scarring of the tubes leads to incorrect implantation
99
What are the "gunpowder lesions" associated with endometriosis?
Speckles of endometrial tissue in tissue
100
What is adenomyosis?
Endometriosis with involvement of the myometrium
101
What area in particular is at increased risk of forming carcinoma 2/2 endometriosis?
Ovary
102
What is the general histological change that defines endometrial hyperplasia?
Increase in the number of glands of the endometrium relative to the stroma
103
What is endometrial hyperplasia? What usually causes it? How does it present?
- Hyperplasia of endometrial glands relative to stroma
- Consequence of unopposed estrogen
- Presents as postmenopausal uterine bleeding
104
What is the estrogen that is converted from androstenedione in adipose tissue?
Estrone
105
What are the two ways of defining endometrial hyperplasia?
Architectural growth and cellular atypia
106
What is the most important predictor for progression of endometrial hyperplasia to carcinoma?
Cellular atypia
107
What is the consequence of untreated endometrial hyperplasia?
Endometrial carcinoma
108
What is endometrial carcinoma? How does is usually present?
- Malignant proliferation of endometrial glands
| - Postmenopausal bleeding
109
What is the sporadic pathway of endometrial carcinoma? What is the type of histology found with this? What age group does this usually occur in? What is the gene associated with this?
Sporadic CA from atrophic endometrium
- Serous or papillary
- Older women (70s)
- Mutations in p53
110
What is the hyperplasia pathway of endometrial carcinoma? What is the type of histology found with this? What age group does this usually occur in?
- Hyperplasia leads to CA
- Endometrioid (looks like endometrium)
- Younger women (60s)
111
Is sporadic endometrial CA aggressive or benign?
Aggressive
112
What lung cancer can also develop psammoma bodies?
Mesothelioma
113
What, generally, is a leiomyoma?
Benign proliferation of smooth muscle, arising from the myometrium
114
True or false: leiomyomas are related to estrogen exposure, enlarge with pregnancy, and shrink with menopause
True
115
What are the gross characteristics of leiomyomas? (single vs multiple. well or ill defined. color. shape, etc)
Multiple, well defined, white whorled masses
116
Are multiple lesions suggestive of benign leiomyomas, or malignant leiomyosarcomas?
Benign
117
How can you differentiate leiomyosarcomas from leiomyomas grossly, not relating to number
```
White = leiomyoma
Necrotic = leiomyosarcoma
```
118
What is the age range for leiomyomas? Leiomyosarcomas?
Premenopausal - leiomyomas
Postmenopausal = leiomyosarcomas
119
What is the usual presentation of leiomyomas?
Asymptomatic
120
What are the s/sx of leiomyomas, if symptomatic?
- Abnormal uterine bleeding
- infertility
- pelvic mass
121
True or false: leiomyosarcomas generally arise from leiomyomas
False false false--leiomyosarcomas arise de novo
122
Which is usually a single lesion, and which has multiple: leiomyomas vs leiomyosarcoma?
```
Single = leiomyosarcoma
Multiple = leiomyoma
```
