Flashcards in 22 Female Genital Tract Deck (34):
What forms the urogenital sinus?
The cloaca after formation of the urorectal septum
What forms the paramesonephric or lateral Mullerian ducts?
Invagination of coelomic epithelium
What is the final organ(s) formed by the urogenital sinus?
Lower vagina and vestibule
What does the unfused portion of the lateral Mullerian ducts form in the adult female?
What do the fused portions of the lateral Mullerian duct form in the adult female?
The uterus and upper vagina
Where do Gardner duct cyst originate?
Remnants of mesonephric duct in cervix and vagina
What factors may lead to HSV reactivation
Stress, UV radiation, hormonal changes, immunosuppression, trauma
What increases vertical transmission of HSV?
Active infection and initial maternal infection
What are some methods of testing for HSV?
Tissue viral culture, PCR, direct immunofluorescent antibody tests on lesional secretions
Which subtype of molluscum contagiosum is most often sexually transmitted?
MCV-2; MCV-1 is most prevalent and can be seen in children who are infected by shared fomites
What are three main causes of PID?
Neisseria gonorrhea, Chlamydia trachomatis and peurperal infections (polymicrobial)
What infection gives the gross appearance of 'strawberry cervix'?
What are the local manifestations or complications of gonococcal disease in PID other than acute cervicitis or vaginitis?
acute suppurative salpingitis
chronic follicular salpingitis
What are some complications of PID outside of the genital tract?
After bacteremia, infection can spread to cause:
intestinal obstruction from pelvic adhesions
What are the differences in etiology of basaloid and warty carcinomas as opposed to keratinising squamous carcinoma of the vulva?
Warty and basaloid carcinomas are HPV-related while keratinising squamous cell carcinomas are not. Instead the latter is often associated with chronic lichen sclerosis/
What are the precursors for basaloid and warty carcinomas as opposed to keratinising squamous carcinoma of the vulva?
Warty and basaloid carcinoma - classic VIN
Keratinising squamous cell carcinoma - differentiated VIN
What are the risks factors for progression of VIN to invasive carcinoma?
Age over 45, extent, and immunosuppression
What etiologies cause vaginal anomalies?
in utero exposure to diethylstilbestrol
Abnormalities in reciprocal epithelial-stromal signalling
Where does one find Gartner duct cysts?
Lateral wall of the vagina in the submucosa location.
What two chemical entities does lactobacilli secrete to deter cervicitis?
What are causes of alkaline pH in the vagina?
What are the risk factors for cervical cancer? Name at least 8.
HPV exposure: multiple sexual partners, male partner with multiple sexual partners, young age at first intercourse, high parity, use of oral contraceptives
Viral oncogenicity: persistent infection
Inefficiency of immune response: immunosuppression, certain HLA subtypes, use of nicotine
What are the approximate rates of clearance of HPV at 8 months and 2 years?
8 months - 50% cleared
2 years - 90% cleared
What accounts for the difference in epithelial susceptibility to HPV infection at different sites?
HPV infection requires access to the basal cells, either at sites of trauma or to metaplastic squamous epithelium. Sites such as the cervix and the squamocolumnar junction of the anus have large areas of metaplasia.
What enables HPV to replicate in mature squamous cells?
Viral proteins E6 and E7 induce the mitotic cycle. E7 binds Rb and upregulates cyclin E. E6 binds p53, interrupts apoptotic pathways and upregulates telomerase. Both E6 and E7 work together to induce centrosome duplication and genomic instability.
How does the physical state of HPV DNA differ between disease entities?
Integrated viral DNA into host DNA in carcinoma but usually free or episomal viral DNA is found in precancerous lesions and condylomata.
What percentage of LSIL regresses, persists and progresses (to HSIL) after 2 years?
Regress - 60%
Persist - 30%
Progress to HSIL - 10%
What percentage of HSIL regresses, persists and progresses (to carcinoma) after 2 years?
Regress - 30%
Persist - 60%
Progress - 10%
What are the histological subtypes of lobular carcinoma?
Signet ring cell
What defines T4 stage in cervical carcinomas?
Beyond true pelvis or involvement of mucsoa of the bladder or rectum.
What is the size criteria for microinvasive carcinoma of the cervix?
Stage IA - invasion < 5 mm with horizontal spread not exceeding 7 mm
What determines prognosis and survival for invasive cervical carcinomas?
Stage and cell type
-neuroendocrine tumours have very poor prognosis
Due to what cause do most patients with Stage IV cervical carcinoma perish?
local extension of tumour leading to any of the following:
-ureteral obstruction, pyelonephritis and uremia