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Cervix, Vagina, Vulva Flashcards

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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
What are the gross features & histologic features of HSV-2?
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
26
What are inclusion bodies pathognomonic for HSV-2? WHat test is done to detect the virus?
Cowdry A inclusion bodies Tzanck test
27
WHat strains of HOV are low risk and high risk?
High risk HPV: 16, 18, 31, 33 Low risk HPV 6, 11, 42, 44
28
What HPV serological type causes Condylomata acuminatum?
HPV type 6
29
What are the gross & histo featuers of Condylomata acuminatum?
Gross: Verrucuous papillary exophytic outgrowth (flat on the perineal surface of the vagina & vulva) Histo: Acanthosis, hyperkeratosis, parakeratosis, papillomatosis & koilocytosis (perinuclear halo)
30
WHat is an intermediate cell w/ perinuclear halo associated with COndylomata acuminatum?
Koilocytes
31
What are the 4 serologic types of Molloscul contagiosum?
MCV 1, 2, 3, 4
32
What strain of Molloscum contagiosum is the most common and which one is assoc with STI?
MCV 1 = most common MCV 2 = STI
33
What are the gross & histo features of Molloscum contagiosum?
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
34
WHat are the lesions seen in primary & secondary syphilis?
Primary syphilis - chancre SEcondary syphilis - condylomata lata
35
What kind of infection begins in the vulva/vagina & spreads upwards to involve the uterus, fallopian tubes, ovaries, and pelvic peritoneum?
Pelvic inflammatory disease
36
What are the most common sites of PID (pelvic inflammatory dis)? WHat are the causative agents?
Fallopian tubes & ovaries CAs: N gonorrheae, Chlamydia, Enteric bacte, polymicrobial orgnanisms But most common is Neisseira gonorrhoeae
37
What are acute & chronic complications of PID?
Acute: Peritonitis, Bacteremia Chronic: Salpingitis, Tubo-ovarian abscess, Intestinal osbtructions, Infertility
38
What are the 3 benign cystic lesions of the vulva?
Epidermoid cyst of the vulva Bartholin’s duct cyst Epithelial tumors of the vulva
39
What benign cystic lesion of the vulva is lined by stratified squamous epithelium that contains keratin of amorphous material in the lumen?
Epidermoid cyst of the vulva
40
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?
Bartholin’s duct cyst
41
What is the cause of Bartholin’s duct cyst?
Scaring & obstruction of the duct & eventual cystic dilations of the duct
42
How do u tx Bartholin’s duct cyst?
Marsupialization: surgery to remove the cyst
43
What are the 2 types of epitheliam tumors of the vulva?
1. Fibro-epithalial polyp 2. Papillary/nodular hidradenoma
44
What are the gross & histo features of Acrochordon/Fibro-Epithelial polyp?
Gross: Papillomatous pedunculated outgrowth of the mucosa of the vulva & vagina Histo: - Elevated, dome-shaped, pedunculated, polypod outgrowth
45
What are the gross & histo features of Papillary/Nodular Hidradenoma?
Gross: Small brown nodules on vulva Histo: Benign proliferative glands that have Aprocirin features lined by columnar/cuboidal pink cytoplasm
46
What are groups of non-neoplatic disorders of the mucosa of the vulva and the skin seen in post-menopausal women?
Vulvar dystrophies
47
What are the common presentations of Vulvar dystrophies?
Assoc with Pruritus Presents w/ white, scaly, plaque-like mucosal thickening
48
What are 2 types of vulvar dystrophies?
Lichen sclerosus Squamou hyperplasia
49
what type of vulvar dystophy is aka Hyperplastic hystrophy or LIchen simplex chronicus?
Squamous hyperplasia
50
What is the cause of squamous hyperplasia or LIchen simplex Chornicus?
Rubbing/scratching/chronic irritation of the skin to relive pruritus
51
What is the clinical presentation of Hyperplastic dystrophy?
Leukoplakic lesion
52
What are the histo & gross features of Lichen Simplex Chronicus?
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
What type of vulvar dystrophy is aka Chronic Atrophic Vulvitis caused by an autoimmune rxn of activated T cells in the sub-epithelium?
Lichen Sclerosus
54
What is the clinical presetation of LIchen Sclerosus? IN what age grp does this commonly seen?
Porcelain or parchment surface of the vulva Age grp: Post-menopausawomen
55
What are the histo & gross features of Lichen Sclerosis?
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
What are the 3 categories of vulvar intraepithelial neoplasia (VIN)?
VIN I - mild dysplasia VIN II - moderate dysplasia VIN III - Severe dysplasia
57
Are px w/ VIN lesions less susceptible to HPV sero type 16?
No, they are MORE susceptible
58
What are the gross & histo features of VIN lesions?
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
What type of VIN has 1/3 epithelial thickness from the basement membrane up to the surface?
VIN I - Mild dyplasia
60
What are the causes of VIN I?
Disordered maturation Nuclear enlargement Hyperchromasia Mitosis
61
What VIN has atypical proliferation exceeding 1/3 of the epithelium but does not exceed 2/3 of it?
VIN II = moderate dysplasia
62
WHat VIN type exceeds 2/3 of the epithelial thickness but does not involve the full thickness of the epithelium?
VIN III - severe dysplasia`
63
What are the caues of ViN II?
Disordered maturation of squamosu cells Hyperchromatic large nuclei Mitotic figures
64
What is an important sign of maturation in VIN III?
Top of the epidermis that appear longitudinally parallel to the basement membrane
65
What are the most common type of vulvar carcinoma?
Squamous cell carcinoma: - Keratinizing SCCA - Warty basaloid SCCA
66
What are the causes of vulvar carcinoma?
- Lichen sclerosus - VIN lesions or VIN simplex: carried a high risk of cancer devt - HPV-associated warty and basaloid carcinoma
67
What are the gross features of Vulvar carcinoma?
Exophytic, ulcerative, infiltrative Slow growing mass w/ surface extension to contiguous skin, vagina, and rectum
68
What are the 2 grps of vulvar carcinoma?
Assoc w/ HPV Assoc w/ VIN, Squamous cell hyperplasia, Lichen sclerosus
69
What type of vulvar carcinoma represents the tumor that has invaded the underlying connective tissue trauma?
Invasive SCCA vulva
70
What are the gross & histo features of Invasive SCCA vulva?
Gross: - large, whitish, exophytic, fungating mass - endophytic ulcerating lesion Histo - Nests and islands of malignant squamous cells - Keratinizing and intracellular bridges --> Keratin pearls
71
What is aka Extramammary Paget Disease where it is assoc with carcinoma of the skin adnexa?
Paget's disease of the vulva
72
What are the gross & histo features of Extramammary Paget dis?
Gross: - Large, red, moist, sharply demarcated encrusted lesion in the labia Histo - Piaget cell: + Mucopolysaccharide stain
73
What are the 3 pathologies of the vagina?
Mesonephric cyst/Gartner's duct cyst Squamous papilloma Vagina intraepithelial Neoplasia
74
Where is Gartner's duct cyst located?
Anterolateral wall of the vagina, ff the route of mesonephric duct
75
What is the histologic feature of Gartner's duct cyst?
Simple cuboidal, non-mucin-secreting cells that is reminiscent from mullerian cell derivative
76
What benign lesion of the vagina is commonly seen in reproductive-age women and includes Stromal tumors, Leiomyomas, and Hemangiomas?
Squamous papilloma
77
What are the gross & histo features of squamous papilloma?
Gross: Shows exophytic small, pedunculated lesions Histo: - benign squamous epithelium arranged in complex papillary frond - single papillary front around a central fibrovascular core
78
What is the location of squamous papilloma?
near the hymenal ring
79
What are the group of spectrum epithelium lesions of atypia involving the vaginal mucosa?
Vaginal intraepithelial neoplasia
80
What is the Bethesda system of vaginal intraepithelial neoplasia?
Low grade squamous epithelial lesion: VaIN 1 (Mild dysplasia) High grade squamous epithelia lesion: VaIN 2 and VaIN3
81
What are the gross & histo features of Vaginal Intraepithelial neoplasia?
Gross: raised, flat white or pink, eroded Histo: - loss of normal maturation - nuclear atypia - INC mitotic activity - abnormal mitotic figures - acanthosis & dyskeratosis
82
What are the characteristics of Bethesda system?
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
What are the risk factors of vaginal carcinoma?
- high risk HPV: detected via vaginal testing - premalignant lesion - assoc with cervical and vulvar carcinoma
84
What is the pattern of spread of vaginal carcinoma?
Upper vaginal tumor -> Iliac lymph node Lower vaginal tumor -> inguinal lymph node
85
What is an important histo feature of vaginal carcinoma?
keratinization forming laminated pink keratin pearls
86
What are the 2 types of vaginal adenocarcinoma?
Clear cell adenocarcinoma Embryonal rhabdomyosarcoma
87
What are histological features of clear cell adenocarcinoma?
1. Hobnail = cell pattern that presents a nucleus protruding out of their lumen 2. Solid, Tubulocystic pattern 3. Clear cells due to glycogen
88
What is the risk factor of developing vaginal adenocarcioma?
Vaginal adenosis (precursor lesion)
89
What is the most common malignant tumor of the vagina in infants & children?
Embryonal rhabdomyosarcoma/Sarcoma botryoides
90
What are the gross & histo features of Embryonal Rhabdomyosarcoma?
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
What condition presents with inflammation of the cervical mucosa and stroma?
Cervicitis
92
What are the histological features of Cervicitis?
- Glycogenated squamopus cells - inflammation of the stroma
93
What is the common cause of Cervicitis?
Chlamydial infection
94
What are the clinical features of Cervicitis?
- freq asymptomatic - mucosal changes: erosion, superficial ulceration - vaginal discharge
95
What are the 3 important hallmarks of Chronic Cervicitis?
1. Squamous metaplasia of the endocervix 2. Nabothian cysts 3. Endocervical polyp
96
What are the histo findings of Nabothian cysts?
- cystic dilation of endocervical glands w/ accumulation of secretory material in the lumen - scarring, securitization
97
What cells line the Endocervical polyp
Mucous columnar cells Squamous metaplastic cells
98
What sero typeof HPV is assoc w/ higher risk of LSIL? What viral oncogene interferes with tumor suppressor proteins and DNA repair mechanisms?
sero type: HPV-16 Viral oncogene E6&E7
99
What structures are affected in Cervical intraepithlial lesion & invasive squamous neoplasia?
Intraepithelial atypia to invasive squamous cell carcioma
100
What are the risk factors of Cervical Intraepithelial lesion & invasive squamous neoplasia?
- early age of 1st intercourse - multiple sexual partners (HIGHER in males) - immunosuppression - HPV 16, 18, 31, 33
101
What are atypical changes in the cervix causing Cervical Intraepithelial Neoplasia?
Atypical changes: - dyskeratosis - nuclear pleomorphism - mitoses - koilocytosis
102
Where does Cervical Intraepithelial Neoplasia commonly occur?
Squamo-columnar junction
103
what are the 3 significant biomarkers of squmaous intraepithelial lesions?
p16, Ki67 & high-risk HPV
104
what biomarker distinguishes from benign mimics? What is indicated if it is negative for thsi biomarker?
P16 Neg P16 - focal positivity that are patchy & distributed all throughout epithelium
105
What biomarker is expresses in SIL and correlates with the extend of disordered maturation?
Ki-67
106
What are the clinical presentation of Cervical carcinoma?
- Nodular, infiltrative & fungating lesions - advanced spread & metastasis - vagina bleeding/discharge
107
What are the gross & histo features of Cervical caricnoma?
Gross: - fungating or exophytic, ulcerating & infiltrative/endophytic histo - SCC, adenocarcinoma, adenosquamous carcinoma & neuroendocrine carcinoma
108
What are the 5 types of cervical carcinoma?
Cervical squamous cell carcinoma Cervical adenocarcinoma Cervical adenosquamous carcinoma Clear cell adenocarcinoma Neuroendocrine carcinoma
109
At what age should males & females have their HPV vax?
11-12yr - 26 y/o
110
When should the 1st screening for cervical cancer be? How often should px 21-29 yo undergo cytologic testing?
21 yrs or 3 yrs after onset of sex Cyto test: every 3 yrs
111
What is px 30-65 yo test negative for HPV, when should they have their next test?
After 5 yrs
112
If a px is + for HPV, what should be advised to the px?
Cotesting every 6-12 mons
113
What should we do if there is a + abnormal pap smear?
Colposcopoc biopsy
114
What are the 3 morphologic variants of Cervical SCC/
Large cell keratinizing Large cell non-keratiniizing Small cell
115
WHat are the morphological clues of squamous differentiation?
Keratin pearls Intracellular bridges Intracytoplasmic keratin
116
What are the most common morphological var of cervical SCC?
Large Cell, Nonkeratinizing - presence of iNTRACELLULAR BRIDGES
117
What are clues of Large Cell Keratinizing variant?
Sheaths, islands & nests of malignant polygonal cells w/ KERATIN PEARLS
118
What are clues of small cell var of cervical SCC?
NO KERATINIZATION NO INTRACELLULAR BRIDGES
119
What are the gradings of cervical SCC?
G1 = well-diff G2 = moderately diff G3 = poorly diff
120
What type of cervical carcinoma may present w/ Cushings & Carcinoid syndromes? What are its histological features?
Neuroendocrine carcinoma Histo features: - fine chromatin pattern - nuclear molding - signs of apoptosis positive for Chromogranin & Synaptophysin

Pathology (8 decks)

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