Diseases of Vulva, vagina, cervix/fallapian tubes, uterus

Question 1

Etiology of condyloma acuminatum

Answer 1

HPV 6 and 11 associated;

Question 2

condyloma acuminatum increases risk of what?

Answer 2

cervical CA

Question 3

where is condyloma acuminatum distributed

Answer 3

vulva; perineum; vagina; cervix

Question 4

Give gross and micro description of condyloma acuminatum

Answer 4

gross=> verrucous, wartlike lesions

micro=>koilocytosis, acanthosis, hyperkeratosis; parakeratosis

Question 5

Give gross description of papillary hidradenoma

Answer 5

gross: benign tumor similar to intraductal papilloma of breast

Question 6

distribution of papillary hidradenoma

Answer 6

occurs along milk line

Question 7

Give gross and micro description of extramammary Paget disease of vulva

Answer 7

gross: erythematous, crusted rash
micro: intraepidermal malignant cells w/ pagetoid spread

Question 8

distribution of extramammary Paget disease of vulva

Answer 8

labia majora

Question 9

T/F extramammary Paget disease of vulva is always assoc w/ underlying tumor

Answer 9

FALSE => not associated w/ underlying tumor

Question 10

Gross description of Candida vulvovaginitis

Answer 10

erythema, thick white discharge

Question 11

distribution of Candida vulvovaginitis

Answer 11

vulva and vagina

Question 12

Candida vulvovaginitis etiology

Answer 12

extremely common => especially in diabetics and after antibiotic use

Question 13

Define vaginal adenosis

Answer 13

benign condition thought to be precursor of clear cell carcinoma

Question 14

What increases risk for clear cell adenocarcinoma of vagina?

Answer 14

females exposed to deithylstilbestrol (DES) in utero during the 1940-1970s

Question 15

What ages are associated with highest risk of clear cell adenocarcinoma of vagina?

Answer 15

40-70 years old

Question 16

Define embryonal rhabdomyosarcoma

Answer 16

rare, grapelike soft tissue tumor affecting female infants and children <4

Question 17

describe micro picture of embryonal rhabdomyosarcoma

Answer 17

polyploid;

spindle cell tumor showing cross striations

Question 18

How can you prove the origin of the embryonal rhabdomyosarcoma?

Answer 18

positive for desmin => skeletal muscle origin

Question 19

How would a patient with pelvic inflammatory disease present?

Answer 19

vaginal discharge/bleeding;
midline abdominal pain to bilateral lower abdominal/pelvic pain;
abdominal tenderness; peritoneal signs;
fever

Question 20

Define pelvic inflammatory disease

Answer 20

ascending infection from cervix to endometrium, fallopian tubes and pelvic cavity

Question 21

What are the 2 common etiologies of pelvic inflammatory disease?

Answer 21

Neisseria gonorrhoeae (gram neg diplococcus);

Chlamydia trachomatis (intracytoplasmic inclusion in mucosal cells)

Question 22

What are the disease manifestations of pelvic inflammatory disease?

Answer 22

cervicitis; endometritis; salpingitis; peritonitis; PELVIC ABSCESS ; chandelier sign
perihepatitis (Fitz-Hugh-Curtis syndrome)

Question 23

complication assoc w/ pelvic inflammatory disease

Answer 23

tubo-ovarian abscess; tubal scarring; infertility; ectopic pregnancy; intestinal obstruction

Question 24

What is the 3rd most common malignant tumor of genital tract in US? when does it peak in incidence?

Answer 24

cervical carcinoma => peak in 40s

Question 25

Etiologies of cervical carcinoma

Answer 25

assoc w/ early 1st intercourse, multiple partners; HPV 16, 18, 31, 33; smoking and immunosuppression

Question 26

Describe how cervical carcinoma progesses

Answer 26

1) cervical intraepithelial neoplasia 2) carcinoma in situ 3) invasive squamous cell cancer

Question 27

How will a patient with cervical carcinoma present?

Answer 27

may be asymptomatic or may have postcoital bleeding, dyspareunia, discharge

Question 28

How might cervical carcinoma be detected early?

Answer 28

Pap smear => koilocytic cells

Question 29

Define endometritis

Answer 29

ascending infection from cervix

Question 30

Where is endometritis located?

Answer 30

endometrium and decidua

Question 31

What different pathologies can cause endometritis?

Answer 31

ureplasma, peptostreptococcus; Gardnerella; Bacteroides; Group B strept; Chlamydia trachomatis; Actinomyces

Question 32

If endometritis is caused by actinomyces, what will be present on IUD?

Answer 32

yellow granular filaments

Question 33

What are the 2 associations with endometritis?

Answer 33

associated w/ pregnancy or abortions (acute); chronic PID (pelvic inflam disease) and IUD

Question 34

Etiology of endometriosis

Answer 34

presence of endometrial glands and stroma outside uterus; | women of reproductive age

Question 35

Location for endometriosis

Answer 35

ovary; ovarian and uterine ligaments; Pouch of Douglas; Serosa of bowel and bladder; Peritoneal cavity

Question 36

How does endometriosis present grossly? include buzzwords

Answer 36

red brown serosal nodules => "powder burns"

Question 37

What are 2 types of endometriosis?

Answer 37

endometrioma; | adenomyosis

Question 38

Define endometrioma and buzz words

Answer 38

ovarian "chocolate" cyst

Question 39

Define adenomyosis

Answer 39

endometrial glands in myometrium

Question 40

How will a patient with endometriosis present?

Answer 40

***chronic pelvic pain linked to menses*** dysmenorrhea, dyspareunia; rectal pain and constipation; infertility

Question 41

Define Leiomyoma

Answer 41

benign smooth muscle tumor that grows in response to estrogen

Question 42

Define malignant form of leiomyoma

Answer 42

leiomyosarcoma => smooth muscle sarcoma of uterus

Question 43

Who has the highest incidence of leiomyoma?

Answer 43

African americans

Question 44

Where can a leiomyoma be located?

Answer 44

subserosal, intramural or submucosal locations in myometrium

Question 45

What does a leiomyoma look like?

Answer 45

well circumscribed; rubbery, white tan 'whorled' masses generally multiple

Question 46

How will a patient with leiomyoma present?

Answer 46

menorrhagia; abdominal mass; pelvic pain, back pain, suprapubic discomfort; infertility

Question 47

Where is leiomyosarcoma located?

Answer 47

myometrium

Question 48

Gross pathology for leiomyosarcoma

Answer 48

bulky tumor w/ necrosis and hemorrhage

Question 49

micro pathology for leiomyosarcoma

Answer 49

malignant smooth muscle cells=> nuclear pleomorphism an dincreased mitotic rate

Question 50

Who is at highest likelihood to get a leiomyosarcoma?

Answer 50

increased incidence in blacks

Question 51

What are characteristics of leiomyosarcoma?

Answer 51

aggressive tumor that tends to recur; | may present w/ cervical bleeding

Question 52

most common malignant tumor of female genital tract

Answer 52

endometrial adenocarcinoma

Question 53

highest risk for endometrial adenocarcinoma

Answer 53

postmenopausal women

Question 54

location for endometrial adenocarcinoma

Answer 54

begins in endometrium and may invade myometrium

Question 55

gross pathology for endometrial adenocarcinoma

Answer 55

tan polyploid endometrial mass; | INVASION of myometrium is diagnostically important

Question 56

micro pathology for endometrial adenocarcinoma

Answer 56

endometrioid adenocarcinoma (most common)

Question 57

How will a patient present with endometrial adenocarcinoma?

Answer 57

postmenopausal vaginal bleeding

Question 58

What are the Risk factors for endometrial adenocarcinoma?

Answer 58

``` EARLY MENARCHE / LATE MENOPAUSE; NULLIPARITY; HTN and diabetes; obesity; CHRONIC ANOVULATION ESTROGEN PRODUCING OVARIAN TUMORS; ERT; TAMOXIFEN; endometrial hyperplasia; Lynch syndrome (colon, endometrial and ovarian cancers =HNPCC) ```