Female Genital System Flashcards
Bartholin Cyst
Cystic dilation of Bartholin gland
Due to obstruction & inflammation of gland
Reproductive age, related to STD’s
Can develop abscess
Condyloma
Warty neoplasm of vulva OR vaginal canal OR cervix
Due to HPV 6 or 11, “Low risk” of carcinogenesis
Koilocytic change, “Raisinoid nuclei”
Lichen Sclerosis
Benign, slight increased risk of SCC
Thinning of EPIdermis, fibrosis of DERmis
Leukoplakia* with “parchment-like” vulvar skin
Seen in post-menopausal women, atrophy
Lichen Simplex Chronicus
Benign
Hyperplasia of SQ epithelium
Leukoplakia* with thick, leathery skin
Due to CHRONIC irritation and scratching
Vulvar Carcinoma VS. Vaginal Carcinoma VS. Cervical Carcinoma
Seen in 40-50s, acquired HPV in 20s
Other risk: Smoking, immunodeficiency
Vulvar (Rare, SCC)
-Also caused by long-standing Lichen Sclerosis
-Leukoplakia* (Ddx: LS, LSC)
Vaginal (SCC)
-Upper 2/3 to ILIAC nodes
-Lower 1/3 to INGUINAL nodes
Cervical
-SCC if EXOcervix
-Transformation zone
-Adenocarcinoma if ENDOcervix
-Vaginal bleeding, post-coital
-Tumor stays local, metastasizes late
-May invade to bladder & ureters causing hydronephrosis
All due to high risk HPV 16, 18, 31, 33
-Cleared by immune system 90% of the time
-VIN vs. VAIN vs. CIN 1, 2, 3, CIS, & Invasive cervical carcinoma
Extramammary Paget Disease (Of Vulva)
Malignant cells in epidermis
Ery, pruritic, ulcerated skin
Ddx:
-Carcinoma (Paget): Keratin+, S100-, PAS+
-Melanoma: Keratin-, S100+, PAS-
NO underlying CA (C/c Paget Disease of Nipple)
Adenosis
Vagina lined by stratified SQ epithelium
-Upper 2/3 derived from Mullerian Duct
-Lower 1/3 derived from Urogenital Sinus
Adenosis = Persistence of COL epithelium in upper 2/3 of vaginal canal, (Not a big deal on it’s own)
Seen in F exposed to DES (estrogen-like) in utero, Was given to women to “prevent pregnancy complications”
DES:
-Rare progression to Clear Cell Adenocarcinoma
-Abnormalities of uterus & fallopian tubes
-Mom’s with slight increased risk in breast cancer
Embryonal Rhabdomyosarcoma
MALIGNANT proliferation of immature skeletal muscle (rhabdomyo) & mesenchyme (sarcoma)
Bleeding & grape-like mass protruding from vagina (or penis) of kids < 5 y/o
Rhabdomyoblast is key cell…
-Cross-striations (like skeletal muscle)
-IHC+ staining for desmin & myogenin (intermediate filament & transcription factor in immature skel muscle)
What makes HPV “high risk?”
E6: Destruction of p53
-Tumor suppressor gene
-Regulates G1 to S phase transition
-Calls for repair enzymes if needed, or…
-Calls for BAX/ BCL2/ Cyto C to +Apoptosis
E7: Destruction of Rb
-So E2F floats freely
-Cell can move G1 to S phase
Pap Smear
Gold standard
Scrape at transformation zone to avoid False(-)
Dark nuclei & high N:C ratios (Large nucleus, little cytoplasm)
Confirm abnormal pap with colposcopy & biopsy
***Does not detect adenocarcinoma well
Endometrium
Grows with E (Proliferative phase)
Prepared for implantation with P (Secretory phase)
Sheds with loss of P (Menstruation)
Asherman Syndrome
Secondary amenorrhea due to loss of basalis (endometrium’s regenerative stem cell layer) & scarring
Due to over-aggressive dilation & curettage
Anovulatory Cycle
No ovulation -> No secretory phase -> No menstruation
But proliferative phase will repeat itself
Growth of endometrium on top of previous growth
Will outgrow its blood supply
Dysfunctional uterine bleeding
Seen in menarche & menopause
Acute Endometritis
Bacterial infection
Due to retained placenta
Fever, AUB, pelvic pain
Chronic Endometritis
Chronic inflammation with PLASMA CELLS
Due to retained placenta
+PID
+IUD
+TB (+Granulomas)
AUB, pelvic pain, infertility
Endometrial Polyp
Hyperplastic protrusion
Side effect of tamOXifen (Used for ant-E effect in breast, but has weak pro-E effect in uterus)
AUB
Endometriosis
Abnormal placement of GLANDS & STROMA, which proliferate/shed with normal cycle (hence dysmenorrhea)
Due to ?retrograde menstruation
DYSMENORRHEA, pelvic pain, infertility
Symptoms Tell You Site of Involvement/ Risk of Carcinoma
-Chocolate cyst ~ Ovary
-Pelvin pain ~ Uterine ligaments
-Pain with defecation ~ Pouch of Douglas
-Pain with urination ~ Bladder wall
-Abd pain ~ Bowel serosa
-Scarring, ectopic pregnancy ~ Fallopian tubes
ALSO: “Gunpowder lesions” with involvement of soft tissue
ALSO: Adenomyosis is endometriosis of MYOmetrium
Endometrial Hyperplasia
Benign hyperplasia of GLANDS
Due to unopposed estrogen
POST-meno bleeding
Classified by…
-Architectural growth (simple or complex)
-Cellular atypia (most important predictor)
Endometrial Carcinoma
Malignant proliferation of GLANDS
Due to hyperplasia / unopposed estrogen
-Endometrioid
-Seen in 50-60s
Due to sporadic (p53 mutations)
-Serous, papillary, Psammoma bodies
-Seen in elderly >70, associated with atrophy
POST-meno bleeding***
Leiomyoma VS. Leiomyosarcoma
-Benign proliferation of smooth muscle
-“MULTIPLE, well-defined white whorled masses”
-Due to estrogen exposure in PRE-meno & pregnancy (shrinks in menopause)
-Asymptomatic
-Malignant proliferation of smooth muscle
-“SINGLE lesion with necrosis & hemorrhage”
-De novo POST-meno
Ovary
Follicle is functional unit
Oocyte < Granulosa < Theca
- LH hits theca cells to produce androgen
- FSH hits granulosa cells to convert androgen to estradiol
- Estradiol hits oocyte to mature
- Estradiol hits endometrium to undergo Proliferative phase
- Ovulation of oocyte
- Residual follicle becomes corpus luteum for Secretory phase
- Secretes P to prepare endometrium for implantation
- Loss of P causes shedding
Hemorrhagic luteal cyst = Bleeding into corpus luteum
Surface/ Coelomic Epithelial Tumors
Most common type of ovarian tumor
Present LATE/ Poor prognosis
Spread to peritoneum
Vague abd pain, urinary frequency
Serum marker CA-125 to monitor response & recurrence
BENIGN Cystadenomas (Serous vs. Mucinous)
-Single cyst with “simple flat, one-layer lining”
-PRE-meno
MALIGNANT Cystadenocarcinoma (Serous vs. Mucinous)
-Multiple cysts with “complex thick, shaggy lining”
-POST-meno
-BRCA1 mutation (Serous type)
Borderline
-Metastatic potential
-Better prognosis than malignant
Other Ones:
-Endometrioid Tumor: Malignant, +/- Endometriosis
-Brenner Tumor: Of urothelium
Sex Cord Stromal Tumors
Granulosa-Theca Cell Tumor
-Produces estrogen
-Sx’s of estrogen excess (vary by age)
Sertoli-Leydig Cell Tumor
-Tubules & Reinke crystals
-Produce androgen
-Hirsutism, virilization
Fibroma
-Benign fibroblasts
-If pleural effusion & ascites = Meigs syndrom
