Female Genital System

Question 1

Condyloma accuminata

Answer 1

1. Warty neoplasm of squamous epithelium of vulva
2. Most commonly due to low-risk HPV subtypes 6 and 11
3. HPV induces koilocytic change, causing the nuclei of infected cells to appear crinkled like a raisin

Question 2

Lichen sclerosis

Answer 2

1. Thinning of epidermis and fibrosis of dermis
2. Leukoplakia with parchment-like vulvar skin
3. Most commonly seen in postmenopausal women
4. Usually benign, but associated with a slightly increased risk for squamous cell carcinoma

Question 3

Lichen simplex chronicus

Answer 3

1. Hyperplasia of vulvar squamous epithelium
2. Leukoplakia with thick, leathery vulvar skin
3. Associated with chronic irritation and scratching
4. Benign with no increased risk for squamous cell carcinoma

Question 4

Vulvar carcinoma

Answer 4

1. Presents as leukoplakia
2. Biopsy may be required to distinguish carcinoma from other causes of leukoplakia
3. May be HPV-related or non-HPV-related

Question 5

Extramammary Paget disease

Answer 5

1. Associated with malignant epithelial cells in epidermis of vulva
2. Presents as erythematous, pruritic, ulcerated skin
3. Represents carcinoma in situ
4. DDx: carcinoma vs. melanoma

Question 6

How can you distinguish Paget disease of the vulva from melanoma via histologic examination of the affected tissue?

Answer 6

Paget cells stain PAS+, keratin+, S100-, while melanoma stains PAS-, keratin-, S100+

Question 7

Adenosis

Answer 7

1. Focal persistence of columnar epithelium in upper 1/3 of vagina
2. Increased incidence in females exposed to DES in utero

Question 8

Clear cell adenocarcinoma of the vagina

Answer 8

1. Characterized by malignant proliferation of glands with clear cytoplasm
2. Rare complication of DES-associated vaginal adenosis

Question 9

Embryonal rhabdomyosarcoma (also known as sarcoma botryoides)

Answer 9

1. Consists of malignant mesenchymal proliferation of immature skeletal muscle
2. Presents as bleeding, grape-like mass protruding from a child’s vagina or penis
3. Usually presents in children

Question 10

Vaginal carcinoma

Answer 10

1. Carcinoma arising from squamous epithelium lining vaginal mucosa
2. Usually related to infection with high-risk HPV subtypes 16 and 18
3. Precursor lesion is vaginal intraepithelial neoplasia

Question 11

Cancer from lower 2/3 of vagina metastasizes to…

Answer 11

Inguinal nodes

Question 12

Cancer from upper 1/3 of vagina metastasizes to…

Answer 12

Regional iliac nodes

Question 13

Bartholin cyst

Answer 13

1. Usually occurs in women of reproductive age
2. Presents as unilateral, painful cystic lesion
3. Found in lower vestibule adjacent to vaginal canal

Question 14

High-risk HPV produces…

Answer 14

E6, which inactivates p53, a crucial regulator of the G1 to S transition of the cell cycle, and E7, which inactivates Rb, a important regulator of E2F

Question 15

Distinction between dysplasia and carcinoma is…

Answer 15

Reversibility.

Question 16

Cervical carcinoma

Answer 16

1. Invasive carcinoma that arises from cervical epithelium
2. Most commonly seen in middle-aged women (40-50 yrs old)
3. Presents as vaginal bleeding
4. Key risk factor is high-risk HPV infection
5. Secondary risk factors include smoking and immunodeficiency
6. Can be either squamous cell carcinoma (most common) or adenocarcinoma (less common)

Question 17

One of the most common causes of death in pts with advanced cervical carcinoma is…

Answer 17

Post-renal failure with hydronephrosis.

Question 18

Pap smear

Answer 18

1. Gold standard for screening
2. Abnormal Pap smear must be followed up with confirmatory colposcopy and biopsy
3. Inadequate sampling of the transformation zone (i.e., the junction between the endocervix and exocervix) may yield a false-negative screening result
4. Of limited efficacy in screening for adenocarcinoma

Question 19

Asherman syndrome

Answer 19

1. Result of overaggressive dilation and curettage

2. Presents as secondary amenorrhea due to loss of stratum basalis (regenerative layer) and scarring

Question 20

Anovulatory cycle

Answer 20

1. Characterized by estrogen-driven proliferative phase without progesterone-driven secretory phase due to lack of ovulation
2. Common cause of abnormal uterine bleeding during menarche and menopause

Question 21

Acute endometritis

Answer 21

1. Bacterial infection of endometrium
2. Usually due to retained products of conception
3. Presents as fever, abnormal uterine bleeding, and pelvic pain

Question 22

Chronic endometritis

Answer 22

1. Consists of chronic inflammation of the endometrium
2. Characterized by plasma cell infiltration of the endometrium
3. Common causes include retained products of conception, chronic PID, IUD use, and TB
4. Presents as abnormal uterine bleeding, pelvic pain, and infertility

Question 23

Endometrial polyp

Answer 23

1. Hyperplastic protrusion of endometrium
2. Presents as abnormal uterine bleeding
3. Can arise as a side effect of tamoxifen, which exhibits a weak pro-estrogen effect on the endometrium

Question 24

Endometriosis

Answer 24

1. Endometrial glands and stroma outside of the uterine endometrial lining
2. Presents as dysmenorrhea and pelvic pain
3. May cause infertility
4. Increased risk of carcinoma at the site of endometriosis

Question 25

Sites commonly involved in endometriosis

Answer 25

1. Ovary -- chocolate cyst 2. Uterine ligaments 3. Pouch of Douglas -- pain with defecation 4. Bladder wall -- pain with urination 5. Bowel serosa -- abdominal pain and adhesions 6. Fallopian tube mucosa -- scarring

Question 26

Involvement of uterine myometrium in endometriosis is called...

Answer 26

Adenomyosis.

Question 27

Endometrial hyperplasia

Answer 27

1. Hyperplasia of endometrial glands relative to stroma 2. Consequence of unopposed estrogen 3. Presents as postmenopausal uterine bleeding 4. Cellular atypia is the most important predictor of progression to carcinoma

Question 28

Endometrial carcinoma

Answer 28

1. Consists of malignant proliferation of endometrial glands 2. Presents as postmenopausal bleeding 3. Can be of either sporadic or hyperplastic etiology 4. Endometrial hyperplasia leading to endometrial carcinoma is associated with endometrioid histology 5. Sporadic endometrial carcinoma arises from atrophic endometrium and is associated with papillary serous histology; sporadic tumors are frequently driven by p53 mutations; average age of affected pts is 70 yrs; may find psamomma bodies in these tumors due to necrosis of papillae

Question 29

Leiomyoma

Answer 29

1. Benign proliferation of smooth muscle arising from myometrium 2. Related to estrogen exposure 3. Histology reveals multiple, well-defined, white-whorled masses 4. Prevalent in premenopausal women 5. Usually asymptomatic, but can cause infertility and abnormal uterine bleeding

Question 30

Leiomyosarcoma

Answer 30

1. Malignant proliferation of smooth muscle arising from myometrium 2. Arises de novo; does not arise from leiomyoma 3. Usually seen in postmenopausal women 4. Presents as single lesion displaying necrosis and hemorrhage

Question 31

FSH acts on...

Answer 31

Granulosa cells.

Question 32

LH acts on...

Answer 32

Theca cells.

Question 33

Hemorrhage into corpus luteum can result in...

Answer 33

Hemorrhagic luteal cyst.

Question 34

Degeneration of ovarian follicles results in...

Answer 34

Follicular cysts.

Question 35

PCOS

Answer 35

1. Multiple follicular cysts in ovaries 2. Characterized by increased LH and decreased FSH such that LH:FSH > 2 3. Classic presentation: obese young woman with infertility, oligomenorrhea, and hirsutism 4. Subset of pts exhibit insulin resistance and go on to develop T2DM 5. High circulating estrone levels increase risk for endometrial carcinoma; estrone is a form of estrogen produced by adipose tissue