Female GU Pathology I: Vulva/Cervix/Vagina Flashcards Preview

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Flashcards in Female GU Pathology I: Vulva/Cervix/Vagina Deck (41):
1

What is the exo/ectocervix made of?

Nonkeratinized Stratified Squamous Epithelium

2

What is the vaginal mucosa lined with?

Nonkeratinized Stratified Squamous Epithelium

3

What is the endocervix lined by?

Simple Columnar Epithelium

4

What is an inherent factor of the vagina that can encourage squamous metaplastic change?

Acidity of the vagina

5

Transformation Zone

Band of squamous metaplasia lying between the original SCJ and new SCJ

6

What happens to the cervix during puberty?

Eversion of the columnar epithelium occurs - normal physiologic response

7

What is the final step of squamous metaplasia?

Cells mature into glycogen-rich squamous cells

8

What is the site of cervical squamous carcinoma?

Transformation Zone

9

What does the PAP smear screen for?

Cervical Cancer

10

Wha tis Cervical Intraepithelial Neoplasia AKA?

Squamous Intraepithelial Lesion

11

What types of HPV has the highest risk for cancer?

HPV-16 and 18

12

How is HPV spread?

Sexual Intercourse

13

How do high risk HPVs lead to cancer?

Infection leads to HPV integration in the metaplastic squamous cells of the cervix which can lead to cancer

14

What are the functions of HPV oncoprotein, E6 and E7?

Bind to Rb and p53 and neutralize their function - inhibitor of tumor suppressors

15

What HPV type infection is condyloma found in?

HPV-6 and 11

16

Koilocyte

Nuclear enlargement with irregular nuclear membrane and hyperchromasia

17

When are koilocytes seen?

In low risk HPV-6 and 11 infection with condyloma formation

18

Nearly complete abnormal maturation of cells in cervix

CIN3

19

CIN1 is AKA

Low-grade Squamous Intraepithelial Lesion (SIL)

20

CIN2 and CIN3 are AKA

High-grade SIL

21

Where are cells from a PAP smear scraped from?

Transformation Zone

22

What types is the bivalent HPV vaccine made against?

HPV-16 and HPV-18

23

What is the majority of the invasive carcinoma of the cervix?

Most are SCCs

24

What is the key risk factory for invasive carcinoma of the cervix?

HPV Infection

25

How common is SCC of the vulva and vagina?

VERY uncommon

26

Lichen Sclerosis

Symptoms of pruritus, soreness, irritation with thinning of the epidermis and fibrosis of the dermis

27

What will be seen on physical exam of lichen sclerosis?

Leukoplakia on the vulva

28

A 23‐year old woman presents multiple vulvar lesions depicted in the image. The lesions are flat, moist, and minimally elevated. The physician believes the lesions represent condylomata lata. If the diagnosis is correct, which of the following is the etiologic agent?

A. HPV 31 or 33
B. Treponema pallidum
C. Chlamydia trachomatis
D. Neisseria gonorrhea

B. Treponema pallidum

Condyloma lata = syphilis

Condyloma acuminata = HPV

29

Lichen Simplex Chronicus

Associated with chronic irritation and scratching that leads to hyperplasia of vulva epithelium

30

How does Lichen Simplex Chronicus present on physical exam?

Leukoplakia with thick leathery skin

31

Is there an increased risk of malignancy with Lichen Simplex Chronicus?

NO

32

What is the risk of progression from lichen sclerosis to cancer?

Small risk

33

Paget Disease of the Vulva

Intra‐epidermal proliferation of malignant cells that arises from intra-epidermal progenitor cells

34

How does Paget Disease of the Vulva present?

RED and scaly crusted plaque

35

How is Paget disease of the vulva distinguished from melanoma?

Melanoma is S100 positive
Paget disease is PAS positive

36

What disease is associated with diethylstilbestrol exposure in-utero?

Clear Cell Adenocarcinoma of the Vagina

37

What will be a physical finding of clear cell adenocarcinoma of the vagina?

Red, granular areas adjacent to normal pale pink vaginal mucosa

38

What is the origin of rhabdomyosarcoma?

Skeletal muscle

39

Who does rhabdomyosarcoma of the vagina typically occur in?

Children less than 5 yrs

40

How does rhabdomyosarcoma of the vagina present?

Bleeding, soft, grape‐like masses protruding through vagina

41

A 68‐year‐old woman has had itching with irritation of the vulvar region for the past 6 months. On physical examination she has pale grey patches measuring 1 to 2 cm in size on the vulva. Biopsy of one lesion is performed and on microscopic examination shows epithelial thinning, dermal fibrosis, and perivascular chronic inflammation. Which of the following is the most likely diagnosis?

A. Extramammary Paget Disease
B. Condyloma acuminatum
C. Lichen sclerosis
D. Lichen simplex chronicus
E. Squamous cell carcinoma

C. Lichen sclerosis

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