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Female Reporductive Flashcards

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1
Q

The skin and mucosa external to the hymen, lined by squamous epithelium

A

Vulva

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2
Q
  • Cyctic dilation of batholin gland (secretes mucous to lubricate the vestibule)
  • there is inflammation due to infarction with an STD leading to an obstruction which leads to the dialation
A

Bartholin cyst

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3
Q

Presents with a unilateral painful cystic lesion at the lower vestibule adjacent to the vaginal canal

A

Bartholin cyst

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4
Q

Warty neoplasm of vulvar skin, most commonly due to HPV 6 and 11

A

Condyloma acuminata

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5
Q

What is Condyloma acuminata characteristized with

A

Kolycystic change ( raisin shaped nucleus)

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6
Q

What does HPV Infect

A

The lower genital tract (vulva, vaginal canal and cervix)

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7
Q

Characteristic of HPV infection

A

Koliocytic change

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8
Q

Risk of HPV - based on DNA sequencing

A

Low risk 6,11 - Condyloma acuminata

High risk 16,18,31,33 dysplasia -> carcinoma

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9
Q
  • thinning of epidermis and fibrosis of dermis
  • leukoplakia with parchment like vulvar skin (paper thin)
  • most commonly seen in post menopausal women (atrophy)
  • benign with slight risk scc
A

Lichen sclerosis

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10
Q

Squamous cell hyperplasia

-hyperplasia of vulvar squamous epithelium

A

Lichen simplex chornicus

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11
Q
  • Presents as leukoplakia with thick leathery vulvar skin
  • associated with chronic irritation and scratching
  • no risk of scc
A

Lichen simplex chronicus (hyperplasia of vulvar squamous epithelium)

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12
Q
  • presents with leukoplakia
  • can be HPV related or NON-HPV related(morecommon)
  • arise from squamous epithelium
A

Vulvar carcinoma - must be biopsied to rule out other causes of leukoplakia

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13
Q

What does HPV RELATED vulvar carcinoma present with?

A

A women 40-50 years old with vulvar leukoplakia, on biopsy she shows multifocal, warty and poorly differentiated cells. (Classic vulvar intraepithelial neoplasia)

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14
Q

What does NON HPV RELATED vulvar carcinoma present with

A

A women 70+ with vulvar leukoplakia and on biopsy it showed a unifocal well differentiated keratinising squamous eipithelium

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15
Q

What are the vaginas malignant neoplasms

A

Squamous cell carcinoma

Clear cell adenocarcinoma

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16
Q

What is clear cell adenocarcinoma

A

A begins malignant neoplasm which is the formation of small glands, red granular appearing foci

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17
Q

An uncommon malignant neoplasm that presents in women older than 60years of age
-VAIN is a precursor less ion almost always associated with HPV infection
-

A

Squamous cell carcinoma of the vagina

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18
Q

What is more than half invasive cell carcinoma associated with

A

HPV

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19
Q

Neck of the uterus

A

Cervix - divided into exocervix and endocervix

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20
Q

What is exoxervix lined with

A

Squamous epithelium

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21
Q

What is endocervix lined with

A

Columnar epithelium (transformation zone)

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22
Q
  • sexually transmitted DNA VIRUS
  • INFECTS Lowe genital tract especially the cervix in the transition formation zone
  • presistant infection leads to risk CIN
A

HPV INFECTION

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23
Q

What makes high risk HPV high risk?

A

Production of E6 and E7
E6 - increases destruction if P53
E7 - increases destruction of RB

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24
Q
  • Characterised by koliocytic change, nuclear pleomorphism and increased mitotic activity
  • Divides in to grades based on extent of immature dysplastic cells
A

CIN

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25
Grades of CIN
CIN 1 / 2 / 3 -> CIS -> invasive carcinoma ``` 1= 1/3 thickness 2= 2/3 thickness 3= most CIS = the Whole thickness ```
26
Is CIN reversible
Yes it is, may regress
27
Does CIS invade the basement membrane
No it doesn’t
28
Does cervical carcinoma invade the basement membrane
Yes it does
29
Most commonly seen in middle aged women and is seen as vaginal bleeding With invading of the basement membrane
Invasive carcinoma - cervical carcinoma
30
Low grade squamous intraepithelial lesion
Is CIN 1
31
High grade squamous epithelium lesion
CIN 2 and 3
32
What is the key risk factor for cervical carcinoma
High risk HPV infection #1 | Smoking and immune deficiency #2
33
What are the most common types of cervical carcinoma
``` Squamous cell (more common) Adenocarcinoma (Both types are related to HPV) ```
34
What happens in advanced tumors of the cervical carcinoma?
It invades the bladder through the anterior uterine wall, (hypdronephrosis)-> post renal failure
35
What is the goal of screening
Catch dysplasia before it develops into carcinoma (20 years window)
36
Gold standard screening (most successful) | A brush is used to scrape off cells from the transformation zone and check for dysplasia under the microscope
Pap smear
37
How do dysplastic cells appear after papsmear
Cells with dark blue nuclei and cytoplasm and increased nuclear / cytoplasmic ratio
38
What is done after an abnormal papsmear
Confirmatory colposcopy and biopsy
39
What are the limitations of Pap smear
Inadequate sampling of the transformation zone results in a false negative Limited efficacy in screening for adeno carcinoma
40
An infective way to prevent HOV INFECTION
Immunisation Vaccine covers hpv 6,11,16,18 Lasts 5 years Pap smear still done due to 31 and 33 hpv
41
Benign polyposis mass protruding from endocervical mucosa A few cm in size with a smooth surface filed with mucinous scretiojs both the surface epithelium and epithelial lining the mucinous cavity is Columnar
Endocervical polyp They can bleed No malignant potential
42
What does superimposed chronic inflammation do to endocervical polyp
Leads to squamous metaplasia and ulcers
43
Endometrium is hormonal sensitive
Grow-> prepared-> shedding
44
What drives the growth of the endometrium
Estrogen
45
What drives the endometrium to be prepared for implantation
Progesterone
46
When does shedding of the endometrium occur
With loss of the progesterone support
47
Lack of ovulation Results in esteogen driven proliferation without progesterone secretory phase Common cause is dysfunction uterine bleeding especially during menarche and menopause
Anovultary cycle
48
Bacterial infection of endometrium Usually due to retained products of conception (eg piece of placenta remains behind) Presents with fever abdominal uterinebleeding and pelvic pain
Acute endometrisis
49
Chronic inflammation of the endometrium Characterised by plasma cells (patho genomic for chronic endometriosis) - Common cause retained products of conception, TB, Chronic PID(chlamydia) and intrauterinedevice. (With TB we get granulomas) -presents with abdominal uterine bleeding, pelvic pain and infertility.
Chronic endometritis
50
Hyperplastic protrusion of endometrium Abnormal uterine bleeding Usually due to side effects of TAMOXIFEN
Endometrial polyp
51
Abnormal placement of endometrial glands and stromal outside the uterine cavity (endothelial lining) - presents with dysmenorrhea( pain during menstral cycle) and pelvic pain , could cause infertility
Endometriosis
52
Some menstral products go backwards through the tube in to the ovary and pelvis
Retrograde mensturation theory of endometriosis
53
The mallee Ian duct from which the endometrial wall develops (and other cervical and begins epithelium develop from) -> endometrium metaplasia takes place
Metaplastic theory of endometriosis
54
Endometrial epithelium spreading through lympatics( this theory proves how endometriosis for example reaches the lung)
Vascular or lymphatic dissemination theory of endometriosis
55
What are the most common sites of involvement of endometriosis
1- ovary - chocolate cyst (most common site) 2- uterine ligament - pelvic pain 3- pouch if douglas- pain with deification 4- bladder wall- pain with urination 5- bowel serosa - abdominal pain 6- Fallopian tube mucosa - scarring -> can increase risk of infertility
56
- hyperplastic endothelial glands relative to stroke - consequences of unopposed esteogen (not followed by progesterone) - presents as post menopausal uterine bleeding
Endometrial hyperplasia
57
Endometrial hyperplasia on biopsy
Based on architecture growth (simple or complex) and atypia(with or without) Typical hyperplasia- no atypia Atypical hyperplasia - atypia
58
What is the most common predictor for progression of endometrial hyperplasia to carcinoma
Atypia
59
Malignant proliferation of endometrial glands | Presents as post menopausal bleeding
Endometrial carcinoma
60
What are the 2 types of endometrial carcinoma
Based on what they arise from Hyperplasia (type 1 ) Sporadic (type 2)
61
Type 1 Hyperplasia - endometrial carcinoma
Histologically - endometriod Occurs in woman of 50-60 years Risk factor is estrogen
62
Sporadic endometrial carcinoma
Cancer from atrophic endometrium Histologically serous with papillae (papiallry serous) Occurs in elderly >70 Driven by p53 mutation Pasmoma bodies can be present (calcification of papillary structures
63
What are psammoma bodies present in
1- papillary carcinoma of of thyroid 2-papillary serous endometrial carcinoma 3- meningioma 4- mesothelioma
64
Benign proliferation of smooth muscle arising from myometrium - related to esteogen exposure (premenopausal women) - multiple well defines white whirled masses with cigar chapped nucleus - usually asymptomatic, when present there is-> infertility, uterine bleeding and mass
Leiyimyoma
65
Malignant proliferation of smooth muscle arising from myometrium - arises de novo (leiyomyoma does not become leiyosarcoma) - arises in post menopausal women - single lesion with necrosis and haemorrhage - necrotic mitotic activity and cellular atypia also with cigar shaped nucleus
Leiyomyosarcoma

pathology (15 decks)

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