Female Repro Pathology I Flashcards
Uterus, Vulva, Vagina (37 cards)
State some common congenital abnormalities occurring in the uterus.
- uterus unicornis - degeneration of one half of the mullerian duct, only half of uterus present
- uterus didelphys - non-fusion of the mullerian duct, uterus splits and each has own cervix
State types vaginal infection and their corresponding discharge colour.
- Bacteria
- BV - grey-white
- Other bacterias - yellowish purulent - Virus (herpes)
- vesicles - Protozoa (trichomonas)
- bubbly frothy - Fungus (candida)
- whitish exudate
State the conditions of the vulva.
- Lichen sclerosus
- Lichen simplex chronicus
- Paget’s disease
- Vulvar malignancy (invasive and non-invasive)
- Bartholin cyst
State the histological features of Lichen sclerosus.
- very thinned epidermis
- hydropic degeneration of basal layer
- sclerotic stroma
- dermal inflammation
State everything you know about Lichen sclerosus.
- non-neoplastic epithelial disorder (potential to become neoplastic)
- autoimmune
- gross: whitish plaques (leukoplakia)
State the histological features of Lichen simplex chronicus.
- thickened epidermis (acanthosis)
- Hyperkeratosis
- Dermal inflammation
State everything you know about Lichen simplex chronicus.
- non-neoplastic epithelial disorder (potential to become neoplastic)
- secondary to pruritus
State the histological features of Vulva Paget’s disease.
- Presence of neoplastic glandular cells
State everything you know about Vulva Paget’s disease.
- positive CK7 immunohistochemistry stain that picks up glandular cells
- originates from primitive epithelial progenitor cells
- in situ glandular neoplasm that arises from stratified squamous epithelium
- presents as red lesions on weeping skin
- premalignant condition
State the histological features of vulvar cancer.
- irregular islands of invasive SCC
- kerratin pearls
- intercellular junctions
State the common vaginal diseases. (3)
- VAIN
- clear cell adenocarcinoma
- embryonal rhabdomyosarcoma
State everything you know about VAIN (vaginal intraepithelial neoplasia)
- associated with HPV 16 and HPV 18
- premalignant condition
State the histological features of clear cell adenocarcinoma.
- clear cytoplasm clusters
- stratified squamous epithelium with formation of glands
State everything you know about clear cell adenocarcinoma.
- common in young women
- due to in-utero exposure to DES (diethylstilbestrol) in mothers treated with DES during pregnancy
- possibly preceded by vagina adenosis (presence of metaplastic cervical or endometrial epithelium within vaginal wall)
State the histological features of embryonal rhabdomyosarcoma
- normal stratified squamous epithelium of vagina
condition affects external genitalia, less impact on internal
State everything you know about embryonal rhabdomyosarcoma.
SARCOMA BOTRYOIDES
- common in infants and children
- gross: grape like clusters projecting into vaginal lumen
- treat: resection surgery (vaginectomy) and chemotherapy
State the common cervix diseases. (2)
- Cervical intraepithelial neoplasia
- Cervical Carcinoma
State the common histological features associated with cervical intraepithelial neoplasia.
- high N:C ratio
- nuclear irregularity
- increased mitotic rate
- dysplastic change
- CIN I - koilocytosis
State everything you know about cervical intraepithelial neoplasia (exclude risk factors).
TARGETS THE SQUAMOCOLUMNAR JUNCTION BETWEEN ECTOCERVIX AND ENDOCERVIX
- ectocervix = non-keratinised stratified squamous epithelium
- endocervix = simple columnar epithelium
Staging of cervical intraepithelial neoplasia:
- mild dysplasia (lower 1/3) - CIN I - low grade SIL
- moderate dysplasia (lower 2/3) - CIN II - high grade SIL
- severe dysplasia (full length) - CIN III - high grade SIL
State the risk factors for cervical intraepithelial neoplasia.
- many sex partners
- early age at first intercourse
- increase parity (number of births)
- male partner with multiple previous sex partners
- cancer associated HPV 16 and 18 (MOST IMPORTANT!!! usually located within transitional zone)
- certain HLA and other subtypes
- oral contraceptives and nicotine
- genital infections (chlamydia)
How does HPV lead to cervical cancer?
95% OF CANCERS SHOW HPV DNA
Pathogenesis:
HPV 16 is associated with amplification of 3q -> cell cycle regulation disrupted by viral oncogenes E6 and E7 (p53 and Rb respectively)
(most HPV infections regress and do not progress into cervical cancer)
Integrated vs episomal viral DNA
- integrated -> link to cervical cancer
- episomal -> low grade cervical cancer
Treat: vaccines
Tests:
1. HPV immunohistochemistry
2. PAP smear (once every 3 years from 25-69 if sexually active)
3. HPV DNA test
State the histological features of HPV.
- perinuclear haloes
- multinucleation
- crinkled nuclei
State the histological features of cervical carcinoma
SCC:
- large cell non-keratinising
- large cell keratinising
- small cell
or
- adenocarcinoma
- adenosquamous
- undifferentiated
State everything you know about cervical carcinoma.
75-90% IS SCC, 10-25% IS ADENOCARCINOMA
- gross: fungating, ulcerating, infiltrative, cauliflower erosion
- presentation: intermenstrual blood, post-coital blood (post-intercourse), postmenopausal blood, dyspareunia (pain during intercourse)
- spreads by local invasion into uterus&vagina&bladder&rectum, lymphatics, haematogenous (lung, liver, bone, brain)
Staging:
I - 90% 5 year - cervix only
II - 75% 5 year - upper vagina, paraimetrium (fat and connective tissue around uterus)
III - 30% 5 year - lower vagina, pelvic wall
IV - 10% 5 year - rectum/bladder, extrapelvic
