Female Reproductive Pathology

Question 1

vagina

1. overview

Answer 1

a. distensible fibromuscular tube usually collapsed in a h shape with its anterior and posterior walls in contact
b. superior three folds of the pelvis and inferior fourth of the perineum
c. recess around the uterine cervix divided into anterior, posterior, and lateral fornices
d. opening into vestibule may be partially closed by a thin , concentric hymn in virgins

Question 2

vagina

2. blood supply

Answer 2

vaginal branch of the uterine artery , vaginal artery , and internal pudendal artery

Question 3

vagina

3. venous drainage

Answer 3

vaginal tributaries of internal iliac arteries

Question 4

vagina

4. lymphatic drainage

Answer 4

superior to hymen drains to external and internal iliac nodes; inferior to hymen follows perineal drainage to superficial inguinal nodes

Question 5

vagina

5. vaginal supports

Answer 5

a. inferior part: perineal body
b. middle part: urogenital diaphragm
c. superior part: levator ani and transverse cervical , uterosacral ligament and pubocervical ligament

Question 6

the posterior fornix of the vagina has access to…

Answer 6

the rectouterine pouch

Question 7

vaginismus

Answer 7

involuntary spasm of the muscles surrounding the lower vagina, causing inability to engage in coitus and often making pelvic examinations difficult. it may have an organic basis, be caused by sexual abuse or trauma , or be entirely psychological in origin

Question 8

vaginismus

Answer 8

involuntary spasm of the muscles surrounding the lower vagina, causing inability to engage in coitus and often making pelvic examinations difficult. it may have an organic basis, be caused by sexual abuse or trauma , or be entirely psychological in origin

Question 9

cervix

Answer 9

cylindrical lower third of the uterus projecting inferiorly into the vagina
cervical canal communicated with the uterine cavity at the internal os and with the cavity of vagina at the external os

Question 10

cervical cancer

Answer 10

PAP smears leading to the detection of premalignant conditions called dysplasia and regular examinations have decreased the incidence . vaccine called HPV

Question 11

vulva

A. clitoris

Answer 11

a. erectile organ formed by the fusion of two crura as corpora cavernosum in body of clitoris
b. ends distally in high sensitive glands
c. attached to pubic sumphysis by suspensory ligament of clitoris

***the clitoris has no corpus spongiosum and does not contain urethra

Question 12

B. labia majora

Answer 12

a. two prominant fatty folds of skin that extend inferiorly and posteriorly from the mons pubis separated by medial pudendal cleft
b. unite anteriorly at anterior labial comissure
c. contain terminations of round ligaments of uterus

Question 13

the pudendal cleft between labia majora contains

Answer 13

contains the labia minora and the vestibule with the openings of urethra and vagina

Question 14

C. labia minora

Answer 14

a. skin folds lying between labia majora and extending posteriorly from clitoris on either side of the vestibule
b. divide anteriorly into laminae laminae that fuse above clitoris to form prepuse and below to form frenulum

Question 15

D. vestibule

Answer 15

cleft between labia minora containing openings of urethra, vagina, and ducts of greater vastibular glands

Question 16

D. vestibule

Answer 16

cleft between labia minora containing openings of urethra, vagina, and ducts of greater vastibular glands

Question 17

E. bulb of the vestibule

Answer 17

homologue of bulb of the penis, a paired mass of erectile tissue on each side of the vaginal orifice

Question 18

greater vestibule glands

Answer 18

a. paired mucous secreting glands homologous to bulbourethral glands in male
b. lie in the superficial perineal pouch deep to posterior part of bulbs of vestibule and open into the vestibule to provide lubercation for coitus

Question 19

the greater vestibular gland infection

Answer 19

the greater vestibular glands are usually not palpable unless infected or inflamed (bartholinitis) . AN abscess may develop and hamper pelvic examination or sexual relations due to pain and swelling. Most infections are due to neiserria gonorrhea. occlusion of the glands duct may result in Bartholin gland cyst. Vulvular carcinoma arises in the gland

Question 20

bartholin cysts

Answer 20

• bartholin cysts in woman are analogous to cowpers glands ( bulbourethral ) in men. they are also called greater vestibular glands.
• results in inflammation and obstruction of bartholin glands
• infection in bartholin gland porduces inflammation (adenitis) and may result from abcess
• large 3-5 cm / surgical removal/ drainage
• NEVER BECOME MALIGNANT

Question 21

non eoplastic epithelial disorder

Answer 21

leukoplakia is a descriptive clinical term for opaque, white, plaquelike epithelial thickening that may produce puritus (severe itching of the skin) and scaling

• inflammatory dermatosis (psoriasis, chronic dermatitis)
• lichen sclerosis and squamous cell hyperplasia
• neoplasias such as vulvar intraepithelial neoplasia, paget disease, and invasive carcinoma

Question 22

non neoplastic disorders

- lichen sclerosis

Answer 22

• “smooth” lesions
• white macules (plaques)
• when the entire vulva is affected, the labia become atrophic and agglutinated, the vaginal orifice constricts
• sclerosis
• disease occurs in all age groups and it is most common in post- meopausal woman
• its pathogenisis is uncertain, but the precense of activated T-cells in the subepithelial inflammatory infiltrate and the increased frequency of autoimmune disorders affected in woman suggest that an autoimmune reaction is involved
• although lichen sclerosis is not a premalignant lesion, woman with symptomatic lichen sclerosis have an increased chance of developing squamous cell carcinoma

Question 23

nonneoplastic disorders

- squamous cell hyperplasia

Answer 23

• previously called hyperplastic dystrophy or lichen simplex chonicus
• non specific conditon resulting in rubbing or scratching of the skin to relieve puritis
• clinically it presents a leukoplakia and histologic examination reveals thickening of the epidermis (acanthosis) and hyperkeratosis
• > 45 years

Question 24

benign exophytic lesions

Answer 24

-warty like lesions

Question 25

benign exophytic lesions

- condyloma acuminatum

Answer 25

benign genital warts caused by low oncogenic risk HPVs mainly types 6 or 11
- sexually transmitted
histollogically they comprise of sessile branching epithelium proliferations or stratified squamous epithelium
- mature superficial cells exhibit perinuclear cytoplasmic clearing with nuclear atypia (koilocytotic atypia)
- not considered precancerous

Question 26

squamous neoplastic lesions

- vulvar intraepithelial neoplasia and vulvar carcinoma

Answer 26

vulvar carcinoma is uncommon representing only 3% of female genital cancers ; most occur in woman over the age of 60 . prognosis depends on size , depth of invasion and lymph node status ; patients with lesions less than 2cm have a 90% survival rate after vulvectomy and lymphadectomy ; whereas regional lymph node metastises portends a poor prognosis

• *** basaloid and warty carcinomas
• ***keratized squamous cell carcinoma

Question 27

VIN

- basaloid and warty carcinomas

Answer 27

• classic VIN
• arise from
  precancerous in situ lesions called VIN
• most positive for HPV 16
• Risk related to HPV infection - often associated with vaginal or cervical HPV related lesions
• cancer risk increases with age and immunosuppression
• reporductive age

Question 28

keratinized squamous cell carcinomas

Answer 28

differentiated VIN 
- no HPV link 
>80 yoa
- TP53 mutations - chronic irritation 
- typically arise from a setting of long-standing lichen sclerosis or squmous cell hyperplasia; the immediate premalignant lesions are called differentiated VIN