Female Reproductive Tract Pathology Part 1

Question 1

the vulva is comprised of what parts?

Answer 1

Labia Majora
Labia Minora
Clitoris
Vaginal Orifice
Glands

Question 2

Where are the skenes glands located

Answer 2

adjacent to the urethra

Question 3

where are the bartholin glands

Answer 3

posterior to the vaginal orifice/opening

Question 4

both the skene and bartholin glands contribute to _ released during sexual actitivty

Answer 4

fluid

Question 5

between the external genitalia and anus is the area known as?

Answer 5

perineum

Question 6

the vagina is posterior to the _ and internally gives rise to?

Answer 6

urethra

uterus

Question 7

the uterus is _ and _ to the bladder

Answer 7

posterior and superior

Question 8

the vaginal is a _ lined spaced

Answer 8

squamous mucosal

Question 9

the iterus has a surface _ endometrial lining which is under the myometrium which is composed of _

Answer 9

glandular

smooth muscle

Question 10

the top of the uterus is called the?

Answer 10

fundus

Question 11

the fundus and the uterine cavities feed into the bilateral?

Answer 11

fallopian tubes

Question 12

the lower portion of the uterus is the cervix, the outside dome of the cervix is lined by? and the internal cervix is lined by?

Answer 12

ectocervix (outside) is lined by squamous mucosa

transitions to

endocervix (internal) is lined by columnar mucosa

Question 13

the point where the ectocervix goes to the endocervix is termed the?

Answer 13

transition zone (also known as the SCJ, squamous columnar junction)

Question 14

the transition zone is important because this is where _ occurs

Answer 14

HPV

Question 15

female embryologic development starts with germ cells that migrate during the 5th/6th week to an area comprised of MESODERM to form the?

also what is this area comprised of mesoderm called?

Answer 15

migrate to the genital ridge (formed by mesoderm) to form the gonads

Question 16

during the 6th week of gestation in female development bilateral ducts form called the _ ducts and later the bilateral ducts called _ ducts form

Answer 16

mullerian/paramesonephric

wolffian/mesonephric

Question 17

lack of _ gene leads to ovary formation of the gonads

Answer 17

SRY (sex determinet region on the Y chromosome)

Question 18

presence of _ leads to female from the ovary will lead to femal anatomical differentiation

Answer 18

estrogen

Question 19

during female development under the influence of estrogen the mullerian ducts become?

Answer 19

fallopian tubes, uterus, upper portion of the vagina

Question 20

during femal development what happens to the wolffian duct under estrogen control

Answer 20

the regress

Question 21

if wollfian ducts dont regress what can happen?

Answer 21

they can form benign cysts like paratubal or gartner duct cysts

Question 22

in femal development the urogenital sinus becomes?

Answer 22

the lower portion of the vagina

Question 23

what is uterus didelphys?

Answer 23

a double uterus that presents with 2 uterine cavities and 2 cervices

Question 24

uterine didelphys is caused by?

Answer 24

failure of fusion of the mullerian ducts during embryoloic development

Question 25

septate vaginas are present in 3/4 of the cases of uterine didelphys, what is this?

Answer 25

there is a septum in the vagina that divides the vagina into 2 seperate cavities double vaginas

Question 26

uterine abnormalities are typically _ in origin

Answer 26

genetic ## Footnote present with kidney abnormalities as well

Question 27

what is the presentation of uterus didelphys and septate vagina

Answer 27

the presentation is variable amongst individuals pain during intercourse/delivery cyclic pain during meses

Question 28

what is mayer-rokitansky-hauser-syndrome

Answer 28

when there is a complete absence or underdevelopment of structures formed by the mullarian ducts uterine/vaginal absence ## Footnote genetic cause

Question 29

what causes mayer-rokitansky-kuster-hauser syndrome?

Answer 29

mullerian agenesis

Question 30

clinical sign of mayer-rokitansky-kuster-hauser syndrome

Answer 30

amenorrhea

Question 31

a bartholin cysts arises from?

Answer 31

obstruction (mucus cant get out) ## Footnote infection or trauma can cause obstruction

Question 32

bartholin cysts present as?

Answer 32

unilateral, nontender, soft masses in the posterior aspect of the vaginal introitus

Question 33

if a batholin cyst becomes infected what can happen?

Answer 33

they will become painful with surrounding cellulitis, and edema

Question 34

what does a infect bartholin cyst look like inside?

Answer 34

an abcess with yellow of green fluid

Question 35

what pathogen is most notable a cause for an infected bartholin cyst?

Answer 35

E.Coli

Question 36

lichen sclerosis is a _ disorder which involves activated _ cells

Answer 36

inflammatory T cells

Question 37

lichen sclerosus is associated with what 2 things

Answer 37

autoimmune disorders and low estrogenic states

Question 38

lichen sclerosus is most common is _ (menopausal/post menopausal) women

Answer 38

post menopausal

Question 39

lichen sclerosus typically affects what area of the skin

Answer 39

vulva and angiogenital skin

Question 40

common symptoms of lichen sclerosus

Answer 40

itching, painful sexual intercourse, and painful urination

Question 41

licehn sclerosus has an increased risk for what?

Answer 41

TP53 driven positive keratinizing squamous cell carcinoma

Question 42

what does the histology of lichen sclerosus look like? grossly?

Answer 42

grossly it shows white plaques that can coalesce histologically: hyperkeratosis and atrophy of the epidermis with an underlying lymphocytic infiltrate and a prominent edematous band (hyaline zone)

Question 43

squamous cell hyperplasia of the vulva is also known as?

Answer 43

lichen simplex chronicus

Question 44

what is lichen simplex chronicus/squamous cell hyperplasia?

Answer 44

thickening of the skin due to chronic rubbing or scratching of the vulva

Question 45

physical examination of lichen simplex chronicus shows?

Answer 45

thickened/reddened surface which can overtime turn white it exposed to urine, sweat or vaginal secretions

Question 46

lichen simplex chronicus is associated with what conditions

Answer 46

contact dermatitis/psoriasis lichen sclerosus squamous cell carcinoma

Question 47

histological findings of lichen simplex chronicus

Answer 47

markedly thickened (acanthosis) epidermis and hyperkaratosis

Question 48

condylomas acuminatum refers to

Answer 48

anogenital warts

Question 49

anogenital warts are caused by?

Answer 49

HPV typically low risk HPV 6 and 11

Question 50

HPV is spread through

Answer 50

sexual contact

Question 51

how to anogential warts present

Answer 51

fleshy, skin like colored papules and plaques with a cauliflower like apperance

Question 52

how does a condyloma acuminatum look on histology?

Answer 52

hyperplastic papillary projections comprised of squamous cells and parakeratosis squamous cells have koilocytes

Question 53

what is parakeratosis

Answer 53

surface keratinocytes that are nucleated

Question 54

what is a koilocyte?

Answer 54

enlarged hyperchromatic nuclei that have a cleared out halo space around it ## Footnote some hpv strains cause perinuclear cavitations

Question 55

most vulvar carcinomas are _ carcinomas

Answer 55

squamous cell

Question 56

what are the two categories of vulvar carcinomas

Answer 56

basaloid/warty squamous cell carcinomas keratinizing squamous cell carcinoma

Question 57

both types of vulvar squamous cell carcinomas arise from what precursor lesion?

Answer 57

VIN (vulvar intraepithelial neoplasia)

Question 58

affected age of basaloid warty squamous cell carcinoma age for keratizing squamous cell carcinoma

Answer 58

60 75

Question 59

vin precursor lesion for basaloid/warty squamous cell carcinoma vin for keratinizing squamous cell carcinoma

Answer 59

classical VIN differentiated VIN

Question 60

risk factor for basaloid/warty SCC risk factor for keratinizing SCC

Answer 60

High risk HPV 16,18 chronic irritation, longstanding lichen sclerosus or squamous cell hyperplasia (lichen simplex chronicus)

Question 61

_ increases the risk of progression to carcinoma from VIN

Answer 61

immunosuppression

Question 62

keratinzing SCC of the vulva has high frequency of _ mutations

Answer 62

TP53

Question 63

histologically what do classic vin precursors look like?

Answer 63

they have full thickness atypia and pleomorphism and mitotic figures

Question 64

basloid vs warty apperance histologically

Answer 64

basaloid- dark blue basaloid nests warty- superficial papillae and underlying invasive nests

Question 65

how does differeniated vin look (precursor for keratinizing SCC)

Answer 65

basa, and parabasal atypia with parakeratosis and increased thickness

Question 66

how does keratinzing scc look histologically

Answer 66

with invasive nests of keratin termed keratin pearls

Question 67

what is a papillary hidradenoma

Answer 67

a benign neoplasm that presents as a dermal or subcutaneous nodule

Question 68

papillary hidradenomas arise from?

Answer 68

mammary type glands along the primitive milk line

Question 69

how does a papillary hidradenoma look? what is it comprised of what cells? what differentiation does it have?

Answer 69

circumscribed nodule in the dermis columnar cells, myoepithelial cells, and apocrine differentation

Question 70

extramammary pagets disease (EMPD) is an _ _ of unclear histogenesis

Answer 70

intraepithelial adenocarcinoma

Question 71

EMPD cells display differentation of what type

Answer 71

sweat gland (appocrine and eccrine) and squamous cell markers like keratinocytes

Question 72

it is postulated that EMPD tumor cells stem from

Answer 72

multipotent stem cells

Question 73

EMPD present like what clinically

Answer 73

itchy! erythematous and white crusted lesion that looks like a map

Question 74

what immunochemical stain is positive in EMPD

Answer 74

Ki67 ## Footnote same as luminal ER+ breast cancers of high grade

Question 75

with EMPD there is a risk of _ carcinoma

Answer 75

noncontiguous syncrhonous like bladder or urethra or any other gynecologic site

Question 76

histology of EMPD

Answer 76

clusters of single tumor cells in an intraepithelial location