Path: Vulva, Vagina, Cervix

Question 1

Top 3 most common sites of genital herpes infection.

Answer 1

1. Cervix 2. Vagina 3. Vulva

Question 2

Time it takes for lesions to appear after exposure to herpes.

Answer 2

3-7 days

Question 3

Location of sequestered genital herpes viruses.

Answer 3

Lumbosacral dorsal root ganglia

Question 4

If a herpetic lesion is active during labor and delivery, how should the delivery be handled?

Answer 4

C-section to prevent transmission to the newborn

Question 5

What are 3 characteristics of cells of a pap smear when it is infected with Herpes?

Answer 5

Molding of nuclei

Margination of nucleoli

Multinucleation

Question 6

Infectious agent of Molluscum Contaigiousum

Answer 6

Poxvirus

Question 7

Most common population to develop Molluscum Contaigiosum.

Answer 7

Children between age 2 - 12

Question 8

How does Molluscum Contaigiosum appear on microscopy?

Answer 8

The cells of the papules with be full of viruses and the nuclei are absent.

Question 9

Patient presents with white clumpy vaginal discharge and complains of vulvar pruritis.

Answer 9

Candidiasis

-the image shows hyphae (or pseudospores) on papsmear

Question 10

Patient complains of vaginal pain, speculum exam reveals bright red cervix. Pap smear reveals:

Answer 10

Trichomonas Vaginalis: protozoan infection

Question 11

Patient presents with white/gray vaginal discharge with fish smell odor. Pap smear reveals

Answer 11

Bacterial Vaginosis caused by Garnerella vaginalis infection. The image shows clue cells.

Question 12

Main causative agent of pelvic inflammatory disease (PID).

Answer 12

Chlamydia trachomatis

Question 13

Why is PID caused by Chlamydia worse than PID caused by Gonorrhea?

Answer 13

Chlamydia takes longer to produce symptoms. Damage occurs before symptoms arise whereas Gonoccocal PID is treated earlier due to earlier symptoms.

Question 14

Patient presents with persistent lower abdominal pain. Salpingo-oophorectomy reveals:

Answer 14

Tubo-ovarian abscess caused by Gonococcal infection.

Question 15

Major complication of current or past PID.

Answer 15

Ectopic Pregnancy

Question 16

Name the two major categories Non-neoplastic vulvar disorders.

Answer 16

1. Lichen Sclerosis
   - thinning epidermis, hyperkeratosis, dermal fibrosis
2. Squamous Cell Hyperplasia (Lichen Simplex Chronicus)
   - epithelial thickening, leukocytes infiltrate the dermis

Question 17

Causative agent of Condyloma Acuminatum

Answer 17

HPV

(aka genital warts or syphilitic lesion)

Question 18

Infectious serotypes of agents that cause Condyloma Acuminatum that are oncogenic.

Answer 18

HPV 16 and 18

Question 19

Name the two types of Squamous Cell Carcinoma of the vulva.

Answer 19

1. Basal and Warty Carcinoma
2. Keratinizing Squamous Cell Carcinoma

Question 20

Major risk factor for developing Basal or Warty Carcinoma of the vulva.

Answer 20

Infection of HPV serotype 16 (18 and 31 are also possible but less common)

-usually sexually transmitted

Question 21

What does this biopsy of vulvar tissue indicate?

Answer 21

Indicates Basal or Warty carcinoma that is still in situ or intraepithelial (VIN). The basement membrane is still intact. The cell layers show a lack of maturation characteristic of neoplasia. The patient is HPV (+).

Question 22

What does this biopsy of vulvar tissue indicate?

Answer 22

Basal or Warty carcinoma that has invaded through the basement membrane.

Question 23

What is different about the risk of developing Keratinizing Squamous Cell Carcinoma vs. Basal or Warty Carcinomas?

Answer 23

Keratinizing Squamous cell is NOT associated with HPV infection.

It is mainly a result of individuals with long-standing Lichen Sclerosus or Squamous cell hyperplasia.

Question 24

What does this vulvar biopsy show?

Answer 24

Keratinizing Squamous Cell Carcinoma.

The dermis contains “nests and tongues” of squamous cells. This cell type is only supposed to be present in the EPIdermis.

Question 25

What is the prognosis for patients with a Keratizing Squamous Cell Carcinoma lesion 2cm or less vs. one that has entered lymph nodes?

Answer 25

2cm lesion: high survival (60-80% at 5 years) Lymph node involvement: low survival (less than 10% at 5 years)

Question 26

What does this biopsy from a sharply circumscribed nodule of vulvar tissue indicate?

Answer 26

Papillary Hidradenoma: a glandular neoplastic lesion with intraductal papilloma projections

Question 27

A patient presents with a red, pruritic, crusted vulvar lesion. Biopsy reveals this:

Answer 27

Extra-mammary Pagets Disease -large tumor cells in the epidermis with a "clear halo" separating them from other epithelial tissue

Question 28

Treatment for extramammary Paget Disease.

Answer 28

Surgical Excision

Question 29

What is vaginal adenosis?

Answer 29

Persistence of columnar epithelium in the upper 1/3 of the vagina. It should be stratified squamous cells.

Question 30

Major cause of vaginal adenosis.

Answer 30

Use of the medication Diethylstilbestrol by pregnant patients for estrogen replacement therapy. The adenosis would occur in the later in the life of the fetus of the pregnant patient.

Question 31

Major complication of vaginal adenosis.

Answer 31

Clear cell vaginal carcinoma

Question 32

Malnignant vaginal tumor in infants.

Answer 32

Sarcoma botryoides (embryologic rhabdomyosarcoma) -grapelike

Question 33

How does Sarcoma Botyroides appear on histological examination?

Answer 33

Cambium Layer: tumor cells appear crowded beneath the vaginal epithelium

Question 34

Most common site of development of squamous cell carcinoma of the vagina.

Answer 34

At the junction of the upper vagina and ectocervix

Question 35

What maintains acidic pH in the vagina and cervix?

Answer 35

Lactobacilli sp. -secrete acid keeping vaginal pH below 4.5

Question 36

What are endocervical polyps and how are they treated?

Answer 36

Cervical growths of fibromyxomatous stroma. Benign growths that can be removed with simple curettage or surgical excision.

Question 37

Major risk factor for developing cervical carcinoma.

Answer 37

Infection with HPV serotypes 16 and 18 -carcinomas form once the patient is in an immunocompromised state

Question 38

Cell type that HPV likes to infect.

Answer 38

Immature basal cells of squamous epithelium. Located at the squamocolumnar junction of the ectocervix and upper vagina.

Question 39

What is the main classification system used for PREcancerous cervical lesions?

Answer 39

A simplified two-tiered system 1. Low Grade (LSIL or Lowgrade Squamous Intraepithelial Lesion): involves Cervical Intraepithelial Neoplasia (CIN) I, the atypical cells exapnd less than 1/3 the epithelial thickness 2. High Grade (HSIL): invovles CIN II and CIN III, the atypical cells expand 2/3 of the epithelial thickness

Question 40

What does an exophytic lesion mean?

Answer 40

Tending to grow outward from its epithelial origin. Seen in a lot of squamous cell pathology.

Question 41

What is the treatment for most invasive cervical carcinomas?

Answer 41

Hysterectomy with lymph node dissection + Radiation