What is the defining characteristic of molluscum contagiosum lesions?
umbilicated vesicles filled with hard waxy stuff
What does psoriasis look like histologically?
hyperkeratosis with parakeratosis loss of granular layer epidermal acanthosis elongation of rete ridges vascular dilation
What does lichen simplex chronicus look like histologically?
thickened epidermis with leukocyte infiltration of dermis elongation/widening of rete ridges hyperkeratosis acanthosis dermal inflammation
What do we think of with lichen simplex chronicus?
scratch-itch cycle
Who is at most risk for lichen planus?
women of child bearing age
In what condition is the saw tooth appearance of rete ridges pathognomonic?
Lichen planus
Which of the “lichen” are most likely to cause cancer?
Lichen sclerosus
What is the gross appearance of Lichen sclerosus?
thickening of skin
pale/white/variation in color
What does lichen sclerosus look like under the microscope?
edematous degeneration of the basal layer
epidermal atrophy/no rete ridges
dense CT replaces dermis
band-like lymphocytes
T/F. Bartholin’s duct cysts are a certain indicator of a STD
False
What types of cells line Bartholin’s duct cysts?
transitional epithelium or squamous metaplasia
Name 4 bacterial causes of a STI
chlamydia
gonorrhea
syphilis
chancroid
Name 5 viral causes of a STI (4 of 5 start with H)
HSV HIV HPV Hep B/C MSV
What is the histological appearance of HSV?
multi-nucleated giant cells
What infection is implied with Condyloma acuminata?
HPV
What is another name for condyloma acuminata?
genital warts
Which two HPV types are responsible for 90% of genital warts cases?
6 and 11
T/F. Most people who acquire HPV never develop warts or any other sxs
True
Which two HPV types account for 70% of all cervical cancer?
16 and 18
What are three microscopic changes seen with HPV?
acanthosis
hyperkeratosis
cytoplasmic vacuolation
Treponema pallidum causes what STI?
syphilis
What what three characteristics classify Treponema pallidum?
Gm-
spiral shaped
mobile
T/F. Both genital warts and syphilis cause painless lesions.
true
Characterize the d/c of BV, Trich, Candida.
BV: fishy, thicker
Trich: foamy, thin coating
Candida: cottage cheese
Clue cells are an indicator of what kind of infection?
BV
What kind of bacteria is Neisseria gonorrhoeae?
gram negative diplococci
The presences of ______________________ characterizes Vulvar intraepithelial neoplasia (VIN).
hyperpigmented skin plaques
What is VIN associated with?
primary squamous neoplasm in vagina or cervix
What does VIN look like histologically?
diffuse cellular atypia
nuclear crowding
increased mitotic index
What kind of DNA is found in over 90% of VIN cases?
DNA of high risk HPV (16, 18, 31, 45)
What increases the risk of VIN progressing to invasive cancer?
age
immunosuppression
What is the most common vulvar cancer?
squamous cell cancer
After squamous cell cancer, what are the 3 most likely forms of vulvar CA?
basal cell
melanoma
adenocarcinoma
What are the two main categories of vulvar carcinoma?
HPV
Non-HPV (caused by lichen sclerosus, squamous cell hyperplasia, idiopathic)
What does tissue look like microscopically when vulvar carcinoma is caused by HPV.
poorly differentiated
When the microscope reveals well differentiated, keratinized cells, what kind of vulvar carcinoma are you thinking?
HPV negative
Which LNs are usually involved with vulvar carcinoma?
inguinal
pelvic
iliac
periaortic
Where does vulvar carcinoma usually metastasize?
lung
liver
What drug is associated with clear cell adenocarcinoma?
Diethylstilbestrol (DES)
Which HPV strains are implicated in cervical cancer?
16, 18, 31, 45
What gene is associated with cervical cancer?
HLA-B7
Name some cervical cancer risk factors
many sexual partners tobacco OCP HPV multiple births
Koilocytosis is associated with what Bethesda scale rating?
Low grade SIL
What is Koilocytosis characteristic of?
ASC-US (atypical squamous cells of undetermined significance)
What are typical features of koilocytes?
enlarges nuclei (2-3x normal size) darkly staining
What does CIN1 look like histologically?
koilocytotic atypia
perinuclear halos
What type of DNA is most abundant in koilocytes and what color does it stain?
HPV
blue
Up-regulation of __________ characterizes high risk HPV, histologically
p16ink4 (a tumor suppressor gene)
looks like intense immunostaining
Define Stage 1 cervical cancer.
carcinoma confined to the cervix
Define Stage II cervical cancer.
Carcinoma extends beyond cervix but not into pelvic wall.
involves the vagina but not the lower 1/3
Define Stage III cervical cancer.
carcinoma extended onto pelvic wall
no cancer free space between the tumor and the pelvic wall
Define Stage IV cervical cancer.
carcinoma has extended beyond the true pelvic or has involved the mucosa of the bladder or rectum.
all metastatic cases fall under this category.
What is the most common site of implantation of ectopic endometrial cells?
ovaries
t/f. ectopic endometrial cells are influenced by hormonal changes and respond like glands and stroma within the uterus.
true
What is an endometrioma?
aka chocolate cyst
ovarian cyst formed due to ectopic endometrial tissue that bleeds and builds up within the ovary
Where is ectopic endometrial tissue found in the case of adenomyosis?
within the myometrium
What do you call adenomyosis that specifically involves the uterus?
adenomyometritis
What does adenomyosis look like grossly?
thickened and spongy myometrial wall
What are the most common causes of endometritis?
childbirth related:
retained placental fragments
iatrogenic infection from delivery or abortion
When might endometritis occur not related to childbirth?
PID
What characterizes acute endometritis?
micro-abscesses or neutrophils within the endometrial glands
What characterizes chronic endometritis?
plasma cells in the stroma
PID increases the risk of ectopic pregnancy by how many times?
6-10x
What is the most common gyn CA in the US?
endometrial CA
What is the most common endometrial ca?
adenocarcinoma
When does adenocarcinoma of the endometrium usually present?
age 55-65yo
uncommon <40yo
What distinguishes carcinoma from hyperplasia?
glandular architecture is preserved but the tissue is confluent without intervening stroma
What percentage of endometrial cancers resemble serous carcinoma of the ovary (papillary serous carcinoma)?
20%
If a specialized immunohistochemistry stain reveals accumulation of nuclear p53 protein, what kind of cancer is likely?
papillary serous carcinoma
What do you call a benign smooth muscle tumor of the uterus (or anywhere) and where are they found?
leiomyoma
myometrium of the corpus
What does a leiomyoma look like grossly and microscopically?
gross: well-circumscribed, round, firm, gray-white
microscopic: uniform muscle cells, oval nuclei, whorled pattern
Histology report reports spindle shaped muscle cells with increased mitotic figures. What might this be?
Sarcoma (leiomyosarcoma)
What is the most common cause of female infertility?
PCOS
What is the most common form of ovarian cancer?
epithelial (arising from the surface of the ovary)
Which type of ovarian cancer has more pronounced papillary growth and more hyperchromatic cells seen in a biopsy?
serous cystadenocarcinoma
What do you call the small calcifications as seen with ovarian serous cystadenocarcinoma?
psammoma bodies
What is another name for a teratoma?
dermoid cyst
Define cryptorchism
absence of one or both testes in the scrotum
What is the most common birth defect of the male genitalia?
cryptochidism
T/F. 80% of cryptorchid testes descend by the first year of life.
true
In what percentage of cases can undescended testes be palpated in the inguinal canal?
90%
What does cryptorchidism increase the risk of?
infertility, germ cell tumors, testicular torsion, infarction, inguinal hernias
What do you call the surgery to correct cryptorchidism?
orchioplexy
What aspect of the penis does hypospadias affect?
ventral
What aspect of the penis does epispadias affect?
dorsal
What do you call the condition where the foreskin cannot be fully retracted over the glans?
phimosis
What do you call the condition where the foreskin becomes trapped behind the glans?
paraphimosis
What is the difference between the cause of a primary and secondary varicocele?
primary: defective valves or compression of the vein by a nearby structure
secondary: compression of the venous drainage of the testicle
Is the right of left testicle more likely to be affected by a varicocele?
left 85-90%
Is the right of left testicle more likely to be affected by a varicocele?
left 85-90%
Where does the fluid come from in the case of a hydrocele?
tunica vaginalis
T/F. A hydrocele will tranilluminate
true
What is the malformation called that often is the cause of testicular torsion?
bell clapper deformity
What are the two types of urethritis and their causes?
gonococcal urethritis: Neisseria gonorrhoeae
non-gonococcal urethritis: Chlamydia trachomatis (most commonly)
What is the characteristic bacteria type of Neisseria gonorrhoeae?
gram-negative diplococci
What is the triad of reactive arthritis/reiter’s?
inflammatory arthritis of large joints
inflammation of the eyes
urethritis in men with mucocutaneous lesions
What does Chlamydia trachomatis look like histologically?
granulated cytoplasmic inclusions
immunostaining needed usually
What type of cell is characteristic of herpes simplex?
multinucleated giant cell
What do you call the soft, non-cancerous growth associated with tertiary syphilis?
gumma
What are condyloma acuminata?
genital warts due to HPV (mostly strains 6 and 11)
What virus is high associated with penile cancer?
HPV
What is the most common form of penile CA?
squamous cell carcinoma
What HPV strain is associated with 63% of HPV positive tumors?
HPV 16
What is the most common solid malignant tumor in men aged 20-35?
primary testicular tumors
What is the most common classification of testicular cancer?
seminoma 35%
What makes the affected age group different with seminomas compared with other germ cell tumor of the testes?
average dx is at age 40 (10-15 years older)
What is detectable in serum tests with 50% of seminoma cases?
placental alkaline phosphatase (PLAP)
T/F. Serum alpha fetoprotein is elevated with seminoma
false
What does a seminoma look like histologically?
sheet-like or lobular pattern of cells with fibrous stromal network (nests)
clear/pink cytoplasm with glycogen
prominent nuclei with 1-2 large nucleoli and nuclear membranes
What is the average age of dx for embryonal carcinoma?
31yo
t/f. pure embryonal carcinoma is rare but this tumor type is present in a majority of non-seminoma germ cells tumors.
true
What two serum values are elevated with embryonal carcinoma?
AFP, hCG
What does embryonal carcinoma look like histologically?
sheets of cells trying to form primitive tubules
crowded pleomorphic nuclei
Is BPH a result of hypertrophy or hyperplasia of cells?
hyperplasia
What is the consistency of the prostate with BPH?
rubbery
nodular
In BPH, what do you call the pink concretions within the glandular lumens as seen under the microscope?
corpora amylacea
What percentage of prostate cancers are slow growing?
66%
What is the most common form of prostate cancer?
adenocarcinoma
What is the characteristic histological appearance of prostatic adenocarcinoma?
small, crowded glands no intervening stroma nuclei are hyperchromic enlarged nucleoli mitotic figures
