The Female Genital Tract - Chapter 22 Flashcards
The Müllerian /paramesonephric duct system becomes what in the female genitourinary tract?
Unfused portions mature into the fallopian tubes, fused caudal portion develop into the uterus and upper vagina, and the urogenital sinus forms the lower vagina and vestibule
What embryologic structure do the ovaries arise from?
Germ cells
What are the three anatomic and functional regions of the uterus?
Cervix, lower uterine segment, corpus (Not in Robbins)
google: corpus just means body of uterus
Besides gonococcal infection, what are other causes of pelvic inflammatory disease (PID)? Compare where the infections begin and the routes of spread of gonococcal vs. non-gonococcal PID. What are some of the complications of PID?
causes of PID: Chlamydiae and enteric bacteria; Staphylococci, Streptococci, coliform bacteria, Clostridium perfringens following abortions or puerperal infections
Gonococcal inflammation usually begins in endocervical mucosa and in Bartholin and other vestibular glands or periurethral glands; organisms may then spread to the fallopian tubes and tubo-ovarian region.
Nongonococcal bacterial infections are thought to spread from the uterus upward through the lymphatics or venous channels rather than on the mucosal surfaces. They produce more inflammation within the deeper layers of the organs than gonococcal infections.
Acute complications include peritonitis and bacteremia, which may produce endocarditis, meningitis or suppurative arthritis. Chronic sequelae include infertility, ectopic pregnancy, pelvic pain and intestinal obstruction due to adhesions between bowel and pelvic organs.
Leukoplakia of the vulva may represent a variety of lesions including?
Inflammatory dermatoses (psoriasis, chronic dermatitis)
lichen sclerosus
squamous cell hyperplasia
Neoplasias (vulvar intraepithelial neoplasia (VIN)
Paget disease,
even invasive carcinoma)
google:
Vulvar leukoplakia is not a histological diagnosis and involves several diseases. Most commonly, these are vulvar lichen sclerosus and squamous cell hyperplasia of the vulva. These two conditions have similar aetiology, clinical presentation and treatment but different histopathological changes.
Describe the two nonspecific inflammatory alterations of the vulva.
Lichen sclerosis – smooth white plaques that may enlarge and coalesce, resembling parchment or porcelain. Histologically, characterized by thinning of epidermis, degeneration of basal cells, excessive keratiniation(hyperkeratosis), sclerotic changes of suprficial dermis, and bandlike lymphocytic infiltrate in the underlying dermis
Squamous cell hyperplasia – manifested by epithelial thickening(acanthosis) and hyperkeratosis
What are the three benign verrucous protuberances of the vulva and their causes?
Condyloma acuminatum – HPV 6 and 11
Fibroepithelial polyp – benign stromal proliferation covered by squamous epithelium Syphilitic condyloma latum – syphilis
What is the most common malignant vulvar tumor and its precursors?
Squamous cell carcinoma
Precursor –
1) vulvar intraepithelial neoplasia (HPV related)
2) squamous cell hyperplasia
3) lichen sclerosus
What is the most common malignant vulvar tumor and its precursors?
Squamous cell carcinoma
Precursor –
1) vulvar intraepithelial neoplasia (HPV related)
2) squamous cell hyperplasia
3) lichen sclerosus
What is a hidradenoma?
A papillary hidradenoma is identical in appearance to intraductal papilloma of the breast. It presents as a sharply circumscribed nodule, most commonly on the labia majora or interlabial folds, and may be confused clinically with carcinoma because of its tendency to ulcerate.
google:
Hidradenoma is a relatively rare tumor of sweat gland origin. Although traditionally regarded as displaying can show either eccrine or apocrine differentiation.
how does extramammary paget disease differ from paget disease of the nipple in relation to the probability of underlying carcinoma?
In contrast to Paget disease of the nipple, in which 100% of patients show an underlying ductal breast carcinoma, vulvar lesions are most frequently confined to the epidermis of the skin and adjacent hair follicles and sweat glands.
Although extension of a cervical carcinoma into the vagina is much more common than a primary vaginal tumor, what is the most common primary vaginal cancer?
Squamous cell carcinoma
Vaginal adenosis and clear cell carcinoma were associated with _______ and occurred in what age group?
Diethylstilbestrol use by mother during pregnancy 15-20 years
google: A synthetic form of the hormone estrogen that was prescribed to pregnant women between about 1940 and 1971 because it was thought to prevent miscarriages
Embryonal Rhabdomyosarcoma is a tumor of __________ and is also called ________.
Infants and children younger than 5 years
Sarcoma Botyroides
What is a Nabothian cyst?
Mucous-filled cyst on the surface of the cervix
What is the progression of disease in cervical carcinomas? What HPV subtypes are highly oncogenic?
Low grade squamous intraepithelial lesion (LSIL) represent productive HPV infections which usually regress.
High grade squamous intraepithelial lesion (HSIL) are characteized by cell cycle deregulation and increasing atypia, with 10% progressing to invasive carcinoma, also known as carcinoma in situ, CIN III.
Stage 0 carcinoma
carcinoma stage I - confined to the cervix
Ia - preclinical, diagnosed by microscopy
Ia1 - stromal invasion no deeper than 3 mm and no wider than 7 mm (aka microinvasive carcinoma)
Ia2 - maximum depth between 3 and 5 mm, no wider than 7 mm
Ib - histologically invasive, greater than stage Ia2, but confined to cervix
II - carcinoma extends beyond cervix but not to pelvic wall. Involves vagina but not the lower third III - carcinoma has extended to pelvic wall. On rectal exam, there is no cancer-free space between the tumor and pelvic wall. Lower third of vagina involved
IV - carcinoma has extended beyond true pelvis or has involved the mucosa of the bladder or rectum. Also includes cancers with metastatic dissemination
Oncogenic subtypes - 16 and 18
what is the recommended age range for HPV vaccination
Before age 11 or 12 and up to age 26
What is the purpose of “dating” the endometrium?
may be used to assess hormonal status, document ovulation and may determine cause of endometrial bleeding and infertitity
google:
Microscopic examination of a suitable, stained specimen from the endometrium to establish the number of days to the next menstrual period.
What is the most frequent cause of dysfunctional bleeding? What about in each age group?
anovulation
prepuberty - precocious puberty
adolescence - anovulatory cycle, coagulation disorders
reproductive age - complications of pregnancy, anatomic lesions, anovulatory phase perimenopausal - anovlatory phase, anatomic lesion
postmenopausal - endometrial atrophy, anatomic lesions
Define dysfunctional uterine bleeding.
Uterine bleeding not caused by any underlying abnormality
List some of the causes of acute and chronic endometritis.
Acute endometritis – bacterial infections that arise after delivery or miscarriage. Products of conception are the predisposing influence. Caused by group A hemolytic streptococci, staphylococci and other bacteria.
Chronic endometritis – Chronic PID, retained gestational tissue, intrauterine contraceptive devices, and tuberculosis.
Compare endometriosis with adenomyosis.
Adenomyosis – presence of endometrial tissue within the uterine wall
Endometriosis – the presence of “ectopic” endometrial glands or stroma in abnormal locations outside the uterus
What are the two types of endometrial polyps?
Hyperplastic
Atrophic
google:
if an endometrial polyp is attached to the uterine surface by a narrow elongated pedicle, then it is known as pedunculated, however, if they have a large flat base, absence of a stalk, they are known as sessile
A very small fraction of polyps, about 1.0%, may become hyperplastic or show malignant transformation (endometrioid adenocarcinoma and serous adenocarcinoma)
What is the stimulus for endometrial hyperplasia?
Prolonged estrogen stimulation of the endometrium
Describe Brenner Tumor(transitional cell tumors).
Most are benign adenofibromas. The fibrous stroma, resembling that of the normal ovary, is marked by sharply demarcated nests of epithelial cells resembling the epithelium of
the urinary tract, often with mucinous glands in their center.
google: are composed of cells resembling mature transitional epithelium (urothelium) arranged in sharply defined solid clusters, nests and trabeculae within a dense fibromatous stroma.
What is a Call-Exner body?
Small, distinctive, glandlike structures filled with an acidophilic material, resembling immature follicles; associated with granulosa cell tumors.
Describe a Krukenberg tumor.
Metastatic gastrointestinal neoplasia characterized by bilateral ovarian metastases of mucin- producing, signet-ring cancer cells
google: Krukenberg tumor is an uncommon metastatic signet ring cell tumor of ovary that originates primarily in stomach [1]. This gastric cancer can be small enough to remain undetected even after several years of oophorectomy.
Define placenta accreta and describe a clinical complication.
Partial or complete absence of the decidua, such that the placental villous tissue adheres to the myometrium directly, which leads to a failure of separation at birth.
Possible complications: post-partum bleeding due to failure of placental separation; placenta previa and previous cesarian section are predisposing factors
Cloudy amniotic fluid and yellow-green opaque membranes are characteristic of
Acute chorioamnionitis
google:Acute chorioamnionitis is a major cause of spontaneous preterm birth,
What are the two types of molar pregnancies and what is the difference? Why are they important?
Complete mole - all female chromosomes are lost and genetic material is paternally derived. Typically 46,XX. Embryo and fetal parts cannot be identified
Partial Mole - fertilization of an egg with two sperm. Typically 69,XXY or occasionally 92,XXXY. Fetal tissues are typically present.
Complete moles predispose the patient to choriocarcinoma or persistent or invasive mole. Partial moles are not associated with choriocarcinoma
