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Flashcards in Vagina Deck (41)
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1

Mass lesions in Vagina

Gartner's duct cyst
Adenosis, clear cell carcinoma
Carcinoma

2

Remnants of mesonephric ducts
• Anterolateral wall of vagina
• 1-2 cm

Gartner's duct cyst

3

Girls (10 years) whose mother received diethyl
stilbesterol (DES) during pregnancy to prevent
abortion

Vaginal adenosis

4

Endocervical type glands in vaginal wall
• ? Inhibition of transformation of Mullerian
epithelium into squamous epithelium
• Some girls develop clear cell adenocarcinoma (10 -
35 years)

Vaginal adenosis

5

Uncommon
• HPV
• Exophytic, polypoidal, fungating mass
• Pelvic or inguinal nodes based on location
• Poor prognosis

Squamous carcinoma

6

Another term for Embryonal rhabdomyosarcoma

Sarcoma botryoides

7

Sarcoma botryoides

8

Skene's glands

around urethral opening

9

Bartholin glands

open into vaginal
introitus

10

Acute inflammation on the inferior part of
labium major- bartholin gland
• Blocking due to inflammation
• Abscess formation

Bartholinitis

11

INfections for bartholinitis

Strep, Staph, Gonococci, E. Coli

12

Bulky, warty growth; may be multiple; hyperplasia,
koilocytosis;

Condyloma acuminatum

13

Leukoplakia

Non-specific descriptive term for white plaques

14

Why Leukoplakia important

Importance: look for neoplastic potential

15

Risk factors: Vulvar Intraepithelial Neoplasia (VIN),
classic type

HPV mainly 16, 18, 31, 33
Smoking/Immunosuppressed patients
• Leukoplakia, reddish brown plaque
• Multifocal – 50-80%

16

50 – 60% have synchronous lesions in the cervix, vagina,
urethra, anus

Vulvar Intraepithelial Neoplasia (VIN),

17

VIN, differentiated type

• Not HPV infection, p53 mutation
• Older females
• Basal atypical layer

18

• > 60 years
• Plaque, nodule, ulcer
• Anterior 2/3 of labia majora
• Squamous cell carcinoma
• Inguinal and pelvic nodes

Carcinoma vulva

19

Keratizing vs basaloid squamous carcinoma Age

Keratizing: older
Basaloid: younger

20

Keratizing vs basaloid squamous carcinoma MORPHOLOGY

keratizing: keratizing
Basaloid: Warting

21

HPV Keratizing vs basaloid squamous carcinoma

Keratizing: 5,8
Basaloid: 16>18

22

Keratizing vs basaloid squamous carcinoma immunohistochemistry

Keratizing: p53
Basaloid: p16

23

Fertilized ovum implanted outside the uterine
cavity
• Tubes, cervix, ovary, abdomen

Ectopic pregnancy

24

1% of all pregnancies
• ↑ because of PID with tubal adhesions
• endometriosis with fibrosis is also a risk factor
• fibrosis blocks the passage of fertilized ovum (50%
idiopathic)
• Lack of space, poor vasculature, limited placental size.
• Ruptures 2 – 6 weeks after fertilization.
• Embryo dies, rarely implanted in abdomen.

Tubal pregnancy

25

βhCG elevated due to pregnancy
• Once the embryo dies, βhCG drops
• ↓ βhCG leads to degeneration of corpus luteum
• Lead to ↓ estrogen and progesterone
• Endometrium breaks down leading to bleeding.

Ruptured tubal pregnancy

26

Uterus small compared to amenorrhea
• Endometrial curettings show no chorionic
villi but have hypersecretory glands
• R/O spontaneous abortion (chorionic villi)

Ruptured tubal pregnancy

27

Gestational Edema with Proteinuria and
Hypertension - GEPH
• Syndrome: E, P, H usually in third trimester.
• Distinct from a hypertensive person becoming
pregnant
• 5% of pregnancies
• 10% of PE develop seizures (Eclampsia)
• Induce labor or do Caesarian section
• disappears after labor

Pre- Eclampsia: last trimester

28

HELLP syndrome

H: Hemolysis
E/L: Elevated Liver enzymes
L/P: Low Platelets

29

Predisposing factors for pre-eclampsia

Primigravida, over 35 years age
• Multiple pregnancies
• Hydramnios
• Preexisting hypertension
• Hydatidiform mole

30

Pathogenesis of pre-eclampsia

• Undetermined (Toxemia- misnomer)
• Placental ischemia- Hypoxia leads to an imbalance in circulating angiogenic and antiangiogenic factors (sFlt1, endoglin)
• Autoimmune reaction to placenta
• ↓ production of PGE2
and NO by placenta – increased
sensitivity to renin angiotensin
• DIC – in eclampsia (due to thromboplastic tissue factor and
thrombaxane released by ischemic placenta)
• Diffuse endothelial dysfunction; vasoconstriction (HT)
• Increased vascular permeability (proteinuria, edema)