Vaginal diseases Post Flashcards Preview

Unit 1 ID+LC > Vaginal diseases Post > Flashcards

Flashcards in Vaginal diseases Post Deck (36):
1

3 types of lymph node areas that drain the pelvic cavity

1. Periaortic

2. pelvic
- uterine/ovarian cancers

3. inguinal
- vulvar neoplasms

- which LN will you go after and how aggressive?

2

HSV will result in red painful lesions how many days after exposure?

3-7 days

Eosinophilic intranuclear inclusions
- pink

3

Molluscum contagiosum (pox virus) seen in which populations?

Adults
- genital (STD)

Children
- extremities via sharing towels (swimming)

Endophytic growth pattern

4

Condyloma acuminatum are seen with which HPV strain?

6, 11

White lesions
- leaflike, papillae tips
- Koilocytes (raisinoid nucleus with clear cytoplasm)

5

flagellated protozoan,
frothy yellow d/c
foul smelling
dysuria/dyspareunia
"strawberry cervix" on colposcopy

Trichomonas

6

Nl, but can overgrow
Curdlike d/c and pruritis

candida

7

"sulfur granule" with clublike projection, non copper IUD

actinomyces

8

HPV associated SCC
- population
- HPV genes
- precursor lesion

females
- takes a long time to develop

9

Infammatory associated SCC
- population
- HPV genes
- precursor lesion
- histology

female >70 yrs

HPV neg

Lichen sclerosus/ d-VIN

* prominent keratin pearls in well differentiated carcinoma
*resembles parchment, paperlike skin

10

Extramammary paget disease visual

red crusted sharply demarcated map-like area

- histology: tumor cells with halo

- in vulvar: not associated with carcinoma
- in breast: is

11

Malignant melanoma in vulvar region

can look a lot like other cancers

12

Cancer we have to worry about for DES exposure

Clear cell carcinoma

- "kissing lesion"
anterior upper 1/3 of vagina with discontinuous areas

- histology: tubulocystic pattern of growth with dense hyaline stroma. Clear cytoplasm with bland nuclei

13

Endocervical polyps found in which pop?
- sx?
- tx?

2-5% of adult women

can cause spotting

tx: curettage curative

14

staging of cervical cancers

based on clinical findings

*unlike endometrial cancers

15

histology of proliferative phase of menses.
- driven by what?

1. straight tubular glands
2. mitoses
3. nuclear stratification

- driven by E

16

Histology of secretory phase
- driven by what?

"S for secretory"
1. S shaped tortuous, coiling glands, secretory activity
- "piano keys"

- driven by progesterone and E2 falling

17

Menstrual phase
- histology
- drive by what?

1. Stromal/glandular breakdown
2. Inflammation
3. Intravascular fibrin

- driven by decrease in E2 and Progesterone

18

Hormones driving pregnancy
- histology

Progesterone, hcG

- histology: stromal decidualization
- Arias-Stella Reaction

19

Menopause

*lack of E = everything kind of thins down

1. >6 mo w/o menstruation

2. Thin endometrium w/o mitoses

3. Decrease cervical mucous and glycogenation

4. cystic atrophy

20

Polyps response to hormones

dont really respond
- out of phase with endometrial cycle

21

Endometritis

clinicall PID
- acute: increase polyps in stroma and gland

- chronic:
plasma cells + infertility

22

Diff betwen Adenomyosis and Endometriosis

Endometrial glands are not where they should be:

Adenomyosis
- w/in uterine wall

Endometriosis:
- outside of the uterus

*same same
- are hormonaly sensitive (unlike polyps)

23

Most common uterine tumor

leiomyoma
- WELL CIRCUMSCRIBED whorled bundleds of bland sm
- menometrorrhagia, infertility, mass

- hormonally responsive (unlike polyps)

24

Tx of leiomyom

1. surgery
2. embolization
3. GnRH agonist
4. Nothing - not bothering her

25

Most common uterine sarcoma

leiomyosarcoma
- hemorrhage, necrosis
- rapid increase in size (high mitotic activ)
- mets to lungs

26

Adenocarcinoma types

Endometrioid adenocarcinoma (Type I)
- younger women + E dep w/ good prog

Serous adenocarcinoma (Type II)
- older women, higher grade histology w/ poorer prognosis

27

Type I Endometrial cancer
- age groups
- risk factor

Premenopausal

risk: unopposed estrogen, genetics

28

Hereditary nonpolyposis colon cancer (HNPCC) is a risk factor for which types of cancer? Why?

mutated mismatch repair genes --> microsatellite instability

genes that form heterodimers and are mismatch repair proteins: MLH1, MSH2

men: colon cancer
women: endometrial cancer

29

Risk that simple hyperplasia can progress to cancer?
Treatment?

rarely progress to cancer

tx: progestins
(due to unopposed estrogen --> hyperplasia)

*comples hyperplasia 5-30% can progress to cancer

30

Risk that complex hyperplasia can progress to cancer

5-30%

*simple hyperplasia rarely does

31

Endometrial carcinoma (invaded beyond bm of glands)
- symptoms
- peak incid?

Usually asymptomatic

5th and 6th decade (50-60yrs old)

32

Prognosis of endometrial carcinoma
- tx

stage I: 96% 5 yr survival

stage III: 23%

-tx: surgery - take uterus out

33

Type II endometrial cancer
- age group
- aggressiveness?
- % of endometrial cancers

Post menopausal

Agressive: think p53

10-20% endometrial cancers

34

Most important lesions to remember in pts with abnl uterin bleeding (AUB)

1. polyps
2. adenomyosis
3. leiomeyomas
4. hyerplasia
5. carcinoma

35

grade vs stage

grade: degree of differentiation

stage: extent of spread

36

which is type I and which is type II cancer? and name gene involved
Endometrial SEROUS carcinoma

Endometrial ENDOMETRIOID carcinoma

Endometrial SEROUS carcinoma
- Type II
- mut of p53

Endometrial ENDOMETRIOID carcinoma
- Type I
- mut in:
MLH-1, BRAF, B-catenin