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Repro II > Vulva and Vagina pathology > Flashcards

Vulva and Vagina pathology Flashcards

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1
Q

germ cells are from what

A

endoderm

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2
Q

urogenital ridge is from what

A

mesoderm

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3
Q

germ cells migrate to where

A

urogenital ridge to form ovary

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4
Q

what forms the uterus and upper vagina

A

mullerian ducts

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5
Q

all epi surfaces and lining share what origin

A

coelemic (mesothelium)

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6
Q

mesonephric/wolfian duct remnants

A

can create cysts gartner cysts- next to uterus sup to cervix can also form in mesovarium/broad ligament

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7
Q

didelphys

A

when mularian ducts do not fuse -> two uterus’, 2 vaginas different from bicornate bc bicornate only has one vagina slightly higer risk for 2-3rd trimester spontaneous abortions DO NO have higher rate of twins or PID

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8
Q

kelbsiella granulomatous

A

gram neg donovan body

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9
Q

gardnerella vaginalis

A

gram neg clue cells

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10
Q

N. gonorrhoeae

A

gram neg diplococcus

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11
Q

Treponema pallidum

A

syphilis spirochete

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12
Q

HPV

A

koilocyte if low grade koilocyte + nuclear enlargement if high grade

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13
Q

HSV

A

multinucleated giant cell with intranuclear homogenization and inclusion bodies

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14
Q

CMV

A

bulbous intranuclear inclusion body

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15
Q

molluscm contagiosum

A

molluscum body

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16
Q

Trichomonas vaginalis

A

trichomonad

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17
Q

Actinomyces isralii

A

causes PID sulphur granules

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18
Q

M. tuberculosis

A

necrotizing granulomas

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19
Q

C. albicans

A

candida sp

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20
Q

What infections can be seen in vulva

A

herpetic ulcers molluscum lesions HPV (genital warts, intraepi neoplasia, invasive carcinoma) N. gonorrhoeae (skene gland adenitis) Candida trichomonas

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21
Q

what infections can be seen in vagina

A

herpetic ulcers HPV (genital warts, intraepi neoplasia, invasive carcinoma) Gonorrhoeae (vaginitis in kids) candida trichomonas

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22
Q

what infections can be seen in cervix

A

herpectic ulcers HPV (genital warts, intraepi neoplasia, invasive carcinoma) Chlamydia (follicular cervicitis, endometritis, salpingo-oophoritis) Gonorrhoeae (vaginitis in kids) candida trichomonas gardnerella

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23
Q

what infections can be seen in corpus

A

Chlamydia (follicular cervicitis, endometritis, salpingo-oophoritis) Gonorrhoeae (vaginitis in kids)

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24
Q

what infections can be seen in adenxa

A

Chlamydia (follicular cervicitis, endometritis, salpingo-oophoritis) Gonorrhoeae (vaginitis in kids)

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25
Herpes
usually HSV-2, but can be 1 DNA virus on PCR test or IgG serology few weeks of red bumps or tiny white blisters -\> rupture -\> ulcer pain, itchy detrimental to fetal developlment
26
herpes histo
can visualize blisters/ulcers with multinuclear giant cells with nuclear inclusions
27
test for herpes
Tzank test which uses pap stain best way to Dx is to see multinucleated giant cells with intranuclear ground glass viral inclusions
28
common causes of vaginitis
C. albicans (yeast infection) Trichomonas vaginalis Bacterial vaginosis (gardnerella)
29
C. albicans
not considered STD may be normal flora DM, abx, pregnancy, and immunosupressed at risk Dx with KOH prep or pap
30
S&S of C. albicans
leukorrhea, pruitis, erythema
31
Trichomoniasis
flagellated protozoan STI (4d-4wks) motile yellow froathy discharge, pruitis, dysurian, dyspareunia, strawberry cervix
32
strawberry cervic seen in trichomonas vaginalis vaginitis
33
mycoplasma
vaginitis and cervicitis implicated in spontaneous abortion and chorioamionitis
34
molluscum contagiosum
35
molluscum contagiosum
36
molluscum contagiosum
pox family virus painless bumps if scratch open and can spread via contact (towels) usually resolves in 6-12 months, keep covered can be STI in adults Not a blister, central area of lesion is concave
37
mulluscum contagiosum cytoplasmic pink inclusions representing clusters of large virus with nucleus pushed to the side central concavity can be seen
38
PID definition
infection of pelvic organs beyond the uterine corpus
39
most common causes of PID
gonorrhea and chlamydia most infections are polymicrobial
40
complications of PID
rupture of tuboovarian abscess infertility form scarring of tubes ectopic pregnancy intestinal obstruction from fibrous bands and adhesions
41
subclinical PID
common cause of serious sequelae up to 1/3 of infertility women w/o Hx of PID have underlying chlamydia infection
42
fitz-hugh curtis syndrome
perihepatitis infection of liver capsule and peritoneal surfaces can be complication of PID
43
salpingitis
fallopian tube plicae expanded by inflammatory infiltrate and edema if acute filled with neutrophils, if chronic filled with plasma cells
44
bartholin gland cyst
obstuction of duct -\> cyst common all ages can become infected may be polymicrobial or gonorrhea or chlamydia Tx must place catheter or sew open to allow continuous drainage
45
lichens planus pruitic, polygonal, purple, plaques usually symetrical ususally goes away in 1-2 yrs, so just tx itch
46
wickhams striae of lichen planus
47
lichen planus note band of chronic inflammatory cells at dermal-epidermal jnx also squamous epi is normal thickness
48
lichen sclerosus aka LS&A elderly and post menopausal females unknown etiology, maybe autoimmune atrophic change not considered precancerous, but 4% increased risk of CA development
49
lichen sclerosis
50
lichen sclerosis note white 'parchment like' areas
51
lichen sclerosis no band of inflammatory cells, rather a significant band of hylinization also thickened epi layer
52
lichen simplex chronicus squamous hyperplasia and acanthosis NO CYTOLOGICAL ATYPIA (if there were is would be VIN) usually dt chronic scratching
53
LSC
54
CONDYLOMA ACUMINATUM
venereal warts 90% HPV 6,11 (low risk) 10% HPV 16,18,33 (high risk for VIN 2-3 and carcinoma)
55
gross appearance of Condyloma Acuminatum
frequently multiple and papillary warts, occasional flat
56
histo of Condyloma Acuminatum
koilicytosis, mitoses
57
Tx of Condyloma Acuminatum
cryo, chemical, laser, or excision
58
Condyloma Acuminatum note flat white leukoplakia and multifocal on histo exam would see hyperkeratosis, thickened epi, and peri-nuclear clearing
59
condylomata warty type cauliflower multifocal papules
60
condylomata coalescing papules aka bowenoid papulosis typical in low grade infections
61
koilocytosis of Condyloma Acuminatum radinoid nuclei with surrounding cleared area low grade infection if high grade would also see nuclear enlargement
62
VIN
vulvar intraepithelial neoplasm 1-3 3 = CIS
63
VIN 1-3 determination
determined by what thickness has been invaded with nucelar enlarged cells moderate (VIN2) = half thickness if VIN 2 or 3 must be excised
64
invasice SCC of vulva
90% of invaseive vulvar CA usually presents as nodules/masses on background of leukoplakia an ulcerated mass is CA until proven otherwise
65
type 1 SCC of vulva
60% warty and bowenoid type HPV 16,18, 33 occurs in reproductive age women
66
type 2 vulvar SCC
40% keratinizing type not HPV associated may occur in long-standing LS&A or chronic inflammation
67
spread of SCC
local invasion with lymphovascular spreas to region nodes followed by mets to lung, liver, etc
68
tx of SCC
VULVECTOMY AND LYMPHADECTOMY
69
Glandular lesions of vulva
accessory breast tissue along milk line papillary hidradenoma extramammary paget disease
70
papillary hidradenoma
sharply circumscribed nodule in vulva with normal overlying skin considered benign has 2 layers of cells (columnar and myoepithlium)
71
extramammary pagets disease
presents as pruitic, red, crusted sharply demarcated area on labia majora of elderly unlike paget disease of breast, does not have underlying carcinoma tumor mass, but IS malignant aride form primitive germinal cells of mammary like gland ducts in skin
72
Dx pagets
halo cells (epidermal appendages) PAD, Mucin, CEA, EMA, all postive usually confined to epi and skin appendages low potential for mets
73
Tx of pagets
wide local excision may recur look for synchronous tumors of breast, rectum, bladder, ovary
74
malignant melanoma
usuallly poor prognosis S-100 and Melanin-A +
75
DES
given to women with miscarriages 40s-70s it affects adenosis (process by which glandular epi of embryo is replaced by squamous) some affected daughters developed CCC of vagina also have increased risk for CIN and VIN and maybe breast CA
76
generalizations of vaginal neoplasms
80% mets most primary are SCC which arises from Vaginal intraepithelial neoplasm (VaIN) almost all d/t HPV16
77
Embryonal rhabdomyosarcoma
neoplasm of girls \<5 presents as polypoid mass or vaginal bleeding arises in lamina propria high rate of surgical cure if \<3cm local invasion -\> local nodes -\> mets frequently misdiagnosed as inflammatory polyps can see mm spindle cells w/very small nuclei

Repro II (20 decks)

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