Term
| What parts of the female genital tract are affected by HSV infection? |
|
Definition
|
|
Term
| How long does it take for HSV lesions to heal spontaneously? |
|
Definition
|
|
Term
| What causes an increased risk of neonatal transmission of HSV? |
|
Definition
| when the mother's initial infection is during the pregnancy |
|
|
Term
| What does HSV infection look like histologically? |
|
Definition
| intranuclear inclusions, glassy chromatin with margination of the chromatin, multinucleation and molding |
|
|
Term
| Pearly, dome shaped papules with a dimpled center are characteristic of what lesion? |
|
Definition
|
|
Term
| What does molluscum contagiosum infection look like histologically? |
|
Definition
| intracytoplasmic viral inclusions |
|
|
Term
| What are Bartholin's glands? |
|
Definition
| glands that produce clear mucoid secretions to lubricate the vestibule |
|
|
Term
| What is a common pathology of Bartholin's glands? |
|
Definition
| bartholin cyst due to duct obestruction. can lead to a bartholin abscess |
|
|
Term
| What does a bartholin cyst look like microscopically |
|
Definition
| cyst lined by transitional epithelium of the normal duct |
|
|
Term
| What organisms infect Bartholin cysts? |
|
Definition
| gonorrhea, staphylococcus, some anaerobes |
|
|
Term
|
Definition
| non-specific term to describe white, plaque-like mucosal thickening |
|
|
Term
| What diseases manifest as leukoplakia? |
|
Definition
| inflammatory dermatoses (psoriasis, chronic dermatitis), carcinoma or dysplasia, epithelial disorders of unknown etiology (Lichen Sclerosis, Lichen Simplex Chronicus) |
|
|
Term
| What disease manifests as an atrophic vulvitis? |
|
Definition
|
|
Term
| What is the appearance of vulvar lichen sclerosis? |
|
Definition
| pale grey and parchment-like |
|
|
Term
| What patient population does vulvar lichen sclerosis occur in |
|
Definition
|
|
Term
| What causes vulvar lichen sclerosis? |
|
Definition
|
|
Term
| Does vulvar lichen sclerosis turn into carcinoma? |
|
Definition
|
|
Term
| What's another term for lichen simplex chronicus? |
|
Definition
|
|
Term
| What causes lichen simplex chronicus? |
|
Definition
| hyperplastic dystrophy; reaction to rubbing/scratching |
|
|
Term
|
Definition
| enlarged hyperchromatic rasinoid nucleus with perinuclear clearing characteristic of condyloma acuminatum |
|
|
Term
| What are premalignant conditions of the vulva? |
|
Definition
| classic vulvar intraepithelial neoplasia (VIN), and Bowen's disease |
|
|
Term
| What aer the different VIN levels? |
|
Definition
| VIN1- mild dysplasia, VIN2- moderate dysplasia, VIN3-severe dysplasia/carcinoma in situ |
|
|
Term
|
Definition
| HPV (esp 16 and 18) accounts for 90% of the cases |
|
|
Term
| What percent of VINs progress? What increases your risk of them progressing |
|
Definition
| 5% progress to invasive carcinoma; higher risk in women older than 45 or immunosuppressed |
|
|
Term
|
Definition
| carcinoma in situ that involves full thickness of the epidermis and is included in VIN 3 |
|
|
Term
| What is the most common primary carcinoma of the vulva |
|
Definition
|
|
Term
| Squamous cell carcinoma is the most common cancer in women of what age? |
|
Definition
|
|
Term
| What are the two groups of squamous cell carcinoma? |
|
Definition
| basaloid and warty carcinomas (30%) and keratinizing squamous cell carcinoma (70%) |
|
|
Term
| What are the characteristics of squamous cell carcinoma of the vulva? |
|
Definition
| may be exophytic or ulcerated, grows slowly in a contiguous fashion, metastasizes to inguinal femoral, and pelvic lymph nodes |
|
|
Term
| What is the treatment for vulvar squamous cell carcinoma? |
|
Definition
|
|
Term
| What is basaloid and warty carcinoma associated with? |
|
Definition
| high risk HPV and younger age |
|
|
Term
| What are the premalignant lesions of keratinizing SSCa? |
|
Definition
| not related to HPV, frequently arise in patients with lichen sclerosis or squamous hyperplasia |
|
|
Term
| Premalignant lesion to keratinizing SCCa of the vulva is.. |
|
Definition
| differentiated VIN or VIN simplex |
|
|
Term
| What is extramamary Paget disease? |
|
Definition
| rare intraepithelial adenocarcinoma characterized by crusting, elevated, scaley, erythematous rash which probably arises de novo from apidermal adnexal structures. Uncommonly associated with an underlying malignancy. |
|
|
Term
| What is the treatment/prognosis for extramamary paget's disease? |
|
Definition
| wide local excision; high recurrence rate |
|
|
Term
| What is the second most frequent cancer of the vulva? |
|
Definition
| malignant melanoma(~5% of malignant vulvar neoplasms) |
|
|
Term
| What patient population gets melanoma of the vulva? |
|
Definition
| most common in 6th and 7th decades |
|
|
Term
| What is a gartner's duct cyst? |
|
Definition
| develop from wolffian (mesonephric) duct rests and located on the lateral walls of the vagina |
|
|
Term
| What is the appearance of Gartner's duct cysts? |
|
Definition
| common 1-2 cm cysts lined by cuboidal to low columnar epithelium |
|
|
Term
| What is atrophic vaginitis? |
|
Definition
| secondary infectio of atrophic vaginal epithelium due to postmenopausal estrogen deficiency. Epithelium is thinned and easily abraded which allows easy access by organisms |
|
|
Term
|
Definition
| squamous cells covered with coccobacilli |
|
|
Term
| What is the bacterial shift that occurs in bacterial vaginosis? |
|
Definition
| lactobacillus goes down and coccobacilli go up. gardnerella vaginalis is the predominant bacteria |
|
|
Term
| What conditions are associated with the development of vulvovaginal candidiasis? |
|
Definition
| DM, oral contraceptives, antibiotics, and pregnancy associated with the development of infection |
|
|
Term
| hat is the presentation of candida infection? |
|
Definition
| small white surface patches associated with pruritis (cheesy discharge) |
|
|
Term
| A pelvic exam of a patient with trichomonas vaginalis will show... |
|
Definition
|
|
Term
| What percent of primary carcinomas of the vagina are SCCa? |
|
Definition
|
|
Term
| What are the premalignant lesions of the vagina? |
|
Definition
| Vaginal Intraepithelial neoplasia (VAINI-III) are precursor lesions to vaginal carcinoma and often related to HPV |
|
|
Term
| What causes squamous cell carcinomas of the vagina? |
|
Definition
|
|
Term
| Where do squamous cell carcinomas of the vagina occur? |
|
Definition
| posterior wall fo the upper third of the vagina |
|
|
Term
| What pt population is usually affected by squamous cell carcinoma of the vagina? |
|
Definition
|
|
Term
| What is vaginal adenosis? |
|
Definition
| glandular tissue present within the vagina. Seen in small amount of normal women |
|
|
Term
| What drug causes vaginal adenosis? |
|
Definition
| prenatal exposure to diethylstilbestrol (DES). 1/3 of those exposed develop adenosis |
|
|
Term
| Vaginal adenosis is associated with the development of.. |
|
Definition
|
|
Term
| Of all women exposed to DES, how many develop clear cell adenocarcinoma? |
|
Definition
|
|
Term
| Where does clear cell adenocarcinoma of the vagina occur? |
|
Definition
| anterior wall upper 1/3 of the vagina |
|
|
Term
| What pt pop is associated with clear cell adenocarcinoma of the vagina? |
|
Definition
|
|
Term
| What is clear cell adenocarcinoma clear? |
|
Definition
|
|
Term
| 90% of embryonal rhabdomyosarcomas occur in girls who are.. |
|
Definition
|
|
Term
| Where does botyroid rhabdomyosarcoma usually occur? |
|
Definition
|
|
Term
| Botryoid rhabdomyosarcoma is a type of ... |
|
Definition
| embryonal rhabdomyosarcoma |
|
|
Term
| What does an embryonal rhabdomyosarcoma look like microscopically? |
|
Definition
| proliferation of myxomatous stroma with undifferentiated round/spindle cells. Have a "cambian layer"- cells crowd around vessels and beneath squamous epithelium. |
|
|
Term
| What is the behavior of embryonal rhabdomyosarcoma? |
|
Definition
| highly malignant neoplasm with extensive local spread which may metastasize |
|
|
Term
| What's the difference between the ectocervix and the endocervix |
|
Definition
Ecto= stratified squamous epi
endo= mucin producing columnar epithelium |
|
|
Term
| Squamous metaplasia of the cervix occurs at the... |
|
Definition
| squamocolumnar junction (transformation zone) |
|
|
Term
| What is the MC benign cervical growth? |
|
Definition
|
|
Term
| What is the histological appearance of an endocervical polyp? |
|
Definition
| lined by mucinous or squamous epithelium and has thick walled blood vessels |
|
|
Term
| How does an endocervical polyp present? |
|
Definition
|
|
Term
| What is the histo appearance of microglandular hyperplasia of the cervix? |
|
Definition
| complex proliferation of tightly packed small glands that can be confused with well-differentiated adenocarcinoma |
|
|
Term
| What is microglandular hyperplasia associated with? |
|
Definition
| progestin stimulation (pregnancy, pills, progesterone) |
|
|
Term
| T/F HPV infects mature sufrace squamous cells. |
|
Definition
| false (only basal cells or immature squamous metaplastic cells at the squamocolumnar junction |
|
|
Term
| How does HPV activate the mitotic cycle in squamous cells |
|
Definition
| interaction with p53 (via E6) and Rb (via E7). E6 and 7 induce centrosome duplication and genomic instability. Also, overexpression of p16, a cell cycle regulatory protein which interacts with Rb |
|
|
Term
| T/F Most HPV infections are asymptomatic and transient. |
|
Definition
|
|
Term
| How many HPV infections are cleared? |
|
Definition
| 50% within 8 months and 90% within 2 years |
|
|
Term
| What happens to low grade dysplasia of the cervix caused by HPV? which types cause it? |
|
Definition
| 6 or 11. Most regress spontaneously but some can progress to high grade lesions |
|
|
Term
| What HPV types cause high grade dysplasia? |
|
Definition
| HPV types 16, 18, 31, 33, 35 (high risk viral types) |
|
|
Term
| What is the single most important factor in cervical oncogenesis? |
|
Definition
|
|
Term
| Which strains of HPV cause the MOST cases of cervical cancer? |
|
Definition
|
|
Term
| What are risk factors for cervical cancer? |
|
Definition
| persistant high risk HPV infection, multiple sex partners, young age at first intercourse, high parity, immunosuppression, certain HLA subtypes, use of oral contraceptives, use of nicotine |
|
|
Term
| What is the histological appearance of cervical dysplasia? |
|
Definition
| increased N/C ratio with irreg nuclear borders, loss of basal polarity, mitotic figures and pleomorphism |
|
|
Term
| T/F Majority of cervical dysplasia does not pregress to cancer. |
|
Definition
| true (LGSIL 60% regress, 30% persist, 10% progress; HGSIL 30% regress, 60% persist, 10% progress) |
|
|
Term
| What is the most common histologic type of cervical cancer? |
|
Definition
| squamous cell carcinoma (80%) |
|
|
Term
| Is cervical squamous cell carcinoma exophytic or endophytic? |
|
Definition
|
|
Term
| What is the clinical presentation of squamous cell carcinoma? |
|
Definition
|
|
Term
| Metastatic cervical cancer is a stage____ |
|
Definition
|
|
Term
| How do you treat early invasive cervical carcinomas? |
|
Definition
|
|
Term
| How do you treat invasive cervical cancers? |
|
Definition
| hysterectomy with lymph node dissection; irradiation if advanced |
|
|
Term
| What is the survival rate for stage II and stage III cervical cancer? |
|
Definition
|
|
Term
| What is the survival rate for stage Ia cervical carcinoma? |
|
Definition
|
|
Term
| What is the survival rate for stage Ib cervical c/a? |
|
Definition
|
|
Term
| Most patients with stage IV cervical cancer die from.. |
|
Definition
| local extension (over distant mets) |
|
|
Term
| Pap test is a screening test for... |
|
Definition
| cervical dysplasia by looking at exfoliated cells from teh cervical transformation zone |
|
|
Term
| What is the false-negative error rate for pap tests? |
|
Definition
|
|
Term
| Who should be given a pap test |
|
Definition
| begining at 21 yoa, every 2 years. After age 30, woman with 3 consecutive normal paps can be screened every 3 years |
|
|
Term
| Managment of a patient with ASCUS? |
|
Definition
| HPV testing if over 21; if under 21, repeat pap at 12 months |
|
|
Term
| Treatment for pat who has ASCUS and is HPV+? |
|
Definition
|
|
Term
| Patient who has ASCUS and is HPV-? |
|
Definition
|
|
Term
| How do you treat a patient with ASC-H or HGSIL? |
|
Definition
|
|
Term
| How do you treat patients with LGSIL? |
|
Definition
| if adolescent (<21) repeat pap at 12 months. Every else gets a colposcopy |
|
|
Term
| What percent of malignant cervical tumors are adenocarcinomas? |
|
Definition
|
|
Term
| T/F Adenocarcinomas is associated with HPV. |
|
Definition
|
|
Term
| What is the behavior/ appearance of adenocarcinomas of the cervix? |
|
Definition
| well-differentiated and mucin producing |
|
|
Term
| What strains of HPV do the HPV vaccines protect against? |
|
Definition
Gardasil= 6,11,16, and 18
Cervarix= 16, 18 |
|
|
Term
| What is the mean age of adenocarcinomas of the cervix? |
|
Definition
|
|
Term
| What are the components of the uterine corpus? |
|
Definition
endometrium= glandular epithelium consisting of functionalis (hormonally responsive and shed) and basalis (deepest 13 of the endometrium from which the endometrium regenerates)
Myometrium= smooth muscle layer |
|
|
Term
| Describe the proliferative phase of the menstrual cycle? |
|
Definition
| first 14 days when the functionalis "proliferates"= glands change from tubular to coiled and stroma becomes more cellular; mitoses everywhere |
|
|
Term
| Describe the secretory phase? |
|
Definition
| starts approximately day 14 (ovulation). Under the influence of the corpus luteum which produces progesterone. Subnuclear vacuoles appear in the endometrial glands and then move to a supranuclear location and eventually secretions are seen in the glandular lumen. Stroma undergoes predicidual change (cells appear plump) |
|
|
Term
| What happens during the menstrual cycle? |
|
Definition
| degeneration of the corpus luteum results in decreased progesterone, collapse of spiral arteries within the endometrium and disintegration of the endometrium |
|
|
Term
| What are the endometrial changes associated with pregnancy? |
|
Definition
| HCG produced by the trophoblast sustains the corpus luteum and there is an increased production of progesterone which has a hypersecretory effect on the endometrium. |
|
|
Term
| What is the Arias Stella reaction? |
|
Definition
| hypersecretory glands in gestational endometrium with nuclear atypia exhibiting enlargement, hyperchromasia, and irregularity |
|
|
Term
| What are well-defined organic conditions that cause abnormal uterine bleeding |
|
Definition
| endometrial polyp, chronic endometritis, leiomomas, endometrial neoplasm |
|
|
Term
| What causes dysfunctional uterine bleeding with no identifiable underlying organic abnormality? |
|
Definition
| anovulatory cycle is the MC cause and happens commonly at menarche and perimenopausal period due to subtle hormone imbalances, endocrine d/os, primary ovarian lesion, or generalized metabolic disturbances. Endometrial glands show mild architectural changes and is usually self limited with the occurrence of the next ovulatory cycle. May undergo unscheduled breakdown (anovulatory menstruation) |
|
|
Term
| What causes acute versus chronic endometritis? |
|
Definition
acute= an ascending infection (abortion, postpartum, medical instrumentation)
chronic= IUD, PID, retained products of conception, tuberculosis |
|
|
Term
|
Definition
| endometrial glands and stroma outside the uterine corpus |
|
|
Term
| Where is endometriosis located? |
|
Definition
| MC is ovaries (80%), adnexa, uterine, ligaments, pelvic peritoneum, laparotomy scars, bowel |
|
|
Term
| What causes endometriosis? |
|
Definition
| several theories: retrograde menstrual implantation, vascular or lymphatic dissemination, endometrial metaplasia |
|
|
Term
| What is a chocolate cyst? |
|
Definition
| an ovary with cyst due to endometriosis |
|
|
Term
| What are the clinical symptoms of endometriosis? |
|
Definition
| dyspareunia, dysmenorrhea, pelvic pain, infertility |
|
|
Term
| What is adenomyosis? How common is it |
|
Definition
| presence of endometrial glands and stroma deep into the myometrium. Present in 20% of uteri and glands my cycle with the endometrium resulting in menstrual pain |
|
|
Term
| What is an endometrial polyp? Who get's them? |
|
Definition
| benign sessile mass projecting into the endometrial cavity that can be solitary or multiple and is most commonly perimenopausal. |
|
|
Term
| What is the presentation of endometrial polyp? |
|
Definition
|
|
Term
| What controls the growth of endometrial polyps? |
|
Definition
| responsive to estrogen but little or no progesterone response. Tamoxifen has weakly estrogenic effects in the endometrium (despite having antiestrogen effects in teh breast) and is associated with endometrial polyps |
|
|
Term
| What is clinically significant about endometrial polyps? |
|
Definition
| rarely an adenocarcinoma may develop |
|
|
Term
| What is endometrial hyperplasia? |
|
Definition
| increase in endometrial glands relative to stroma |
|
|
Term
| What causes endometrial hyperplasia? |
|
Definition
secondary to exogenous/endogenous estrogen (endogenous estrogen d/t things like anovulatory cycles, polycystic ovaries (PCO), estrogen producing tumors, obesity)
also, genetic changes to the endometrium |
|
|
Term
| What are the common genetic changes of endometrial hyperplasia and why are they significant? |
|
Definition
| PTEn tumor suppressor gene inactivation occurs in >20% of hyperplasia and 30-80% of carcinomas |
|
|
Term
| What are the four major categories of endometrial hyperplasia? |
|
Definition
| simple hyperplasia without atypia, simple hyperplasia with atypia, complex hyperplasia without atypia, complex hyperplasia with atypia |
|
|
Term
| Simple hyperplasia without atypia |
|
Definition
minimal gland complexity with cystic dilatation, mild glandular crowding
Uncommonly progresses to endometrial adenocarcinoma (~1%) |
|
|
Term
| Simple hyperplasia with atypia |
|
Definition
| uncommon lesion with nuclear atypia characterized by loss of nuclear polarity with rounded nuclei, open chromatin, and conspicuous nucleoli. 8% progress to adenocarcinoma |
|
|
Term
| Complex hyperplasia without atypia |
|
Definition
| severe gland complexity (branching) and crowding with loss of intervening stroma (~3% progress to adenocarcinoma) |
|
|
Term
| Complex hyperplasia with atypia |
|
Definition
| ~23-48% of women have carcinoma in teh hysterectomy specimen |
|
|
Term
| What is the most frequent female genital cancer in the US? |
|
Definition
| endometrial adenocarcinoma |
|
|
Term
| What is the typical age of a patient with endometrial adenocarcinoma |
|
Definition
| 55-65 year old women (postmenopausal) |
|
|
Term
| How does endometrial adenocarcinoma present? |
|
Definition
| post menopausal bleeding (endometrial cancer until proven otherwise) |
|
|
Term
| Which type of endometrial adenocarcinoma is most common? |
|
Definition
|
|
Term
| At what age does endometrial adenocarcinoma type I occur? |
|
Definition
|
|
Term
| Endometrial adenocarcionoma type I arises in the setting of... |
|
Definition
| endometrial hyperplsaia and unopposed estrogen; assoc. with atypical hyperplasia PTEN gene mutations, and microsatellite instability |
|
|
Term
| How does endometrial adenocarcinoma type I look like on light microscopy? |
|
Definition
| carcinoma associated with hyperplasia tends to be well-differentiated mimicking normal endometrial glands (endometrioid carcinoma) |
|
|
Term
| What is the behavior of type I endometrial adenocarcinoma? |
|
Definition
| generally indolent with direct extension and lymphatic spread |
|
|
Term
| What percent of endometrial adenocarcinomas are type II? |
|
Definition
|
|
Term
| Endometrial adenocarcinomas type II arise in the setting of... |
|
Definition
|
|
Term
| What is the typical age group that gets endometrial adenoc/a type II? |
|
Definition
|
|
Term
| What does endometrial adenoc/a look like on light microscopy? |
|
Definition
| poorly diffentiated tumors (serous carcinoma, clear cell carcinoma) |
|
|
Term
| What mutations are endometrial adenoc/a type II associated with? |
|
Definition
|
|
Term
| What is the precursor lesion of endometrial adenoc/a type II? |
|
Definition
| endometrial intraepithelial carcinoma |
|
|
Term
| What is the behavior of endometrial adenocarcinoma type II? |
|
Definition
| agressive tumors with intraperitoneal metastasis commonly seen (poorer prognosis) |
|
|
Term
| Name a carcinosarcoma of the endometrium? |
|
Definition
| malignant mixed mullerian tumor |
|
|
Term
| What patient population/setting does malignant mixed mullerian tumor arise in? |
|
Definition
| rare, postmenopausal women, 10% have a history of prior radiation exposure |
|
|
Term
| histology of malignant mixed mullerian tumor= |
|
Definition
| both carcinomatous elements and sarcomatous elements |
|
|
Term
| What is the gross appearance of carcinosarcoma? |
|
Definition
| polypoid growth usually arising from posterior uterine fundus |
|
|
Term
| What is the survival rate of malignant mixed mullerian tumor? |
|
Definition
|
|
Term
| What are the stages of malignant mixed mullerian tumor? |
|
Definition
| I= confined to u corpus; II- corpus + cervix; III= not outside of true pelvis; IV= outside of true pelvis or involves mucosa of the bladder or rectum |
|
|
Term
| What age group gets endometrial stromal sarcoma? |
|
Definition
| middle aged women (~45 yoa) |
|
|
Term
| How does endometrial stromal sarcoma present? |
|
Definition
| vaginal bleeding or pelvic pain |
|
|
Term
| What is the appearance of endometrial stromal sarcoma? |
|
Definition
| neoplastic endometrial stroma lying between muscle bundles of the myometrium |
|
|
Term
| What enhances the growth of a leiomyoma? |
|
Definition
|
|
Term
| What is the gross appearance of a leiomyoma? |
|
Definition
| well circumscribed, white, worled nodules, |
|
|
Term
| What is the histological apperance of a leiomyoma? |
|
Definition
| interlacing fascilcles of spindled cells (smooth muscle) arranged in whorls |
|
|
Term
| What are the three locations of leiomyomas and their presentations? |
|
Definition
submucosal= may present with bleeding
intramural= usually asymptomatic
subserosal= may undergo torsion |
|
|
Term
| What is age group of a leiomyosarcoma? |
|
Definition
| older women (avg= 54 yoa) |
|
|
Term
| Leiomyosarcomas arise from... |
|
Definition
| nothing, they are de novo |
|
|
Term
| Gross appearance of a leiomyosarcoma- |
|
Definition
| bulky fleshy mass invading the uterine wall or as polypoid masses projecting into the uterine lumen |
|
|
Term
| How do you diagnose leiomyosarcoma? |
|
Definition
| based on mitotic activity, cellularity and nuclear pleomorphism |
|
|
Term
| How/where do leiomyosarcomas spread? |
|
Definition
| >1/2 metastasize to lungs, bone, and brain (hematogenously) |
|
|
