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35 Cards in this Set
- Front
- Back
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Trichomonas infection characteristics
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Flagellated protozoan; identify on Pap smear or in “wet mount”
--Discharge, dysuria,dyspareunia |
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Chlamydia trachomatis-sexuallty transmitted infection characteristics
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May lead to ascending infection of uterus and fallopian tubes, causing Pelvic Inflammatory Disease (PID) and infertility
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What is a bartholin cyst?
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Cystic dilation of the bartholin glands due to obstruction. Arises in women of reproductive age
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What is the bartholin cyst presentation?
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Unilateral painful cystic lesion at the lower vestibule adjacent to the vaginal canal
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Characterized by thining of the epidermis and fibrosis (sclerosis) of the dermis and looks like a white patch (leukoplakia) with parchment
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Lichen sclerosis
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Who gets linchen sclerosis?
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in postmenopausal women. -NOT premalignant but LS patients have an increased risk of developing a form of vulvar cancer
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Characterized by hyperplasia of the vulvar squamous epithelium and thick leukoplakia and leathery vulvar skin
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Lichen simplex chronicus
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Who gets lichen simplex chronicus?
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Post menopausal women possibly due to immune problems. It is bening and no increase risk for squamous cell cancer
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Warty neoplasms of the vulvar skin and under the microscope there is :”spiky” proliferation with koilocytotic (koilo =halo) change; enlarged irregular nucleus with perinuclear halo
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Condyloma accuminatum
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Condyloma accuminatum usually caused by
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by low oncogenic risk HPV 6 and 11; NOT precancerous
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Vulvar Intraepithelial Neoplasia (VIN)-atypia of the epidermal layer but NO INVASION
--Two forms |
Classic (“Bowen’s Disease)and Differentiated
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reproductive-aged women, associated with high oncogenic risk HPV infections (esp. HPV 16),
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Classic VIN, may be multicentric, may regress; may progress to “basaloid” or “warty” invasive squamous cell carcinoma; full thickness of epidermis demonstrates immature atypical cells with mitoses
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Differentiated VIN who gets it?
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older women (mean age=76), often have long-standing LS, unassociated with HPV;
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Differentiated VIN progression
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frequently progresses to invasive squamous cell carcinoma (“differentiated” type); atypia most pronounced in basal layer but cells above basal layer appear to “mature”;p53 mutations may play a role
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Invasive Squamous Cell Carcinoma of the Vulva Risk of metastasis is related to
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to tumor size, depth of invasion, involvement of lymphatic vessels
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Pruritic eczematoid lesion under the microscope it looks like Large, atypical pale cells in epidermis (“shotgun pattern”);
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Extramammary Paget Disease. Usually UNassociated with an invasive carcinoma
--Wide local excision is performed; frequent recurrences |
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Extramammary Paget Disease how does it arise?
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Adenocarcinoma in situ of the vulva”-probably arises from precursor cells in mammary-like gland ducts of vulvar skin
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Extramammary Paget Disease must be differentiated from
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vulvar melanoma
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-a Chicago story: connection between DES, adenosis, and
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clear cell adenocarcinoma in young women who were DES daughters led to discontinuation of DES treatment
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presence of endocervical glandular epithelium in the vagina
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, vaginal adenosis which can transformed to clear cell carcinoma, a rare but fear malignancy
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Vaginal carcinoma arises from
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Squamous epithelial lining the vaginal mucosa related to high risk HPV
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The precursor lesion to vaginal carcinoma is
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Vaginal intraepithelial neoplasia
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Pediatric ( less than 5yo) sarcoma derived from primitive skeletal muscle cells
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Embryonal Rhabdomyosarcoma-“Sarcoma Botryoides” Botryoides means grapes. --Surgery and chemotherapy are needed
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HPV especially infects what part of the cervix?
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Transformation zone. where endocervical glandular epithelium undergoes squamous metaplasia
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The degree of cervical intraepithelial neoplasia is related to the HPV strain infecting cells
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High risk, HPV 16, 18., 31 and 33
Low risk, HPV 6 and 11 |
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What are the risk factors for cervical cancer?
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--Risk factors for cervical cancer are generally related to acquisition of high oncogenic risk HPV or alterations in immunity:
Multiple sexual partners, male partner with multiple previous or current sexual partners, young age at first intercourse, high parity,persistent infection with a high oncogenic risk HPV,immunosuppression,certain HLA subtypes,use of oral contraceptives,use of nicotine |
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Cervical intraepithelial neoplasia is characterized by
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Koiloeytic change, disorder cellular maturarion, nuclear atypia and increased mitotic activity within the cervical epithelium
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CIN is divided into 4 subcategories
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CIN 1=Less than 1/3 of the thickness of the epithelium
CIN 2=less than 2/3 of the thickness of the epithelium CIN 3=slightly less than the entire thickness of the epithelium Carcinoma in situ: entire thickness of the epithelium |
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Whats the progression of CIN?
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Usually step wise from CIN 1 to invasive carcinoma. However CIN 3 often regresses. The higher the grade of dysplasia, the more likely it is to progress to carcinoma and the less likely it is to regress to normal
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, HPV must reactivate the mitotic cycle in those cells; viral oncogenes are
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E6 and E7 interfere with Rb and p53 tumor suppressor genes and extend the lives of infected cells
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Investigation of abnormal Pap test may include
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colposcopy with cervical biopsy and endocervical curettage
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Cervical carcinoma is mostly seen in
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women 40-50. Presents as vaginal bleeding, especially postcoital bleeding or cervical discharge
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The risk factor for cervical carcinoma is
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high risk HPV infection; secondary risk factors include smoking and immunodeficiency
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A common cause of death due to cervical carcinoma is
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Hydronephrosis with postrenal failure due to blocking of the ureters after invasion through the uterine wall and into the bladder.
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Cervical carcinoma staging
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I-confined to cervix
II-beyond the cervix but not to the pelvic sidewall or lower third of vagina III-to pelvic sidewall or lower third of vagina IV-beyond the true pelvis, involving mucosa of bladder or rectum, metastatic --squamous cell carcinoma frequently fungating (exophytic); all forms may be infiltrative (“barrel-shaped cervix) |
