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24 Cards in this Set
- Front
- Back
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What is Lichen Schlerosis (aka Chronic Atrphic Vulvitis)?
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One form of vulvar dystrophy (disorder of epithelial growth that presents with white, patch-like lesion)
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What is the visual characteristics of Lichen Schlerosis? (3)
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1. skin is gray and parchment-like with labial atrophy (thin and shiny)
2. Micro: thin epidermis with loss all cells 3. Dermis replaced with fibrous tissue and "band-like" lymphocytes. |
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What is Lichen Simplex Chronicus?
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Another non-neoplastic vulvar epithelial disorder with an exaggerated labia minora and majora; has acanthosis and hyperkeritosis along with prescense of lymphocytic infiltrate.
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Compare the appearances of Lichen Simplex Chronicus to Lichen Schlerosis:
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Lichen Simplex Chronicus: enlarged labia majora and minora
Lichen Schlerosis (opposite): flattened out, atropic appearance. |
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What are two neoplastic vulvar epithelial disorders?
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1. condyloma acuminatum (veneral wart) - caused by HPV 6 and 11
2. Vulvar intraepithelial neoplasia (VIN) - caused by HPV 16 and 18. VIN is often a predesecor to Squamous cell CA. Mnemo: my VIN #1618 and if you got a wart dial 611! |
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How do HPV #'s correlate to the risk of obtaining CA?
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The lower the number the lower the risk.
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What is VIN (vulvar intraepithelial neoplasia) correlate with in the cervix?
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HSIL - high grade squamous _____
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Describe the appearance of a vulvar condyloma:
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It has a unique look (like hemorrhoids around vuvla); can see koilocyte changes (so you know its caused by an HPV infection). And can see a halo around the koilocytes.
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What preceeds squamous cell CA of the vulva?
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One of two types of VIN (vulvar intraepithelial neoplasia)
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What is the age group for developing squamous cell CA of the vulva?
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2/3rd are > 60yo
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Describe extramammary Paget's disease:
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1. It can occur in the vulva
2. Gross: red, pruritic, maplike, sharply demarchated on labia majora 3. Micro: large, pale Paget cells in small clusters. 4. Cells found at dermal/epidermal junction |
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What are Gartner duct cysts?
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A vaginal congenital abnormalities that is a result of a Wolffian duct.
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What does vaginal adenosis look like?
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Glandular epithelium present in the vaginal mucosa causes the formation of red areas next to nL pink vaginal mucosa.
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VIP
What is the main cause of vaginal adenosis? |
the use of Diethylstilbestrol (DES) in mothers for attempted abortion -- daughters get vaginal adenosis.
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What CA does DES exposure cause?
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Adenocarcinoma (ID by presence of clear glycogen rich cytoplasm) - seen in the upper 1/3 of vaginal wall
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VIP
What is a Rhabdomyosarcoma? |
It is a rare tumor in infants and girls < 5yo. They are grapelike, fill, and protrude out of the vagina.
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VIP
What is the transitional/transformation zone of cervix? Why is it so important? |
The region of endocervical canal that immediately follows the squamo-columnal junction (just before basal cells)
This is where cervical dyplasia arises!! |
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What causes acute and chronic cervicitis?
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Estrogen production from ovaries stimulates squamous cells to take up glycogen and mature.
Mature cells shed and glycogen is released and it produces a drop in pH. Cervix responds to this drop by squamous metaplasia in transformational zone. Squamous epi than can cover crypt opennings = cervicitis |
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VIP
What are two risk factors for Cervical Intraepithelial Neoplasia? |
1. multiple sexual partners
2. high-risk HPV types |
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What HPV types form condylomas over CIN I (Cervical intraepithelial neoplasia)?
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Condyloma: HPV 6 and 11
Flat CIN I: HPV 16, 18 |
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VIP
What is the mechanism of HPV? |
Viral oncogenes (E6 and E7) of high-risk types can disrupt the cell cycle and enhance DNA synthesis.
E6 = inhibit p53 (tumor suppressor)by binding to it to increase its degradation E7 = binds to RB gene and upregulates Cyclin E and p16 INK 4. |
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What is a condyloma (cervix) a precursor to?
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Cervical cell dysplasia
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VIP!
What do condylomas look like? What does CIN I look like? II/III? |
Condylomas = plaque on cervix
CIN I = flat lesions with koilocytes with punctations on the cervix. Cells with large "clear zone". CIN II - cells have variable nuclear size and loss of cell polarity, hyperchromastia and atypical mitoses CIN III - full thickness atypia and loss of surface differentiation with atypical mitotic figures -mosaic pattern on cervix |
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Define staging of cervical cancer:
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Stage o - CIN III (carcinoma insitu)
Stage 1 - carcinoma confined to cervix Stage 2 - extends beyond cervix but not to the pelvis wall. Involves vagina but not lower 1/3 Stage 3 - extends to pelvic wall. No free CA space between tumor and rectal wall and involves lower 1/3 of vagina. Stage 4 - extends beyond true pelvis or involves bladder/rectal mucosa |
