Dd&t2 Cervix, Vagina, Vulva

Front 1

What is it called when the squamous epithelium closes off a gland?

Back 1

Nabothian cyst

Front 2

When is acute cervicitis seen?

Back 2

STIs

Front 3

When does chronic cervicitis occur?

Back 3

Menarchal hormonal and chemical changes favor growth of endogenous microorganisms, such as lactobacillus

Front 4

What does chronic cervicitis look like?

Back 4

Chronic inflammatory infiltrate with epithelial injury and repair occurs, leading to squamous metaplasia at transformation zone and secondary endocervical gland obstruction (nabothian cysts)

Front 5

Endocervical polyp: symptoms?

Back 5

Bleeding
False atypia on pap smear

Front 6

Condyloma: epi? caused by? gross appearance? prognosis?

Back 6

Most common benign epithelial tumor of CVV

Caused by sexually transmitted HPV (types 6 and 11)

Distinct verrucous gross appearance, often multiple

Not considered premalignant in absence of significant dysplasia

Front 7

Histopathology of condyloma.

Back 7

Composed of arborizing epithelium supported by fibrovascular stroma, characterisitic koilocytes (perinuclear halos, hyperchromasia)

Front 8

CIN: what is it?

Back 8

Spectrum of abnormal/premalignant squamous maturation (dysplasia)

Front 9

What is the etiologic agent of CIN?

Back 9

HPV (16, 18, 31, 33)

Front 10

What increases the risk of CIN?

Back 10

Increasing number of sexual partners
Earlier age of onset of sexual activity
Promiscuity of the male partner
Smoking, high parity, other factors

Front 11

HPV: sx?

Back 11

DS-DNA non-enveloped virus

Front 12

HPV: two groups

Back 12

Based on risk for cancer

Low risk: 6, 11, 42, 44 (condyloma)
High risk: 16, 18, 31, 33 (dysplasia, carcinoma)

Front 13

HPV: what does it infect?

Back 13

Infects basal cells of mature squamous epithelium or metaplastic squamous epithelium in transformation zone

Front 14

HPV: what occurs after infection?

Back 14

Can be
cleared
remain latent
produce a productive infection with morphologic abnormalities like CIN

Front 15

How are preinvasive lesions graded?

Back 15

% of epithelial thickness that is atypical (CIN I-III, cytology)

Front 16

What determines the likelihood of progression to a high grade lesions of CIN?

Back 16

Immune status
Smoking

Front 17

What are the majority of abnormals in pap tests?

Back 17

Atypical squamous cells of undetermined significance (ASCUS)

Front 18

How common is an abnormal pap test?

Back 18

More than 90% are normal

Front 19

What happens once an ASCUS is obtained on a pap test?

Back 19

HPV test
Subset - colposcopic examination, based on established guidelines

Front 20

What is the biggest difference between LSIL and HSIL?

Back 20

LSIL - no change in NC ratio
HSIL - increase in NC ratio

Front 21

What is the most common cancer in women worldwide?

Back 21

Squamous cell carcinoma of the cervix

Front 22

SCC of the cervix: age? etiology?

Back 22

40-45 years

Oncogenic HPV - 16, 18, 31, 33 (most by 16)

Front 23

What are most SCC of the cervix associated with?

Back 23

HGSIL
Long pre-invasive period

Front 24

Clinical manifestations of SCC of the carcinoma.

Back 24

Localized: bleeding, discharge
Dyspareunia
Dysuria

Advanced: urinary obstruction
Manifestations of metastases

Front 25

Adenocarcinoma of the cervix: epi? etiologic agent? precursor lesions? prognosis?

Back 25

15% of cervical carcinomas
HPV 18
Adenocarcinoma in-situ
May have slightly worse prognosis than SCCA

Front 26

How does cervical carcinoma spread?

Back 26

Local extension

Front 27

What is the most important prognostic factor for cervical carcinoma?

Back 27

Stage

Front 28

What cancer is associated with DES exposure in utero? What is DES?

Back 28

Clear cell adenocarcinoma

Synthetic nonsteroidal estrogen

Front 29

SCC of the vagina: location? epi?

Back 29

Must not involve the cervix or vulva to be classified as vaginal

Represents 80 to 90% of primary vaginal cancers, but only 1% of all malignancies of the female genital tract

Front 30

What cancer is in young girls and looks like red, grape-like clusters?

Back 30

Embryonal rhabdomyosarcoma

Front 31

Vulvar leukoplakia: what is it? what is it caused by? how is this determined?

Back 31

White, scaly, plaque-like lesions

Caused by variety of inflammatory and neoplsatic disorders
Dermatoses
Squamous hyerplasia
Condyloma, etc.

Biopsy is necessary

Front 32

Lichen sclerosus: etiology? who? appearance?

Back 32

Unknown

Postmenopausal

Atrophy, fibrosis/scarring
Pain, pruiritis

Front 33

SCC of the vulva: epi? precursor lesions? prognosis depends on?

Back 33

Most common malignant tumor of the vulva

VIN

Stage

Front 34

What are the 2 clinicopathologic types of SCC of the vulva?

Back 34

30%: high risk HPV, younger women, often multifocal
70%: not HPV, older women, p53 mutations, worse prognosis

Front 35

What is Paget's disease?

Back 35

Intra-epithelial adenocarcinoma

Front 36

Paget's disease: where? symptoms? progression?

Back 36

Labia majoria

Pruritic

Infrequent association with underlying adenocarcinoma. May progress and invade the dermis: invasive Paget's