Endometriosis; Path Of Cervix, Vul, Vag

Front 1

endometriosis: defn

Back 1

presence of endometrial tissue found outside of uterine cavity

Front 2

What kind of receptors does ectopic endometrium have?

Back 2

progesterone and estrogen, so it responds to hormonal stimulation with proliferative, secretory and menstrual changes

Front 3

What is the retrograde menstruation theory?

Back 3

That there is direct implantation of endometrial cells on extrauterine sites. This is the most important theory.

Front 4

Most common sx associated with endometriosis

Back 4

pain

Front 5

What other signs and sx are associated with endometriosis?

Back 5

Dysmenorrhea
Chronic pelvic pain
dyspareunia
back pain
adnexal pain
infertility
GI and UT problems
Combo of all or some

Front 6

adnexa of uterus : what is it?

Back 6

efers to the structures most closely related structurally and functionally to the uterus.

Generally the fallopian tubes, ovaries, and supporting tissues.

Front 7

Prevalence of endometriosis: General population

Back 7

7-10% (seen a lot incidentally even when asymptomatic)

Front 8

What are signs of endometriosis on PE?

Back 8

1) Tenderness to palpation (on bimanual exam)

2) Adnexal mass - tender, may be fixed or mobile

3) Nodularity in cul-de-sac or uterosacral ligaments

4) Retroverted, fixed uterus

5) Decreased uterine mobility

Front 9

What single thing is pathognomonic for endometriosis?

Back 9

NOTHING.

Front 10

Only definitive metho of establishing dx of endometriosis

Back 10

Surgical : biopsy

Front 11

What role does pelvic ultrasound play in ealuation of endometriosis?

Back 11

Good for assessing female pelvic anatomy, but will only identify LARGE lesions, not small implants or scarring.

Ovarian endometriomas have a characteristic homogenous and echogenic pattern.

Front 12

T/F The gross appearance correlates with sx severity in endometriosis

Back 12

F

Front 13

Most common location of endometriosis implants

Back 13

ovarian surface

Front 14

What is a chocolate cyst?

Back 14

When there is endometriosis of the ovary. It's due to growing and shedding with subsequent cycles (congealed blood looks like chocolate).

The closest thing to a pathognomonic lesion

Front 15

To make a bx proven dx of endometriosis, what must one see in the biopsy?

Back 15

1) Endometrial glands AND stroma
2) Hemosiderin-laden macrophages
3) May also be positive for estrogen and prog.

Front 16

How is endometriosis staged?

Back 16

Using a point system similar to cancer staging based on presence of implants, adhesions, endometriomas, and anatomic distortion.

Front 17

What is the relationship between endometriosis and fertility?

Back 17

Endometriosis is associated with infertility due to distortion of fallopian tubes with scar tissue in severe cases,

but in mild disease, the reason of infertility is less clear, may be related to problems with fertilization or implantation.

Front 18

What must always be ruled out in differential dx of endometriosis?

Back 18

pregnancy

Front 19

About ______ get better spontaneously from endometriosis

Back 19

1/3

Front 20

First line tx of endometriosis

Back 20

Ovarian suppression: with oral contraceptives, progestins, and NSAIDS (block prostaglandins)

Front 21

How are GnRH agonists used in endometriosis?

Back 21

Down regulates the pituitary production of FSH and LH by interfering with the normal pulsatile secretion of GnRH by the hypothalamus
Creates a hypo estrogenic state similar to menopause

Can only use for about 6 months because it induces menopause.

Front 22

CA-125: how does it related to endometriosis?

Back 22

It's a tumor marked that is sometimes elevated. Poor specificity.

Front 23

T/F Pain severity correlates to anatomic “stage” of disease.

Back 23

F

Front 24

adenomyosis: defn

Back 24

endometriosis of the myometrium
(adeno means glands, myosis is in muscle)

Front 25

What are "gunpowder" lesions?

Back 25

endometriosis in soft tissue

Front 26

What is a bartholin cyst?

Back 26

obstruction of the bartholin gland's duct. An enlarged unilateral lesion that occurs in women of reproductive age.

Front 27

What is a complicated bartholin cyst?

Back 27

One that has a bacterial infection, abscess formation and pus
draining from the gland and the
vagina.

Front 28

Condyloma is associated with HPV __ and ___

Back 28

6 and 11

Front 29

What part of the genital tract does HPV infect?

Back 29

The lower genital tract: vulva, vaginal canal, cervix

Front 30

High risk HPV types

Back 30

16, 18 (also 31, 33)

Front 31

What is Lichen Sclerosis?

Back 31

A THINNING of the epidermis and fibrosis of the dermis.

Has leukoplakia.

Vulva is parchment-like: thin, feels like paper

Front 32

In what patients does Lichen Sclerosis occur?

Back 32

older, post menopausal

Front 33

T/F Neither lichen sclerosis nor lichen simplex chronicus is associated with increased cancer risk

Back 33

F. Lichen sclerosis is associated with a slightly increased risk of Squamous cell C.

Front 34

What is lichen simplex chronicus ?

Back 34

Aka squamous hyperplasia.

THICKENING of the epidermis.

Skin is leather like.

Due to chronic irritation and scratching.

It's the opposite of lichen sclerosis

Front 35

WHat is koilocytic change?

Back 35

Nucleus of an HPV infected cell looks like a crinkled raisin.

Front 36

Clinical presentation of vulvar Paget's disease

Back 36

Pruritic, scaly, red lesions on the vulva
–
Usually postmenopausal women

Front 37

What is in the differential for vulvar Paget's disease?

Back 37

also melanoma (because it's another malignant epithelial cell)

Front 38

What is the significance of a tumor cell being PAS+?

Back 38

It is a marker for mucus. ONLY carcinoma (not melanoma or sarcoma, etc) makes mucus.

Front 39

What is the significance of a tumor cell being keratin +?

Back 39

ONLY carcinoma

Front 40

What is the significance of a tumor cell being S100+?

Back 40

Only melanoma

Front 41

How will the melanoma and carcinoma differ regarding:


PAS and keratin

Back 41

Carcinoma is PAS+ and Keratin +

Melanoma is negative

Front 42

How will the melanoma and carcinoma differ regarding:

S100?

Back 42

Melanoma is S100+
Carcinoma is negative.

Front 43

Intraepithelial proliferation of malignant cells (large, round glandular cells)

Back 43

Paget disease

Front 44

Paget’s cells will stain positively for ____ and ____, while melanoma cells will not stain for either marker.

Back 44

CEA and mucin

Front 45

tumor tissue derived from putative epithelial cells whose genome has become altered or damaged to such an extent that the cells become transformed, and begin to exhibit abnormal malignant properties.

Back 45

carcinoma

Front 46

Vulvar Squamous Cell Carcinoma: What patients?

Back 46

postmenopausal (>60)

Front 47

Vulvar Squamous Cell Carcinoma: two types

Back 47

1) HPV-related (basaloid/warty) : from vulvar intraepithelial neoplasia (VIN)

2) Non-HPV related: from long-standing lichen sclerosis (VIN simplex)

Front 48

What is differnce between VIN simplex and VIN?

Back 48

VIN: classic vulvar intraepithelial neoplasia related to high risk HPV

VIN simplex: differentiated vulvar intraepithelial neoplasia (VIN)

Front 49

Histological features of classical VIN

Back 49

cellular epithelium,
thickening, lack of complete maturation, individual cell atypia, mitosis

Front 50

Vaginal adenosis: defn

Back 50

Remnant of columnar edocervical epithelium that persists (normally it's in the upper 1/3 of vagina and gets replaced by squamous over time)

Occurs more often in women exposed to DES in utero

Front 51

Vaginal adenosis: what cancer are they most predisposed to?

Back 51

Clear cell adenocarcinoma

Front 52

Embryonal rhabdomyosarcoma: defn

Back 52

tumor of muscle protruding from vagina or bladder. Will see fleshy or grape-like protrusions

Front 53

In what part of the cervix does cancer occur?

Back 53

In the transformation zone (squamocolumnar jxn) between exo and endocervix

Front 54

What are the proteins that high risk HPV produces?

Back 54

E6 and E7

Front 55

What does E6 do?

Back 55

It's a protein produced by high risk HPV.

It knocks out p53. (p53 is tumor suppressor protein that regulates G1->S phase movement and induces apoptosis if there is too much DNA damage in cell before it can replicate DNA).

Front 56

What does E7 do?

Back 56

It's a protein produced by high risk HPV.

It knocks out Rb. Rb normally holds onto E2F, which is a protein necessary for progression in cell cycle. When Rb isn't holding onto E2F, the cell cycle can progress unchecked.

Front 57

T/F CIN has the potential to reverse

Back 57

T. Only Carcinoma in situ cannot reverse.

Front 58

What %age of CIN I, II and III spontaneously reverse?

Back 58

CIN I : 66%
CIN II: 33%
CIN III: rare

Front 59

How does cervical carcinoma present clinically?

Back 59

As vaginal or post-coital bleeding.

Front 60

What are secondary risk factors for cervical cancer?

Back 60

Smoking

Immunodeficiency (cervical cancer is an AIDS-defining illness)

Front 61

What are the two types of cervical cancer?

Back 61

Squamous cell (most common)
Adenocarcinoma

Front 62

Which of the two types of cervical cancer are detected by Pap smear?

Back 62

Squamous cell

Front 63

Which of the two types of cervical cancer are associated with HPV?

Back 63

BOTH

Front 64

If cervical cancer invades the bladder, what can be a complication?

Back 64

hydronephrosis --> kidney failure

Front 65

Goal of Pap smear

Back 65

Catch dysplasia before it develops into carcinoma

Front 66

What must a pap smear be followed by?

Back 66

Confirmatory colposcopy and biopsy

Front 67

Limitations of pap smear

Back 67

inadequate sampling can result in false negatives (if you don't get the transformation zone).

Limited efficacy of adenocarcinoma.

Front 68

Predisposing factors for Candida infection

Back 68

Pregnancy
–
Diabetes mellitus
–
Recent antibiotics
–
Immunosuppression (e.g. AIDS, chemotherapy)
–
Oral contraceptives

Front 69

T/F HSV is not symptomatic on the cervix

Back 69

T

Front 70

ground glass appearing nuclei are characteristic of what?

Back 70

HSV infected cells

Front 71

What is seen on microscopic pap smear in Herpes?

Back 71

Enlarged infected epithelial cells
–
Multinucleated ground glass nuclei
–
Red-purple intranuclear inclusions

Front 72

When is herpes infection dangerous to find in a Pap smear?

Back 72

This is a dangerous infection when found in a Pap smear in pregnancy or near term. Woman MUST have C section because infection can kill baby.

Front 73

What does CIN look like on colposcopy?

Back 73

Areas of white epithelium
–
Abnormal blood vessels (mosaic)

Front 74

Which HPV type is most associated with adenocarcinoma?

Back 74

18

Front 75

What are cellular changes that can be ID'd on Pap smear that indicate need for colposcopy?

Back 75

Increase in nuclear size
Decrease in amount of cytoplasm
Increased nuclear to cytoplasmic ratio
Coarsening of nuclear chromatin
Changes produced by HPV

Front 76

What does ASCUS/AGUS mean in a Pap smear result?

Back 76

atypical squamous cells of undetermined significance.

It's a gray zone where cells look dysplastic but don't fulfill criteria for Low Grade Squamous Intraepithelial lesion (LGSIL/HPV)

Front 77

What does LGSIL/HPV mean in a Pap smear result?

Back 77

Low Grade Squamous Intraepithelial lesion