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92 Cards in this Set
- Front
- Back
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Where does the vagina start?
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at the introitus
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What casues the cervix and vagina to develop?
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maternal estrogen
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When is the vagina and ectocervix epithelialized?
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10th week of gestation
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What lines the vagina and ectocervix?
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non-keratinized stratified squamous epithelium
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What lines the endocervical canal?
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simple columnar, mucus-secreting epithelium
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What is the transformation zone?
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point at which the squamous and columnar epithelia meet
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Where is the transformation zone at birth?
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external os
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Where is the transformation zone during puberty?
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ectocervix
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Where is the transformation zone in adulthood?
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ectocervix
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What happens in chronic cervicitis?
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hormonal and chemical changes allow bacteria, etc to colonize the cervix and vagina, causes endocervical epithelium to be replaced by squamous epithelium
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What are Nabothian cysts?
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proliferating squamous epithelium obstructs subepithelial gland/crypt openings, results in mucus accumulation in deeper glands
associated with erosion of the epithelium and repair |
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What are the characteristics of chronic cervicitis?
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chronic inflammation, erosion/ulceration of epithelium, repair
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What is the prognosis of chronic cervicitis?
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generally asymptomatic, universal in reproductive age women
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What can cause acute cervicitis?
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chlamydiae, gonococci, mycoplasmas, HSV, trichomonas, candida
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What is the prognosis of acute cervicitis?
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can have greater clinical significance, acute inflammatory response
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What are endocervical polyps?
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neoplastic proliferations of fibrous stroma and endocervicalglands, usually small and solitary, can be multiple
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What are the complications of endocervical polyps?
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can cause bleeding, shed odd-looking cells, but actually innocuous
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How do you treat endocervical polyps?
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excision
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What is the most common benign cervical tumor?
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condyloma acuminatum
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What causes condyloma acuminatum?
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sexually transmitted, HPV-induced
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What HPV strains cause condyloma acuminatums?
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HPV 6 and 11
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What does a condyloma acuminatum look like grossly?
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verrucous, can be multiple
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What do condyloma acuminatum look like histologically?
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arborized proliferation of squamous epithelium, supported by fibrovascular stroma
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What is koilocytosis?
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production of viral particles in mature squamous cells, nuclear atypia, perinuclear cytoplasmic clearing
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What is the prognosis of condyloma acuminatum?
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spontaneous regression, not pre-malignant
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What is cervical intraepithelial neoplasia?
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non-invasive pre-malignant squamous proliferations related to HPV infection
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What are the risk factors for CIN?
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lifetime number of partners, age at first intercourse, number of current partners of the male partner
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What two factors affect CIN?
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HPV and smoking
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What ist he HPV?
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non-enveloped, dsDNA
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Which HPV have a high risk of progression to carcinoma?
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16, 18, 31, 33
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How does HPV work?
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E6 protein binds p53, accelerates its degradation
E7 binds Rb and displaces the transcription factors that Rb normally sequesters |
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Where does CIN occur?
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transformation zone
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What does CIN look like?
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squamous intraepithelial lesions which display abnormal maturation and nuclear atypia
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Upon what are the categories of CIN based?
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fraction of epithelial thickness involved, degree of immaturity, atypia, mitotic activity involved
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Which cervical cells does HPV infect?
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basal cells of metaplastic squamous epithelium
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What is required for HPV infection?
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mucosal tear/defect
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Upon what factors are CIN based on?
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fraction of epithelial thickness involved and degree of immaturity, atypia, mitotic activity of the involved cells
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What happens in CIN I?
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lowest 1/3 of eptihelium, maturation towards the surface, has koilocytes at the surface
most regress in immunocompetent hosts |
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What happens if CIN I lesions completely regress?
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no identifiable residual morphologic abnormality, can't see HPV DNA
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What happens if CIN I lesions regress partially?
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HPV DNA can be detected, may be a morphologic abnormality
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What happens in CIN II?
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disorganization and atypia ocupy lower 2/3rds, less koilocytosis present, decreasing maturation of infected squamous cells
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What is CIN III?
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abnormal squamous cells occupy the entire epithelial thickness, little or no maturation
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With what do high grade CIN lesions associate?
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oncogenic HPV types
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Which HPV strain is most associated with progression from CIN I to CIN III?
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HPV 16
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With which HPV strain is progression of intraepithelial lesions to invasive carcinoma associated?
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HPV 18
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How are high grade lesions treated?
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excising the transformation zone
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How are low grade lesions treated in young women?
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followed clinically without treatment
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What are the symptoms of cervical cancer?
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irregular vaginal bleeding, vaginal discharged, dyspareunia, dysuria, urinary obstruction
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What do squamous cell carcinomas look like histologically?
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exophytic or ulcerous, well-differentiated, comprised of large cells, with or without keratin
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How does cervical carcinoma spread?
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local extension into adjacent pelvic structures, involves iliac and para-aortic and distant notes
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Upon what does the prognosis of cervical carcinoma depend?
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stage at diagnosis
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What are the treatment modalities for cervical carcinoma?
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surgery and radiation
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How does cervical carcinoma cause death?
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complications of local extension, urinary obstruction, uncontrollable vaginal bleeding
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What causes adenocarcinoma of the cervix?
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HPV 18
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What is the prognosis of adenocarcinoma in situ?
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worse than for squamous cell, more early/distant mets
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Who gets benign tumors of the vagina?
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reproductive-age women
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What types of tumors occur in the vagaina?
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leiomyoma, hemangioma, rhabdomyoma, stromal polyps
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What causes most squamous cell carcinoma of the vagina?
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HPV infection
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What is the greatest risk factor for squamous cell carcinoma of the vagina?
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previous carcinoma of the cervix or vulva
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How does squamous cell carcinoma of the vagina spread?
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local invasion of pelvic structures, lymphatic invasion
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To where do lesions in the upper third of the vagina metastasize?
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pelvic nodes
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To where do lesions in the lower two thirds of the vagina metastasize?
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inguinal nodes
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From where do most vaginal carcinomas come?
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extension from cervix or vulva, lymphovascular metastasis
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What drug is associated with clear cell adenocarcinoma of the vagina?
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DES given during mother's pregnancy
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What is an embryonal rhabdomyosarcoma?
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malignant vaginal tumor, grows as an intraluminal polypoid mass, fills/projects out of the vagina
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Who gets embryonal rhabdomyosarcomas?
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ifnants and kids under 5
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What is a rhabdomyoblast?
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cells with round, dark nuclei and occasionally elongated cytoplasmic projections with cross-striations
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What does an embryonal rhabdomyosarcoma look like histologically?
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zonal distribution of cellularity, loose, myxomatous stroma
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How do embryonal rhabdomyosarcomas progress?
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invade locally, produce urinary obstruction
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How do Bartholin gland cysts present?
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obstruction of Bartholin duct, from prior vulvar mucosal infection, with abscess formation
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What do Bartholin gland cysts look like histologically?
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lined with squamous or trnasitional epithelium
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How do Bartholin gland cysts present?
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mass lesion at the introitus +/- pain
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What is vestibulitis?
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inflammation of glands in the posterior introitus, produces mucosal ulceration and severe pain
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What is leukoplakia?
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white, scaly, plaque-like changes
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How does lichen sclerosus present?
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pale areas of "parchment-like" skin, labial atrophy, narrowing of the introitus
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Who gets lichen sclerosus?
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postmenopausal women
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What does lichen sclerosus look like histologically?
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thinning of the epidermis, loss of rete pegs, fibrosis of papillary dermis
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What is the potential complication of lichen sclerosus?
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increased risk of vulvar squamous cell carcinoma
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What is squamous hyperplasia?
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non-specific disorder with hyperplasia of squamous epithelium, often with hyperkeratosis
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What is a papillary hidradenoma?
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benign tumor, like intraductal papilloma of the breast, on labia majora, usually well-circumscribed
fibrobascular core lined by columnar cells |
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From what does a papillary hidradenoma form?
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from modified apocrine sweat glands, analogous to breast tissue
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Who gets carcinoma of the vulva?
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women over 60
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With what are invasive squamous cell carcinomas of the vulva associated?
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HPV, esp 16 and 18
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Who gets invasive squamous cell carcinoma of the vulva?
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younger patients, usually with VIN
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What does invasive carcinoma of the vulva look like?
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multifocal, warty or basaloid
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What is the usual background of squamous cell carcinoma of the vulva in older women?
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lichen sclerosis or squamous hyperplasia
p53 mutations |
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What do non-HPV related squamous cell carcinomas of the vulva look like?
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well-differentiated, lots of keratin
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How does vulvar squamous carcinoma spread?
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locally, later via lymphatics to inguinal nodes, via blood vessels
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Upon what is survival of vulvar squamous carcinoma dependent?
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stage at diagnosis
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Upon what does stage of vulvar carcinoma depend?
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size of tumor, depth of invasion, lymph node status
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What is extramammary Paget's disease?
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adenocarcinoma cells in surface squamous epithelium and appendages, mixed with basal cells
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How does extramammary Paget's disease present?
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pruritic lesions of varying color, usually on labia majora, usually confined to the epidermis
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