Repro Part 6

Front 1

Polymenorrhea =

Back 1

frequent menstrual bleeding (cycle <21 days)

Front 2

Menorrhagia =

Back 2

excessive uterine bleeding that occurs at regular intervals (>80 ml for >7 days)

Front 3

Metrorrhagia =

Back 3

irregular menstrual bleeding or bleeding between period

Front 4

Menometrorrhagia =

Back 4

frequent AND excessive

Front 5

oligomenorrhea =

Back 5

periods at >35 days intervals

Front 6

hirsutism =

Back 6

excessive hairiness (~PCOS)

Front 7

vulva =

Back 7

external female genitalia before the hymen

Front 8

cervix =

Back 8

neck of the uterus

Front 9

NPV =

Back 9

pts with negative test that do NOT have dz

- assesses reliability of negative test

Front 10

condyloma =

Back 10

~~ genital wart, caused by HPV inf.

(condyloma lata = white lesion that ~ syphilis)

Front 11

cervical cancer is caused by:

Back 11

HPV

- includes EITHER SCC or adenocarcinoma - still caused by HPV

Front 12

5 risk factors for cervical CA:

Back 12

1. early age of first intercourse

2. multiple sexual partners

3. *cig smoking*

4. *imm-suppression*
(HIV, chronic steroids)
(low IS = dec. ability to destroy HPV)

5. DES exposure

Front 13

4 general features of HPV:

Back 13

1. dsDNA

2. infects epithelial cells

3. divided into low risk - 6, 11

4. and high risk - 16, 18

Front 14

5 features of HPV infection:

Back 14

1. sexually transmitted

2. m.c, STD globally

3. 80% of adults, and near 100% women, are exposed

4. ...within first decade of sexual activity

5. most will clear infection within 8-24 mths

Front 15

cervical CA is the result of:

Back 15

*persistent* HPV

=> progression to *precancerous lesion*

=> local invasion

Front 16

low risk HPV ~~

(2)

Back 16

1. genital warts (condyloma)

2. low-grade dysplasia

Front 17

high risk HPV ~~

(3)

Back 17

1. low-grade dysplasia

2. high-grade dysplasia

3. cervical CA

Front 18

pathophys of HPV cancer:

Back 18

E6 and E7 (both early genes) inc. destruction of p53 and Rb, respectively

=> DNA is integrated into human genome

Front 19

koilocytosis =

Back 19

perinuclear clearing (early/transient inf)

Front 20

Pap smears only start at:

Back 20

age 21

- no matter sexual history or birth control status

Front 21

Pap smear samples:

Back 21

ecto- AND endocervix

Front 22

colposcopy =

Back 22

look at the transformation zone under a microscope

=> apply Acetic Acid or Lugol’s solution to see dysplastic changes

=> take colposcopic-directed biopsies +/- endocervical currettage (ECC) - getting cells from inside cervical canal (not uterus)

Front 23

acetic acid:

(2)

Back 23

1. dehydrates cells

2. abnl areas appear white (aceto-white) because of decreased glycogen

Front 24

Transformation Zone =

Back 24

area that was initially covered by columnar epithelium, replaced by squamous epithelium through metaplasia

Front 25

5 biopsy results from colposcopy =

Back 25

1. nl

2. condyloma

3. CIN
(cervical intraepithelial neoplasia)
(1-3)

4. adenocarcinoma in situ

5. CA

Front 26

"high grade" CIN =

Back 26

2 and 3

- sometimes hard to distinguish the 2

Front 27

tx of CIN:

(4)

Back 27

1. observation

2. ablation of abnormal cells
(Cryotherapy, Laser Therapy)

3. diagnostic excisional procedures
(LEEP, Cold Knife Cone biopsy (CKC))

4. hysterectomy

Front 28

LEEP is an office procedure, CKC is:

Back 28

an OR event

- allows for larger specimens, non-cauterized (clear) margins

- but most are LEEP

Front 29

tx vs. observation depends on:

(5)

Back 29

1. age

2. parity

3. non-compliant pt

4. unsatisfactory colposcopy

5. discrepancy b/w Pap smear and bx results
(e.g. high grade Pap but low-grade CIN)

Front 30

tx vs. observe in CIN 1:

Back 30

observe - f/u Pap or HPV testing in 1 year

Front 31

tx vs. observe in CIN 2:

Back 31

tx except if young

- if young, Pap/col every 6 mths

Front 32

tx vs. observe in CIN 3:

Back 32

always treat, except for in adolescents

Front 33

tx of adenocarcinoma in situ:

Back 33

CKC

Front 34

always refer cervical CA to:

Back 34

OB/GYN

Front 35

90% of CIN 1 will:

Back 35

regress

- that's why you just observe until something changes

Front 36

HPV inf. can go straight to:

Back 36

CIN 2, CIN 3

Front 37

most cervical CA's are:

Back 37

SCC (90%) check

Front 38

HPV vaccine:

(3)

Back 38

1. recombinant

2. contains L1 (~~capsid prot's)
- inserted into yeast

3. lacks L2 (no viral DNA)

Front 39

Gardisil protects against HPV types:

(4)

Back 39

6, 11, 16, 18

Front 40

Cervarix protects against HPV types:

(2)

Back 40

16, 18

Front 41

HPV testing looks for:

Back 41

types 16, 18

Front 42

HPV vaccine recommendations:

(3)

Back 42

1. ~~age 11, girls and boys
(range: 9-26)

2. PRIOR to sexual activity

3. NOT recommended for preg

Front 43

histo of ectocervix =

Back 43

**stratified squamous** epithelium

Front 44

histo of endocervix =

Back 44

**columnar** mucinous epithelium

Front 45

transformation zone:

(3)

Back 45

1. **m.c. site for cervical dysplasia and carcinoma**

2. high cell turnover

3. sampled during Pap

Front 46

what happens in the transformation zone in a YA?

Back 46

COLUMNAR epithelium extends out into the ectocervix

- in adulthood, the ectocervix is "restored" with stratified squamous

Front 47

HPV is the cause of ALL:

Back 47

cervical CA's and their precursor lesions (CIN/SIL)

Front 48

type 16 ~~

Back 48

SCC

Front 49

type 18 ~~

(2)

Back 49

1. SCC

2. endocervical glandular neoplasias
(i.e. adenocarcinoma in situ and adenocarcinoma)

"in situ" = not invasive - in its original place

Front 50

HPV-mediated carcinogenesis:

(6)

Back 50

1. HPV infects *basal cells* at the transformation zone

2. integrates into host DNA

3. viral oncogenes E6 and E7 are overexpressed

4. E6 and E7 oncoproteins bind and lead to destruction of proteins encoded by p53 and Rb genes, respectively

5. proliferating cells acquire additional genetic errors

6. => malignant

Front 51

3 types of HPV inf.:

Back 51

1. subclinical
(DNA+, cytology-)

2. transient
(DNA+, cytology+)

3. persistent
(persistent cytologic abnormalities; may progress)

Front 52

dysplasia on Pap is confirmed with:

Back 52

colposcopy and bx

=> graded

Front 53

main issue with Paps =

Back 53

false negatives

Front 54

*given the issue with FN's, if a lesion is suspicious clinically,*

Back 54

***it MUST be evaluated further irrespective of negative Pap findings***

Front 55

**Pap smears ~~

Back 55

cytology

- the microscopic appearance of cells

- histology = the mic. appearance of tissues

Front 56

3 features of Metaplastic squamous cells (from transformation zone):

Back 56

1. size/nuclei of parabasal cells

2. cobblestone pattern

3. dense cytoplasm

Front 57

nl endometrial cells =

Back 57

3D balls of dark blue cells with high N:C

- seen if Pap performed during menses

- might be malignant in women >40

Front 58

3 parts of reporting a Pap:

Back 58

1. specimen type and adequacy

2. gen. categorization
(e.g. "neg for lesion or malignancy")

3. Interpretation/Descriptive Result
(e.g. "Candida")

Front 59

causes of inadequacy:

(4)

Back 59

**Too few squamous cells (#1 reason)**

Obscured by blood or inflammation

Excessive lubricant

Specimen rejected - e.g. mislabeled

Front 60

Candida on Pap:

(2)

Back 60

1. common

2. sticks and stones
(pseudohyphae and yeast forms)

Front 61

nl flora of external genitalia =

Back 61

lactobacilli

Front 62

clue cells =

Back 62

superficial or intermediate cells covered with G. vaginalis

=> "furry"

- presence indicates dec. in nl lactobacilli

Front 63

3 M's of HSV on Pap:

Back 63

1. multinucleated

2. molded
(nuclei stick to each other)

3. margination of chromatin
(cells look like glass)

Front 64

what do you do if you see HSV from a preg. Pap?

Back 64

call the clinician immediately

- important for preg.

Front 65

Trichomonas vaginalis:

(4)

Back 65

1. oval/pear-shaped
(s/ts like kites)

2. must see nucleus to dx on Pap

3. cytoplasmic halos

4. background inflam.

Front 66

Actinomyces:

(4)

Back 66

1. GP

2. long and filamentous

3. may look like dust balls on Pap

4. ~~IUD's

Front 67

dysplasia on Pap is called:

Back 67

squamous intraepithelial lesion (SIL)

Front 68

dysplasia on histology is called:

Back 68

CIN *and* SIL

(cervical intraepithelial neoplasia)

Front 69

5 features of CIN/SIL on histo:

Back 69

1. inc. N:C ratio (grading)

2. hyperchromasia and membrane irregularities

3. apoptosis

4. mitotic figures *above* the basal layer

5. loss of maturation of epithelium

Front 70

describing Squamous Cell Abnormality:

(5)

Back 70

ASCUS:
Atypical squamous cells of undetermined significance

ASC-H:
Atypical squamous cells, cannot exclude HSIL

LSIL:
Low grade SIL

HSIL:
High grade SIL

SCC

Front 71

cellular changes in progression of dysplasia:

(5)

Back 71

1. inc. nuclear size

2. inc. nuclear hyperchromasia

3. inc. nuclear pleomorphism

4. dec. cytoplasm (=> inc. N:C)

5. inc. mitotic figures

Front 72

cytology of low-grade dysplasia:

(4)

Back 72

1. koilocytes
(~sharply-delineated perinuclear halo)

2. dense cytoplasm on periphery

3. enlarged, hyperchromatic nucleus
(often with binucleation)

4. low N:C

Front 73

histology of low-grade dysplasia:

(3)

Back 73

1. koilocytes along entire thickness

2. but lack of maturation is limited to LOWER THIRD of epithelium

3. upper layers retain abundant cytoplasm

Front 74

cytology of high-grade dysplasia:

(2)

Back 74

1. enlarged, hyperchromatic, irregular nuclei

2. decreased cytoplasm with high N:C ratios

Front 75

histology of CIN 2 (high-grade) dysplasia:

Back 75

loss of maturation in 1/2 to 2/3 of epithelium

Front 76

histology of CIN 3 (high-grade) dysplasia:

Back 76

full thickness loss of maturation

Front 77

by far the m.c. invasive cervical carcinoma =

Back 77

SCC

- followed by adeno (20%)

Front 78

cytology of SCC:

(5)

Back 78

1. Irregular nuclei

2. chromatin clumping

3. prominent nucleoli

4. high N:C ratio

5. background: degenerating cells, blood, and inflam

Front 79

histology of SCC:

(2)

Back 79

1. if well-differentiated: keratin pearls, some eosinophils

2. if poorly differentiated: tons of eosinophils

Front 80

adenocarcinoma in situ is the _______________ to adenocarcinoma

Back 80

precursor

Front 81

3 special features of adeno in situ cytology:

Back 81

1. feathering of cells

2. nuclear elongation

3. nuclear crowding

Front 82

endocervical adenocarcinoma ~~

(2)

Back 82

1. barrel cervix

2. skip lesions
(infiltrates endocervix diffusely)

Front 83

HPV DNA testing is done on the liquid portion of a Pap and is done:

Back 83

at the same time as cytology

Front 84

ASCUS plus positive high risk HPV DNA test result =>

Back 84

colposcopy

Front 85

ASCUS with negative high risk HPV DNA test result =>

Back 85

observe

Front 86

2 benign lesions of the cervix:

Back 86

1. cervical polyps

2. nabothian cysts

Front 87

2 features of cervical polyps:

Back 87

1. arise in endocervix

2. may be associated with DC or bleeding

Front 88

nabothian cyst =

Back 88

benign mucinous cystic distension of endocervical glands secondary to obstruction from squamous metaplasia

Front 89

primary tumors of the vagina are really rare; m.c.ly =

Back 89

SCC

Front 90

DES (diethylstilbestrol) was used to prevent:

Back 90

spontaneous abortions

Front 91

DES exposure ~~

Back 91

clear-cell carcinoma of vagina or vulva

= malignant prolif. of glands within clear cytoplasm

Front 92

Embryonal rhabdomyosarcoma (sarcoma botryoides) =

Back 92

rare, malignant mesenchymal prolif. of immature skeletal muscle

Front 93

3 features of embryonal rhabdomyosarcoma:

Back 93

1. child <5 yo

2. bleeding and grape-like massprotruding from vagina or penis

3. desmin+, myoglobin+

Front 94

the vulva is covered by keratinizing stratified squamous epithelium (skin), =>

Back 94

any dermatologic condition may involve the vulva

Front 95

Lichen sclerosus of vulva:

(3)

Back 95

1. symmetric white plaques w/ super-thin vulvar skin

2. hyperkeratosis in top-most layer

3. ~~post-menopause women

Front 96

HPV inf's of vulva (like condyloma and lichen sclerosis) also show:

Back 96

koilocytes

- koilocytes ALWAYS result from HPV inf.

Front 97

extramammary Paget dz (of the vulva) =

Back 97

malignant epithelial cells in the epidermis of vulva

Front 98

4 features of extramammary Paget dz

Back 98

1. erythema, pruritis, ulcerated skin

2. clear cytoplasm, atypical nuclei

3. PAS+, keratin+, S100 neg.

4. NO underlying adenocarcinoma

Front 99

what does PAS stain?

Back 99

mucin

=> PAS+ = pink mucin

Front 100

unlike extramammary Paget's, malignant melanoma of the vulva is:

(3)

Back 100

1. PAS neg

2. keratin neg

3. S100+

Front 101

keratin =

Back 101

interm. filament of epithelium

- if there's keratin, it's epithelium

Front 102

key distinction b/w dysplasia and carcinoma =

Back 102

reversibility

Front 103

difference b/w CIN 3 and carcinoma =

Back 103

carcinoma is atypia along entire thickness of cervix, not reversible

Front 104

Paps do NOT:

Back 104

detect adenocarcinoma well

- excellent for SCC, but not adenocarcinoma