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46 Cards in this Set

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What are the four stages of syphilis?
1. Primary painless chancre w/ or w/o inguinal lymph node (often ignored & progresses to secondary form)
2. Secondary--systemic disease, condyloma latum (lesions on HANDS & SOLES of feet.
3. Latent
4. Tertiary--CNS, aorta.
Describe the pathophysiology of H ducreyi.
(gram negative bacillus).
Enters skin thru epithelial break (post minor trauma like sex)-->bacteria breach integument-->recruitment of keratinocytes, fibroblasts, endothelial cells, & melanocyte to secrete IL-6 & IL-8--> Hd cyto-lethal distending toxin secreted causing apoptosis & necrosis of human cells
What is the role of IL-6 & IL-8 in the pathophysiology of H. ducreyi?
IL-8: induces PMNs & macrophages to form intradermal pustules.
IL-6: stimulates T-cell IL-2 receptor expression, which, in turn, stimulates CD4 cells in region.
How long does it usually take to get the palmar pustules of secondary syphilis post a primary syphilis in genitalia?
6-8 weeks.
Why do patients with H. ducreyi chancroids have a predilection of HIV?
Macrophages in their ulcers have greater CCR5 & CXCR4 chemokine receptors, which are receptors for HIV entry, than normal cells.
What is the difference b/w a chancroid & a chancre sore?
-Chancroids have soft ragged edges & are full of pus
-Chancre sores have hard raised edges like a punched out lesion & are painless.
Are chancroids seen more often in circumcised or uncircumcised males?
Describe the path of Granuloma inguinale & lymphogranuloma venereum (LGV).
Caused by invasive serovars L1, L2,or L3 of Chlamydia trachomatis-->entry thru breaks of skin or across mucus membranes-->organism goes from site of inoculation down lymphatic channels to multiply w/in monocytes of lymph nodes it passes.
Describe timing of the primary & secondary stages of LGV.
-Primary stage:self-limited PAINLESS genital ulcer that occurs @ contact site 3-12 days or longer
-Secondary stage: happens 10-30 days to 6 months post primary stage.
What are the clinical manifestations of LGV among males whose primary exposure was genital?
Unilateral lymphadenitis & lymphangitis, often tender inguinal &/or femoral lymphadenopathy
How does LGV present in females?
Perimetritis (inflammation around uterus), salpingitis, lymphangitis & lymphadenitis in deeper nodes.
-Can get end-result(1-20 yrs later) of lymphatic obstruction: genital elephantiasis or esthiomene b/c of strictures or fistulas.
What are the sx's of LGV that was transmitted thru anal sex?
Lymphadenitis, lymphangitis, proctitis, inflammation limited to rectum (distal 10-12 cm. Possible anorectal pain, tenesmus (painful bowel mvmts w/ straining), rectal discharge, or proctocolitis, colonic mucosa inflammation extending to 12 cm above anus, proctitus, diarrhea, abdominal cramps, &/or perirectal or perianal lymphatic tissues inflammation.
How is the diagnosis of LGV made?
-Dx usually serologically (sensitivity of 80% after 2 wks, but may not be serotype specific, need to use culture--L1, L2, L3 cause LGV), exclusion of other causes of inguinal lymphadenopathy or genital ulcers.
-Culture w/ DFA TEST for L-type serovar of C trachomatis-->very sensitive & specific, not too available.
-PCR (Taqman analysis)-->takes 1 day to dx but many not be thorough enough.
Describe the characteristics of Condyloma accuminatum (virus, strains, histo, locations.
i) HPV --usually strains 6,11 (low #'s=more benign)
ii) Perianal, vulvar, vaginal
iii) Hyperkeratosis, papillomatosis, koilocytosis
iv) Low grade strains of HPV (6,11) give wart like condyloma;
-->High grade strains (16,18) give flat condyloma (organism is invasive b/c goes down & into skin surface).
Hence the more dangerous pre-malignant HPV assoc dysplasias often subtle & hard to ID.
Describe the characteristics of a Bartholi gland cyst/abscess (size, cause, age of onset.
a) Result from obstruction of Bartholin's duct. Cyst is 3-5 cm.
b) May develop secondary infection.
c) Common caused by N. gonorrhea, also E. Coli, Staph.
d) Commonly in reproductive years.
Which glands become infected in the pre-menopause years and which post-menopause?
Pre-Menopause: Bartholin's glands
Post-Menopause: Skene's glands
What is the first step in developing a urethral caruncle & what will chronic irritation lead to?
1st step in dev'ment: distal urethral prolapse (estrogen deficiency)
Chronic irritation: growth, hemorrhage, lesion necrosis.
What is in the differential diagnosis for a urethral caruncle?
Urethral diverticulum, urethral prolapse, urethral carcinoma, & periurethral gland abscesses.
What does a Bartholin's gland infection look like on a gross specimen?
Clear multicystic nodule, well circumscribed, easily removed during surgery.
What does a urethral caruncle look like w/ microscopic examination?
Like bed of granulation tissue covered w/ either squamous or transition epithelium. Infolding of epithelium may create papillary architecture. Inflammatory infiltration is common.
With immunoperoxidase study, which cells are + for CD45?
White blood cells
Which immunoperoxidase study would indicate that the tissue was a carcinoma b/c it is found in epithelial cells & an epithelial process?
Which 2 immunoperoxidase studies are usually involved w/ adenocarcinomas of the colon & lover?
CK7 & CK20
HMB-45 & S-100 are positive in which type of cells?
Neural type cells (melanocytes are closely related to neural type cells)
What does vimentin positive indicate?
Mesothelial primitive type cells--precursors to melanocytes.
What is Breslow's thickness?
Depth of invasion--usually measured by ocular microscopy, really invasive is >1cm.
What are 4 characteristics of chronic dystophies of the vulva?
a) Vulvar dystrophy
b) Leukoplakia
c) Keratosis
d) Kraurosis vulvae- vulvar atrophy & inflammation
Define endometrisis.
Non-neoplastic lesion, presence of endometrial tissue anywhere other than endometrial cavity.
Describe the characteristics of accessory breast tissue. Where you can find this tissue?
-Present anywhere along 'milk line'-->so can have primary primary breast CAall the way down to vulva;
-Enlarges during lactation
-Can give rise to breast-like neoplasms e.g. fibroadenoma, papillary hidradenoma.
What is another name for a sebaceous cyst thats benign w/ keratinous material in center?
Epidermal inclusion cyst.
What are the characteristics Lichen sclerosis/Lichen sclerosis et atrophicus (40%) & how do you treat it?
a) Atrophy, narrowed introitus
b) thin epithelium (so can have trauma & bleeding)
c) Rx: anabolic steroids
What is the male equivalent to Lichen sclerosis?
Balanitis xerotica obliterans
In a patient w/ HPV, microscopically when should you start to suspect carcinoma?
When lesion becomes flat, invasion of basement membrane.
What percent of Vaginal Intraepithelial Neoplasm (VIN) ( new term for vaginal dysplasia/carcinoma in situ) progresses to invasive CA?
How do you make a diagnosis of VIN?
Full thickness of epithelium involved w/ dysplastic cells but no evidence of invasion. May be assoc w/ leukoplakia or inflammation. If its assoc w/ a lot of inflammation, may be called Bowen's disease.
VIN is associated w/ which serotypes of HPV?
16 & 18. (also often multi-focal & assoc w/ CA elsewhere in genital tract)
What is the most common vulval-malignancy (90-97%)? In what age group does it occur?
Epidermoid (squamous cell) CA. Rare GYN tumor but most common here;
Older women (60y/o)
What is the treatment for epidermoid (squamous cell) CA?
Radial vulvectomy (bilateral vulvectomy & lymph node dissection). 60% have dz in lymph nodes @ surgery. Lots of lymphatic channels across midline, so need to do surgery. Often multi-focal CA.
What are the three types of Paget's disease?
1. Paget's dz of bone
2. Paget's dz of breast (nipple)
3. Extra-mammary Paget's dz of Vulva.
Which cells are very characteristic of Paget's dz of the breast & extra-mammary Paget's dz of Vulva?
large, clear mucin containing cells. In some pts this condition is assoc w/ underlying CA!!!!!
What is the diagnosis & prognosis for someone with
Extramammary Paget's dz?
Dz: 1. high degree of clinical suspicion
2. Skin biopsy

Prognosis: Catch early!! Dependant on early dx w/ definitive surgical tx.
Which factor plays a role in predicting the risk of associated CA in a pt w/ EMPD?
Risk of genital EMPD? Perianal EMPD?
-the anatomic location of the EMPD. 4-7% of pts w/ genital dz having CA. Perianal dz-->colorectal CA in 25-35%!!
What is the second most common vulvar malignancy (2-5%)?
Malignant melanoma.
What is the prognosis of malignant melanoma?
-Very malignant tumor of nevus cells w/ a 30% 5 yr survival.
-Prognosis depends on thickness of lesion (Breslow's thickness >1cm=poor, Clark's levels--levels3&4=poor)
What does EMPD look like microscopically?
Large vaculoated cells w/ dark nuclei.
Do cancers metastasize to & from the vulva area?
-mets usually from local sites (cervix, endometrium, colon, ovary)
-Vulvar CA can mets to other sites but rare
-can get ectopic breast tissue w/ ductal adenocarcinoma rarely & confused as mets.