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78 Cards in this Set

  • Front
  • Back
name some vaginal congenital anomalies.
vaginal agenesis, obstruction, duplication (incomplete fusion of mullerian tracts), and fusion; urogenital sinus anomalies; imperforate hymen (1:1000)
how do you diagnose congenital anomalies?
PE, ultrasonography, retrograde contrast studies
what causes the mullerian ducts to fuse and elongate?
urogenital sinus
what is the most common cause of primary amenorrhea?
Turner's Syndrome (XO)
name the disorder of congenital absence of the upper vagina and uterus; second most common cause of primary amenorrhea. what stops developing to cause this?
RKH (Rokitansky Kuster-Hauser Syndrome); mullerian duct system stops developing during gestational days 44-48
name the term used to describe when their is a remnant of the wolffian (mesonephric) duct (responsible for male development). how would it present?
Gartner's Duct Cyst - cyst inside on the lateral wall of the vagina
what cells will you see microscopically to indicate gardnerella vaginalis?
clue cells - large cells heavily coated with bacteria
name the pathogen. STD, flagellated protozoan with motility; produces vaginitis, cervicitis, and urethritis with strawberry colored cervix and fiery red vaginal mucosae; greenish, frothy, discharge.
Trichomonas vaginalis - treatment: metronidazole (both partners)
what pathogen produces koilocytic changes in squamous epithelium; the cells have a wrinkled pyknotic nuclei surrounded by a clear halo.
HPV - condyloma acuminata (veneral warts - HPV 6,11); 16,18 with dysplasia and squamous cancer
name the term used to describe a staphylococcal infection that used to kill many women; caused by super absorbant tampons.
Toxic Shock Syndrome
name the cells seen on pap smear that are consistant with postmenopausal women/atrophic vaginitis.
parabasal cells - apparent when lacking estrogen and progesterone
name the most common vaginal cyst and describe it histologically.
epidermal inclusion cyst (aka vaginal inclusion cyst); a distinct squamous lined cyst with debris inside
the most common place for endometriosis is the ovary; however it appears that traumatically removed endometrium can implant in scars. name a place that is commonly scarred and left with endometrial tissue.
episiotomy site - tissue responds and cycles with estrogen (lesion will involute with pregnancy (progesterone dominated) or anytime there is less estrogen (ie postmenopausal)
benign tumors of the vagina are rare, however there is a mixed benign tumor composed of ________ and _______ that generally occurs in young women (30) and is located in or just above the ________ _____.
epithelium and stroma; hymenal ring
goljan: this is a benign tumor of skeletal muscle that shows up in the vagina, tongue, and/or heart.
most vaginal malignancies are an extension of cancer from ______.
squamous cell carcinoma from the cervix - ie they are there because of metastasis
the most common primary cancer of the vagina is this type and is a result of what HPV type?
epidermoid (Vaginal Squamous Cell Carcinoma); result of HPV 16
name the malignant grape-like mass that protrudes from the vagina of girls <6 years of old.describe it histologically.
embryonal rhabdomyosarcoma - surgery and chemo usually curative; see dense cambium layer beneath the epithelium; the sarcoma is beneath the cambian layer
why were women given Diethylstilbestrol (DES) in the 40s?
commonly given to women to prevent miscarriage
what was the common occurence in the female fetus of women taking DES?
the female fetuses that were exposed to DES(especially in the 1st 18wks) commonly had irregular menses; most got vaginal adenosis (remnants of mullerian ducts) and was the precursor to the rare clear cell adenocarcinoma.
embryologically, What did DES do to the fetus?
DES inhibited mullerian differentiation responsbile for mullerian structures: tubes, uterus, cervix, upper 1/3 of the vagina
what is adenosis?
DES exposed women most commonly got adenosis: it is the presence of a columnar mucin-secreting epithelium in the vagina, the glands are often lying in the lamina propria of the vagina - this is a precursor to clear cell adenocarcinoma
what is going on histologically with adenosis?
the glands are moving upwards toward the lamina propria
describe clear cell adenocarcinoma histologically.
arises from vaginal adenosis, the glands are irregular,multiple, and close together; within the lining of the glands you can see the malignant nuclei.
what happened if a women taking DES had a male fetus?
reports of epididymal cysts, hypotrophic testes, microphallus (small penis); sperm abnormalities
name some conditions associated with pelvic relaxation and why does this occur?
the pelvic musculature gets weakened (usually from traumatic childbirth, poor obstetrical care, lots of births); conditions include: uterine prolapse, cystocele, urethracele, and rectocele - often presents as urinary incontinence
describe the appearance on a histo slide of trichomonas vaginalis.
pear shaped flagellated protozoan
describe the appearance on a histo slide of HSV.
classic ground glass appearance; the cells have a multi-nucleated appearance; the nuclei looked rimmed with color
describe the appearance of a histo slide of bacterial vaginosis.
gardnerella vaginalis is characterized by "clue cells" - these cells are large with lots of bacteria on them (the nucleus looks small); the right shift of pH to a more alkaline fluid causes a decrease in lactobacilli; this allows bacteria to grow
name the benign cervical cyst derived from endocervical glands.
nabothian cysts
name the lesion that is usually found around menopause and may protrude from the endocervix and bleed.
endocervical polyps (postcoital bleeding)
this neoplasm comprises 55-65% of all malignancies of the female genital tract.
cervical carcinoma
what strains produce E6 oncoproteins that bind to p53 (tumor suppressor gene).
HPV 16 and 18
what race/ethnicity has the highest incidence of cervical cancer? which has the highest mortality?
hispanic/latino have the highest incidence; blacks have the highest mortality
name the symptoms of cervical cancer.
often none; postcoital bleeding; pain is a late sign
what is the most common cause of death in cervical cancer patients?
the cervical cancer infiltrates the bladder wall and obstructs the ureters; this causes postrenal azotemia and RENAL FAILURE and UREMIA
there are 3 types of cervical cancer. name them and name which is most common.
Epidermoid aka Squamous Cell Carcinoma(90%); Adenocarcinoma (4%); Undifferentiated Small Cell
where on the cervix does cervical cancer arise?
epithelium at the squamocolumnar junction (b/w the squamous exocervix and the transformation zone of the cervix);
describe the progression from HPV infection to invasive cervical cancer.
it progresses from HPV infection -> metaplasia -> dysplasia (CIN I-II)-> CIN III or carcinoma in situ -> Microinvasive carcinoma -> Frankly Invasive Carcinoma (invaded into the lamina propria)
define CIN I,II,III.
CIN = cervical intraepithelial Neoplasia;measures amount of dysplasia; CIN I: mild dysplasia involving 1/3 of the epithelium; CIN II: moderate dysplasia involving 2/3 of the epithelium; CIN III: severe dysplasia involving the full thickness of the epithelium (carcinoma in situ)
describe squamous metaplasia on cytology.
the glandular cells begin looking like squamous cells (due to chronic irritation)
describe condyloma acuminata on cytology.
koilocytosis; the squamous cells have wrinkled pyknotic (shriveled) nuclei
what is ASCUS?
atypical squamous change of unknown significance; something is wrong; its b/w condyloma and metaplasia; the nuclear:cytoplasm ratio has increased but it is unknown as to why
what is HGSIL?
high grade squamous intraepithelial lesion (aka CIN III) - see dark and large nuclei
describe the cytology of SCC (squamous cell carcinoma) keratinizing vs nonkeratinizing.
keratinizing look like pink tadpoles; both have very dark large nuclei
describe the cytology of endocervical adenocarcinoma in situ.
2nd most common type of cervical ca; glands grow very thick; hasn't invaded into the lamina propria (in situ)
describe carcinoma in situ.
CIS or CIN III is diagnosed when the entire epithelium is replaced by dysplastic process (no organization); cells have gone vertical, the nuclei are traveling upward; does NOT always progess to invasive cancer and may even regress; unpredictable
what is FIGO?
International Federation of Gynecology and Obstetrics; used to stage cervical cancer based on clinical examination, rather than surgical findings: Stage 0: CIS; Stage I: invasive carcinoma strictly confined to the cervix (invaded the lamina propria); Stage II: local, but beyond the uterus; Stage III: extended to pelvic wall or the lower 1/3 of the vagina, causes hydronephrosis; Stage IV: beyond true pelivs or into the bladder or rectum (methods do not include CT or MRI findings - based on palpation, inspection, colposcopy, biopsy, endocer. curettage, hysteroscopy, cystoscopy, proctoscopy, IVU, and xrays)
CIS can progress to this? what stage is it in and describe it histologically.
microinvasive carcinoma (stage Ia); treated surgically; may be able to preserve the ability to have children; see "tongues" of dysplastic tissue invading the lamina propria
carcinoma of the cervix has four growth patterns. name them and describe them.
1) exophytic (Most COmmon)- arise from exocervix, large mass that may bleed; 2) Nodular: arise from endocervix, large thick barrel-shaped cervix; 3) Infiltrative: Stone-hard cervix that invades the vaginal fornices and upper vagina; 4) ulcerative: tumor necrosis and sloughing with infectiona and purulent discharge
Squamous Cell Carcinoma (SCC) accounts for 90% of the cervical cancers. name the major histopathologic subtypes.
1)Moderately Differentiated, nonkeratinizing large cell SCC (70%); 2)Well-differentiated, keratinizing large cell SCC (25%); 3) small cell undifferentiated carcinoma - poor prognosis; 4) pure adenocarcinoma from endocervical cells are on the rise (5-20%)
if the cervix gets a secondary metastasis, where is it most likely from?
In the US, invasive cancer of the cervix is the __#__ most common genital malignancy in women, after _____ and _____.
3rd; endometrial and ovary.
worldwide, invasive cervical cancer is the __#__ genital female malignancy and the 2nd most common cause of malignancy in women.
Invasive cervical cancer is __#__ only to ________ cancer as a leading cause of worldwide cancer related mortality in women.
second; breast
CIS is detected at what age? invasive cancer is diagnosed at what age?
25-34; >50yo
on a cytology slide, describe the difference between adenocarcinoma and SCC.
adenocarcinoma clumps together; SCC looks as if the cells are falling off eachother
describe invasive adenocarcinoma on a HISTO slide.
lymphocytes surrounding a gland that is producing something (mucin?); lined by malignant cells; lights up with a special stain for mucin
how do you treat CIN I or II?
mild or moderate dysplasia on pap would then get confirmed by biopsy, then treat by freezing
how do you treat CIN III?
CIS or severe dysplasia, 1st confirm with biospy and coposcopy; then freeze or "cold knife cone" (follow pt closely)
how do you treat a locally invasive (microinvasive carcinoma)?
usually hysterectomy
the ACS and ACOG recommend women to get paps how often?
<30 annual or (ACS only) if use "thin prep" aka liquid-based cytology (every 2); non-immunocompromised women >30: 3 types: conventional pap and liquid-based cytology: do it annually (when you get 3 conseqative negatives, every 3); if using liquid-base with HPV every 3 years if both are negative
what HPV types does the vaccine prevent?
HPV (6,11,16,18)
where in the GU tract are specimens taken to assess hormones?
lateral vaginal wall
where in the GU tract are specimens taken to help diagnose endocervical, endometrial, and ovarian malignancies?
vaginal pool (fluid)
what parts of the GU system are tested in a pap smear?
ectocervical scraping (great for cervical neoplasm detection, poor for endometrial ca), vaginal pool specimen, and/or endocervical specimen. (both vag. pool and endocervical speciments are taken to detect malignancies arising in the endocervix and endometrium)
name the common infectious pathogens that are commonly seen on pap smears.
gardnerella vaginalis, candida albicans, herpes simplex, trichomonas vaginalis, actinomyces, chlamydia, HPV - condyloma acuminata
the squamous epithelium cells will vary depending on what hormones are present in the exocervix and upper the cell and what hormone/s are present.
superficial squamous cells - estrogen; intermediate cells - progesterone; parabasal cells - no estrogen or progesterone (postmenopausal)
in a normal premenopausal menstruating woman, what cells will you see?
70% superficial squamous cells; 30% intermediate cells
what is the maturation index?
a way to express the amount of parabasal/intermediate/superficial (P/I/S); ie. in a completely postmenopausal woman: 100/0/0
name the term. cells of an epithelium convert to a different cell type (ie. columnar -> squamous);
METAPLASIA occurs from chronic inflammation, hormonal changes, not always indicative of a serious problem
name the term. an increase in the number of cells and thickness of the epithelium.
name the term that means regenerative changes.
name the term that means the cytological equivalent of leukoplakia (white patches) often result of irritation or hormonal disturbance and seen commonly in uterine prolapse.
hyperkeratosis - if situated toward the squamocolumnar junction is associated in about 10% of cases with cervical dysplasia or CIS.
name the term. an abnormal form of keratinization in which the nuclei are retained in the keratinized layer. what is the significance?
parakeratosis; dysplasia and carcinoma are found in smears with parakeratosis and this layer of parakeratosis can prevent getting a good sample of a lesion
when should you not see endometrial cells?
postmenopausal women and premenopausal women after day 10
name the term. disorganized growth. is graded as mild, moderate, and severe.