Uterine Pathology

Front 1

Pathologies of the Vulva and Vagina

Back 1

1. Herpes - Infection
2. Candida - Infection
3. Bacterial Vaginosis - Infection
4. Bartholin's Cyst - Infection
5. Squamous Cell Carcinoma

Front 2

Vaginal Herpes Infection

Back 2

A sexually transmitted infection in which painful red papules appear after 3-7 days and progress in blisters, then ulcers, the will regress. Once acute infection is over, virus travels down the nerves and sits dormant on the dorsal root ganglion and can be reactivated at any time.

Hint 2

**The most common type of vaginal infection.
**Microscopically will have multinucleated giant cells.
**If there is an active lesion, do not deliver a baby vaginally due to chance of transmission to the newborn.

Front 3

Candida

Back 3

Infection of the vaginal possibly due to use of an antibiotic that suppresses normal bacteria leading to small white surface plaques that result in a white discharge and itching.

Hint 3

**Present clinically with discharge, itching, and discomfort.

Front 4

Bacterial Vaginosis (BV)

Back 4

Vaginal infection (most commonly from garderella vaginalis) that results in a fishy odor and grey discharge.

Hint 4

**Present with CLUE CELLS: Squamous cells covered in bacteria

Front 5

Trichimonas

Back 5

A sexually transmitted infection of an uncommon single cell, motile parasite. Presents with purulent (pus) vaginal discharge and discomfort.

Front 6

Bartholin's Cyst

Back 6

Acute infection of the Bartholin's Gland due to any obstruction of the duct. Painful.

Hint 6

**Treat by draining or excising the cyst.

Front 7

Vaginal Squamous Cell Carcinoma

Back 7

Only tumor of the vagina you might come across, and even then it is rare.

Front 8

Endocervical Polyp

Back 8

Benign proliferation as a result of estrogen stimulation that forms an inflammatory mass. Not malignant but associated with vaginal spotting or bleeding.

Front 9

Acute and Chronic Cervicitis

Back 9

Bacterial (Gonorrhea, Chlamydia) or Viral (Herpes) infection of the cervix causing intense inflammation and pain with a resulting mucopurulent discharge.

Hint 9

**Important to recognize and treat before organism causes further damage to the upper female genital tract. Hard because symptoms sometimes don't present until organism has reached upper parts.

Front 10

Cervical Intraepithelial Neoplasia (CIN)

Back 10

Abnormal dysplastic growth of cells (non-invasive tumors) confined to the epithelium of the cervix and thus has not crossed the basement membrane. Changes begin at the squamocolumnar junction.

Hint 10

**Progression of cancer is unpredictable.
**Increasing CIN grade = Increase persistence of CIN and risk of invasive cancer.

Front 11

CIN 1

Back 11

Low grade squamous intraepithelial lesions (SIL) with characteristic mild dyplasia in which the cells look like crumpled paper bags or raisin, but still have normal halo appearance.

Hint 11

**Abnormal cells only cover 1/3 of epithelium
**Associated with HPV strains 6, 11

Front 12

CIN 2

Back 12

High grade SIL with moderate dysplasia. Abnormal cells cover the lowest 2/3 of the epithelium.

Hint 12

**Associated with HPV strain 16, 18, 31, 33

Front 13

CIN 3

Back 13

High grade SIL (Carcinoma In Situ) with severe dysplasia. Carcinoma extends the full thickness from the basement membrane to the surface and has a great risk of invasive cancer.

Hint 13

**Associated with HPV strains 16, 18, 31,33

Front 14

Squamous Cell Carcinoma (Cervix)

Back 14

Malignant growth of the epithelial layer of the cervix that present with vaginal discharge or bleeding, post-coital bleeding, dysuria. Cancer is thought not to metastasize but invade local tissues.

Hint 14

**Peak age 40-45
**Mortality depends of local invasion and not distant metastasis.
**Can result in fistula btwn bladder and rectum = infection
**Can result in Ureteral obstruction = renal failure
**Can result in hemorrhaging

Front 15

Chronic Endometritis

Back 15

Pelvic Inflammatory Disease (PID) most commonly caused by gonorrhea or chlamydia in which the inflammation ascends up the FGT from vagina and if left untreated can cause a tubo-ovarian access leading to hydrosalpinx.

Hint 15

**Symptoms include pelvic pain, tenderness, fever, and or vaginal discharge.
**Pathologically you will see plasma cells in the endometrium with lymphocytes and macrophages.
** Complications include peritonitis, infertility due to scarring of tubes, bowel obstruction.

Front 16

Adenomyosis

Back 16

Benign condition in which endometrial stroma with or without glands is found in the myometrium

Hint 16

**Can cause uterine enlargement, menorrhagia, dysmenorrhea, pain with intercourse.
**Dysmenorrhea - Endometrium sitting in the smooth muscle is still subject to hormonal stimulation, so proliferation within the muscle wall causes pain.

Front 17

Endometriosis

Back 17

Benign condition in which normal endometrial mucosa (glands or stroma) is found outside of the uterus.

Hint 17

**Most commonly found in the bladder, rectum, and ovaries.
**Can cause pelvic pain, infertility if in tubes/ovaries, pain during urination or defecation.
**Woman in their 30's and 40's

Front 18

Leimoyoma/Fibroma

Back 18

"Fibroids of the Uterus" - A benign smooth muscle tumor with no invasive or matastatic potential but can grow to huge sizes! Can grow large enough to damage local organs and impair fertility.

Hint 18

**Most common tumor in women!!!
**Think cadaver lab.
**Can necroses and or calcify.

Front 19

Endometrial Polyp

Back 19

Benign hyperplastic overgrowth of the endometrium that does not slough off during menstruation.

Hint 19

**Associated with excess estrogen
**May cause uterine bleeding because they can prolapse out of the cervical canal.

Front 20

Endometrial Hyperplasia

Back 20

In response to high levels of estrogen, instead of 1 layer of endometrial tissue, you get a thick lush looking tissue that contains many layers. NO invasion, just hyperplasia.

Hint 20

1. Simple - Slight increase in the number of endometrial glands
2. Complex - More crowding of glands with more irregularity in shape (<5% progress of carcinoma)
3. Atypical - Gland crowding and complex epithelial abnormalities (23% progress of endometrial adenocarcinoma)

Front 21

Leiomyosarcoma

Back 21

Malignant tumor of the smooth muscle of the endometrium. Unlike benign fibroids, these are VERY rare. They will look like fibroids but with more atypical cells and mitotic activity.