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Rep. Pathology
Reproductive Pathology
| Question | Answer |
|---|---|
| Mullerian Duct Anomalies | Embryologic fusion anomalies that may result in conditions such as organ agenesis, abnormal septation, organ duplictions, etc. May also be associated with renal abnormalities. |
| Gartner Duct Cyst | Arise in women from remnants of the degenerated mesonephric/wolffian duct. Occur in the cervix and in the anterolateral vaginal wall submucosa. 1 to 2 cm in size. |
| Imperforate Hymen | May not be recognized until puberty with lack of menses. May reveal blood in vagina, uterus, and fallopian tubes. |
| Hematocolpos | Vagina filled with blood. |
| Hematometra | Uterus filled with blood. |
| Hematosalpinx | Fallopian tube filled with blood. |
| Hypospadias/Epispadias | Abnormal development of urethral canal. Ventral opening is hypospadia. Dorsal opening is Epispadias. Often associated with cryptorchidism, bladder exstrophy, etc. May obstruct bladder predisposing to bladder infections. |
| Phimosis | The inability to retract foreskin over glans penis. |
| What can cause Phimosis? | May be due to abnormal development or inflammation of glans and foreskin. Prevents adequate cleaning predisposing to other infections. |
| Balanoposthitis | Inflammation of foreskin |
| Paraphimosis | Inability to replace foreskin after retracting due to inflammation and swelling of glans. |
| Cryptorchidism | Failure of testes to descend into scrotum. Usually unilateral. Early arrest of germ cell production and atrophic changes develop in early childhood. Increased risk for testicular cancer in both abnormal and normal testes. |
| Senile Atrophic Vulvitis or Vaginitis | Skin has reduced vascularity and reduced cornification making it thinner and more prone to infection. |
| Who is affected by Senile Atrophic Vulvitis and what causes it? | Occurs in elderly women from hypoestrinism. |
| Urethral Caruncle | Painful polypoid nodule of granulation tissue. |
| Where does a Urethral Caruncle Occur? | Occurring at the urethral meatus secondary to epithelial atrophy. |
| How do you treat a Urethral Caruncle | Regresses with topical estogen therapy. |
| Leukoplakia | white plaque |
| What causes Leukoplakia | May be due to psoriasis, chronic dermatitis, etc. May also be from non |
| Lichen Sclerosis Et Atrophicus (Atrophic Dystrophy) | Smooth vulvar skin with small papules that coalesce into thin gray parchment like areas that are susceptible to infection. |
| Where does Lichen Sclerosis Et Atrophicus occur? | Perivaginal, Periclitoral, and perianal skin. |
| Histological features of Lichn Sclerosis Et Atrophicus | epithelial atrophy with loss of rete ridges overlying a hypocellular, collagenized upper dermis and a band |
| What may happen if Lichen Sclerosis Et Atrophicus is not treated? | narrowing of the introitus or Kraurosis Vulvae. |
| Lichen Simplex Chronicus (Hypertrophic Dystrophy) | a nonspecific reaction pattern to chronic pruritus. |
| Histological features of Lichen Simplex Chronicus | Hyperkertosis and acanthosis of the epidermis with a variable lymphocytic infiltration of the dermis, increased mitoses of the epidermis but no cytologic atypia. |
| What is Lichen Simplx Chronicus considered if there is cytologic atypia? | Vulvar intraepithelial neoplasia. |
| Granular Cell Tumor of Vulva | Tumor of Vulva composed of large cells with prominent granular cytoplasm. Most are small and benign. May induce pseudoepitheliomatous hyperplasia of the overlying skin that can be confused with squamous cell carcinoma. |
| Where else can granular cell tumors appear? | Vagina, breast, and tongue. |
| Hidradenoma papilliferum | benign tumor derived from apocrine sweat glands which presents as a nodular mass usually on or between the labia. |
| Histological features of hidradenoma papilliferum | complicated papillary architecture with two cell layer epithelium differentiating it from adenocarcinoma. |
| What makes Hidradenoma papillerferum different from adenocarcinoma? | two cell layered epithelium. |
| Extramammary Paget Disease | red, crusted, well demarcated lesion usually on the labia majora. Neoplasia may last for years and spread laterally but usually not vertically. If spread is vertical prognosis is poor. |
| Who is predisposed to Extramammary Paget Disease? | women with a history of chronic pruritus and irritation. |
| Histological features of Extramammary Paget Disease | vacuolated tumor cells present singly and in clusters within the epidermis. Confined to epidermis and skin appendages. |
| Extramammary Paget Disease cells test positive for what? | PAS and mucicarmine. |
| Condyloma Acuminata | Verrucous alterations of squamous epithelium (venereal warts). |
| What strains of HPV cause Condyloma Acuminata? | type 6 and 11 |
| Where is Condyloma Acuminata most frequently found? | cutaneous surfaces of the perineal and perianal skin but may also affect vagina, cervix, and other mucosal surfaces. |
| Histological features of Condyloma Acuminata | hyperkeratosis, parakeratosis, acanthosis, and koilocytocis of the epidermis. |
| Vulvar Squamous Cell Carcinoma | carcinoma of vulva that are related to HPV infections and develop after a series of progessive changes of the epithelium. |
| What strains of HPV cause Squamous Cell Carcinoma? | type 16 and 18 |
| Vulvar Intraepithelial Neoplasia (VIN) | progressive but potentially reversible cytologic atypia of squamous cell epithelial caused by HPV. |
| Bowen Disease or Squamous Cell Carcinoma in Situ (VIN III) | may present as raised red lesions involving the labia but can be percentric involving the periclitoral and perianal skin. |
| Average age of Bowen Disease | around 40 |
| Percentage of patients with Bowen disease that will progress to invasive carcinoma of the vulva | 10% to 20% and usually elderly and immunocompromised |
| Percentage of patients that have concurrent CIS or invasive carcinoma of cervix or vagina with Bowen disease | 25% |
| Invasive squamous cell carcinoma (SCC) of vulva | white plaque like lesions with itching and local discomfort as predominant symptoms. Over time they will become firm and indurated with possible central ulceration. May be multicentric. |
| Invasive squamous cell carcinoma of the Vulva occurs in what population? | post menopausal women but is shown increasingly in younger women |
| At the time of diagnosis, about how many SCC have metastasized? | 2/3 |
| Where do SCCs metastasize to? | inguinal, femoral, and pelvic lymph nodes and later to viscera |
| What is the prognosis for SCCs with lesions greater than 2 cm with lymph node metastasis? | 25% 5 year survival |
| What is the prognosis for SCCs with lesions smaller than 2 cm treated with vulvectomy and pelvic lyphadenectomy? | 60% to 80% 5 year survival |
| What is the prognosis for SCCs with no lymph node metastases? | 90% 5 year survival |
| What are the best prognostic factors for SCCs? | patiets age and tumor stage and differentiation |
| Verrucous Carcinoma | variant of squamous cell carcinoma with well differentiated cells although the gross appearance is that of a large fungating tumor. |
| What is the common spread pattern of Verrucous Carcinoma? | laterally rather than vertically |
| What is the most frequently identified malignancy in the vagina? | metastatic as opposed to primary malignancies that start in the vagina |
| Vaginal Squamous Cell Carcinoma | rare, well differentiated tumor that arises from the posteror fornix. |
| What is common in the history of patients diagnosed with squamous cell carcinoma of the vagina? | cervical dysplasia and carcinoma |
| What areas can Vaginal SCC invade by direct extension? | cervix and perivaginal structures |
| What lymph nodes drain the upper 1/3 of the vagina? | iliac |
| What lymph nodes drain the lower 2/3 of the vagina? | femoral, inguinal, and pelvic |
| What symptoms are seen with vaginal SCC? | vaginal discharge and spotting |
| What type of patients is vaginal SCC primarily seen in? | older women |
| Prognosis range of vaginal SCC | 20% to 90% 5 year survival |
| Adenocarcinoma | Rare, clear cell carcinomas that arise in the vagina or cervix. |
| What drug is given to mothers during pregnancy that causes adenocarcinoma of their daughters? | Diethylstilbestrol (DES) |
| What is vaginal adenosis? | persistence of fetal histology where there is a delayed transformation of glandular epithelium to squamous epithelium. |
| Where do adenocarcinomas occur? | anterior wall of the proximal vagina |
| What percentage of DES exposed patients have vaginal adenosis? | 30% to 50% |
| What does vaginal adenosis display as? | red cobblestone areas contrasting with pink areas |
| When does vaginal adenosis disappear? | 4th decade |
| When do adenocarcinomas appear? | adolescence to early adulthood |
| When do non DES associated adenocarcinomas (clear cell carcinomas) appear? | later in adult life |
| Sarcoma Botryoides | rare rhabdomyosarcoma that has a polyploid grapelike appearance. |
| Who do Sarcoma Botryoides affect? | young girls |
| Where do Sarcoma Botryoides invade? | locally and may penetrate into peritoneal cavity. |
Created by:
lawrencejcarter
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