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pathoma
Female Repro: vuvla/vag
| Question | Answer |
|---|---|
| what structures does the vulva represent? | skin and mucosa of female genitalia external to the hymen (labia majora, minora, mons pubis and vestibule) |
| what type of epithelium lines the vulva? | squamous epithelium |
| where is the bartholion gland located and what does it do? | there are 2 on either side of the vaginal canal which produces mucus like fluid, which drains by ducts into the lower vestibule |
| what is a bartholion cyst? | cystic dilation of hte bartholian gland d/t inflammation and obstruction of the gland |
| at what age do bartholian cysts normally occur? | reproductive age. |
| how does the bartholion cyst present to your office? | on palpation you find painful, UL cystic lesion in lower vestible adjacent to the vaginal canal. |
| warty neoplasm of the vulvar skin MC d/t HPV 6 or 11 is? | condyloma accuminatum |
| warty neoplasm of vulvar skin d/t secondary syphillis is? | condyloma latum... less common cuase |
| how are condyloma accuminatum and latum transmitted? | sexually. |
| HPV condylomas are characterized by what type of cell? | koilocytes, nucleus looks like a raisin |
| do condylomas often progress to carcinoma? | NO! they are associated with HPV types 6 and 11... low risk kinds |
| lichen sclerosis is characterized by thinning of the _____ and fibrosis of the ______ and what additional finding? | epidermis, dermis. with leukoplakia (white patches) with paper thin like vulvar skin |
| what age are lichen sclerosis MC seen? | post-menopausal. ?autoimmune etiology |
| lichen sclerosis benign or malignant? | benign. but with slight increase risk in squamous cell carcinoma. |
| lichen simplex chronicus is characterized by hyperplasia of_________? | vuvlar squamous epithelium. they have **thick, leathery vuvlar skin, associated with irriatation and scratching |
| is there an increased incidence of lichen simplex chronicus --> squamous cell carcinoma (like lichen sclerosis)? | nope :) totally benign |
| vulvar carcinoma is CA of what type of lining? | squamous epithelium of the vulva |
| major gross presentation of vuvlar carcinoma? why does this need to be biopsied? | presents with leukoplakia. biopsy is necessary to distinguish it from lichen sclerosis. (and other causes of leukoplakia) |
| vulvar carcinoma d/t what 2 major etiological factors? | HPV 16 and 18 (these pts around 50YO)OR long standing lichen sclerosis (these pts are >70YO, older) |
| what are risk factors for getting the HPV related vulvar carcinoma? | multiple partners and early first age of intercourse, slut. |
| the HPV form of vulvar carcinoma arises from which precursor lesion? | vulvar intraepithelial neoplasia (VIN). dysplastic precursor characterized by koilocytic change, disordered cell maturation nuclear atypia, and increased mitotic activity |
| non HPV related vulvar carcinoma is d/t what? | long standing lichen sclerosis, in women >70YO |
| extramammary pagets disease has malignant cells in what layer of skin | epidermis of the vulva. |
| how will the vulva appear in EM pagets disease? | erythematous, pruritic, ulcerated vulvar skin |
| what is the difference btw extramammary pagets and nipple pagets? | EM represents carcinoma in situ, with no underlying carcinoma. while pagets of nipple almost always has underlying carcinoma |
| what other disease is on our Ddx for EM pagets that should be ruled out? | melanoma- it can rarely develop in the vulva. |
| what tests distinguish extramammary pagets vs melanoma? | paget cells: PAS+, ketain+ and S100- melanoma cells: PAS-, keratin-, S100+ |
| what are the cells lining of the vagina? | non-keratinizing squamous epithelium |
| squamous epithelium of the vagina is derived from what embryological structures? | the lower 2/3 are derived from the urogenital sinus (squamous epithelium) and the upper 1/3 is derived from mullerian ducts (columnar epithelium) |
| what happens in development to allow for the whole vagina to be squamous epithelium? | the squamous epithelium in the lower 2/3 of vagina (derived from UG sinus) will migrate upwards to replace the columnar epi (derived from mullerian duct0 |
| what is the conidition called when you have persistence of columnar epithelium in the upper 1/3 of vagina? what increases your risk to getting this conidition? | vagina adenosis. in utero exposure to DES. |
| what is a serious complication of DES- associated vaginal adenosis? | clear cell carcinoma of the vagina. the persistance of columnar epithelium allows for the malignant proliferation of GLANDS w clear cytoplasm (cant happen in squamous epithelium) |
| embryonal rhabdomyosarcoma is a malignant mesenchymal proliferation of...? | immature skeletal muscle |
| presentation of embryonal rhabdomyosarcoma? | bleeding and grape-like mass protruding from the vagina or penis of a CHILD (<5yo) |
| the characteristic cell in embryonal rhabdomyosarcoma is what? what are its features? | rhabdomyoblast. **cytoplasmic cross-striations and +immunohitochemical staining for desmin and myogenin. |
| carcinoma arising from squamous epithelium lining vaginal mucosa...? | vaginal carcinoma |
| what is the precursor lesion to vaginal carcinoma? | VAIN! vaginal intraepithelial neoplasia |
| which inguinal LN does vaginal carcinoma go to when it starts to metastasize? | the lower 2/3 of vaginal will go to the inguinal LN, and the upper 1/3 goes to regional iliac nodes. |
| what is a risk factor for vaginal carcinoma? | HPV 16, 18 |
Created by:
afrank1