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MS2 - Life Cycle > Pathology of the Uterus, Vagina, and Vulva > Flashcards

Pathology of the Uterus, Vagina, and Vulva Flashcards

1
Q

Vulvar malignancies will drain to the ___________ lymph nodes.

A

inguinal

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2
Q

Cervical malignancies will drain to the ____________ lymph nodes.

A

iliac (first) and then para-aortic (second)

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3
Q

Trace the types of epithelium from vulva to uterus.

A

Vulva: keratinizing squamous
Vagina: non-keratinizing squamous
Cervix: non-keratinizing squamous to glandular
Uterus: glandular

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4
Q

Tumor growth into a tissue is called ___________, while tumor growth outward is ____________.

A

endophytic; exophytic

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5
Q

Single cells growing into an organ is called ___________.

A

pagetoid

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6
Q

Histologic exam of HSV-2 lesions will show ______________.

A

eosinophilic intranuclear inclusions

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7
Q

If a woman in labor has an active HSV-2 recurrence, _____________ is indicated.

A

caesarean section

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8
Q

Molluscum contagiosum is _____________.

A

a benign, self-limited endophytic lesion

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9
Q

Verrucous means ___________.

A

cauliflower-like

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10
Q

Hyperparakeratosis is ____________.

A

too much stratum corneum with nuclei (diagnostic of HPV infection)

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11
Q

What kind of organism causes strawberry cervix?

A

Flagellated protozoa (being Trichomonas)

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12
Q

What can cause vaginal candida?

A

Diabetes
Antibiotics
Pregnancy

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13
Q

Vaginal candida is described as ___________.

A

curd-like discharge

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14
Q

Actinomyces causes _____________.

A

nothing usually

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15
Q

Vulvar SCC is _________ as common as cervical cancer.

A

1/8

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16
Q

Most high-grade vulvar/cervical lesions do not ____________.

A

invade

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17
Q

What increases the risk of vulvar/cervical SCC?

A

Smoking, HPV, immunosuppression, and chronic inflammation

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18
Q

Describe inflammatory SCC.

A

Usually HPV-negative and occurring in women older than 70

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19
Q

What is lichen sclerosis?

A

A pre-malignant diffuse lesion that presents with “parchment paper” vulva and collagenous fibrosis of the stratum spinosum

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20
Q

Extramammary Paget’s disease in the vulva, unlike in the breast, is not associated with _____________.

A

underlying malignancy

Note: because of this, extramammary Paget’s presents in the epidermis.

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21
Q

Histologically, extramammary Paget’s disease presents with _____________.

A

marked hyperkeratosis and pale basal cells with gland formation

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22
Q

____________ presents with S100 staining.

A

Melanoma (Me10nom0)

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23
Q

Girls exposed to DES (an old form of estrogen thought to prevent miscarriages from low estrogen levels) will develop _____________.

A

embryonal rhabdomyosarcoma, a malignant proliferation of skeletal muscle cells just below the surface of the epithelium

Note: this is also called sarcoma botryoides

Note #2: this presents with a “grape-like” protrusion from the vagina

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24
Q

__________ also presents in women exposed to DES and will display patches of red, glandular tissue in the vagina.

A

Adenosis

25
Q

____________ is like a worse form of adenosis.

A

Clear cell carcinoma

Another DES exposure disorder

26
Q

What stain identifies HPV?

A

p16

27
Q

The classic histologic description of the proliferative phase uterus is _____________.

A

“test-tube” like with basal nuclei and occasional mitoses

28
Q

Secretory phase uterus has this appearance: _____________.

A

S-shaped glands with secretory glands that look like piano keys

29
Q

Exogenous hormones will cause ____________ appearance of the uterus.

A

decidualized stromal cells (fluffy cells)

30
Q

In response to hCG and progesterone, the endometrium develops a ____________ appearance.

A

Arias-Stellar Response (ASR) with “crazy-looking” nuclei and decidualized stroma

31
Q

Menopausal uterus looks like _____________.

A

atrophic endometrium, cystic glands, and decreased mucus glands

32
Q

_________ is the pathologic term for PID.

A

Endometritis

33
Q

What is curettage?

A

Scraping out the uterus

34
Q

____________ presents with PMNs in the uterine glands.

A

Endometritis

35
Q

What is endometriosis?

A

Endometrial glands where they should not be (e.g., in the ovary or myometrium)

Note: when endometriosis occurs in the uterus (such as the myometrium) it is called adenomyosis.

36
Q

What are the three locations that a leiomyoma can present?

A

Subserosal, intramural, and submucosal

Outer, middle, and inner

37
Q

The histologic buzzwords for leiomyoma are _______________.

A

well-circumscribed mass with cells containing cigar-shaped nuclei

38
Q

How are leiomyomas treated?

A

They are usually hormonally responsive, so they shrink with menopause. In many cases, however, nothing is done.

39
Q

______________ are the most common uterine sarcoma.

A

Leiomyosarcomas

40
Q

The 5-year survival for endometrial carcinoma is ____________.

A

81%

41
Q

The three most common genes for type I endometrioid carcinoma are ______________.

A

PTEN, KRAS, and beta-catenin

42
Q

What genes are mutated in Lynch syndrome (that can also present with endometrial cancer)?

A

MSH2 and MLH1

Note: these are the MMR proteins that lead to microsatellite instability if impaired.

43
Q

Of endometrial hyperplasias, ____________ rarely progress to cancer while about 30% of __________ do.

A

simple hyperplasias; complex hyperplasias

44
Q

Endometrioid carcinoma sometimes has ____________ metaplasia.

A

squamous

45
Q

Which demographic is more typical for type II endometrial cancer?

A

Older (i.e., post-menopausal) women

46
Q

Type II endometrial cancer is frequently driven by mutations in _________.

A

p53

Lecturer: “You have to know that.”

47
Q

What kind of cancer is type II endometrial carcinoma?

A

Serous papillary adenocarcinoma

48
Q

Mixed Müllerian tumors can present as either ______________.

A

homologous (in which they recapitulate multiple tissue types that are normally found in the uterus, like epithelium) or heterologous (in which they recapitulate tissues not normally found in the uterus, like cartilage)

49
Q

Which kind of Müllerian tumor is worse?

A

Heterologous

50
Q

Type I endometrioid cancer is more common in ______________.

A

obese perimenopausal women

51
Q

Molluscum contagiosum is what kind of organism?

A

Pox virus

52
Q

The most common cause of abnormal uterine bleeding in a perimenopausal woman is _____________.

A

endometrial polyp

53
Q

Histologically, what’s the best way to distinguish between endometrioid polyp and endometrial adenocarcinoma?

A

Endometrial carcinoma will not have stroma between glands, whereas polyps will.

54
Q

If you see keratin pearls in the vagina, the patient will likely test positive for _______________.

A

hrHPV

55
Q

What lesion is itchy and pearly in appearance?

A

Molluscum contagiosum

56
Q

Endocervical polyps can be cured by ____________.

A

curettage

57
Q

Which phase is characterized by straight tubules and which is S-shaped tubules?

A

Straight: proliferative

S-shaped: secretory

58
Q

Remember, endometriosis is glands and ________.

A

stroma

59
Q

Which endometrial cancer is more aggressive?

A

Type II

MS2 - Life Cycle (61 decks)

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