INFECTIONS

major causes of preterm delivery?

FIGURE 22.1

Early in development the mesonephric duct and ________ duct merge at the urogenital sinus to

form the _______ tubercle.

.....by birth the mullerian ducts have fused to form the______

(choose all that apply)

Vaginal lesions due to herpes-simplex virus involve?

Where does HSV hide in the body (viral latency)?

MORPHO

Multinucleated squamous cells containing eosinophilic to basophilic viral inclusions with "ground-glass" appearance.

Previous infection with HSV 1, reduces transmission of HSV 2

The cell shows HSV infection. The center shows HSV _____ effect. Infected cells become ______ and contain ______ viral inclusions with a characteristic of "ground-glass" appearance.

active infection of HSV 2, decreases the risk of HSV 1

Detection of anti-HSV antibodies in the serum is indicative of? _________

Cutaneous or mucosal lesion caused by poxvirus?

Molluscum contagiosum (poxvirus) is common in young children between ___________

MOLLUSCUM CONTAGIOSUM

Reveals intracytoplasmic viral inclusions.

Dx is made by finding pseudospores or filamentous fungal hyphae in wet KOH

Clinical manifestation

Vulvovaginal pruritus.

Erythema.

Swelling.

Curdlike vaginal discharge.

Your new boyfriend, Dr.Cabrera, complains of yellow, frothy penile discharge, dysuria, and painful intercourse. Soon after you become symptomatic as well. You being the smart medstudent Dx both of you with?

Patients typically present with thin, green-gray, malodorous (fishy) vaginal discharge.

Chlamydia Trachomatis leads to Cervicitis

infection that begins in the vulva or vagina and spreads upward to involve most of the structures in the female genital system, resulting in pelvic pain, adnexal tenderness, fever, and vaginal discharge.

most COMMON cause of PID

What are Puerperal infections?

SALPINGITIS

Pus fills the center of the fallopian tube

SALPINGITIS

Scarring and fusion of the plicae with formation of glandlike spaces. This is considered Acute -or- Chronic?

Image A -or- B?

Basal cell carcinoma can also manifest in the vulva

LINCHNEN SCLEROSUS

There is sclerosis of the superficial dermis, and chronic inflammatory cells in the deeper dermis.

The process of Marsupialization is performed in the presence of acute inflammation (adenitis), which results in an abscess.

Major causes of non-neoplastic leukoplakia?

presents as smooth, white plaques or macules that in time may enlarge and coalesce, producing a surface that resembles porcelain or parchment.

Symptomatic women may develop squamous cell carcinoma of the vulva.

The hyperplastic epithelium may show mitotic activity but lacks cellular atypia.

Wart-like lesions of the vulva may be caused by infection or may be reactive conditions of unknown etiology

Vulvar squamous papillomas are ______ exophytic proliferations covered by nonkeratinized squamous epithelium

consist of papillary, exophytic, treelike cores of stroma covered by thickened squamous epithelium.

Not considered cancerous.

(HINT: Koilocytic Atypia)

BASALOID VULVAR CARCINOMA

Composed of invasive small, immature (basaloid) cells. There is a focus of necrosis (red area)

______ - may be discrete and white (hyperkeratotic) or slightly raised and pigmented.

________ - is characterized by marked atypia of the basal layer of the squamous epithelium and normal-appearing differentiation of the more superficial layers

Well-differentiated, keratinizing squamous cell carcinoma of the vulva (HPV negative) composed of invasive tumor nests with central keratin pearls.

Presumably because of the “breastlike” features, the vulva may be involved by two tumors with counterparts in the breast, ______________ and _____________

all primary carcinomas of the vagina are ______ associated with high-risk HPV infection

Polyploid mass protruding from the vagina.

Found in infants and children younger than 5 years of age.

(HINT: grape-like tumor)

______ - is visible on vaginal examination and is covered by a mature squamous epithelium that is continuous with the vaginal wall.

_______ - lined by columnar, mucus-secreting epithelium.

The point where the squamous and the columnar epithelium meet is

referred to as the _______________

Label the Squamocolumnar Junction

composed of a dense fibrous stroma covered with columnar epithelium.

does not progress directly to invasive carcinoma, and, in fact, most cases regress spontaneously

The diagnosis of SIL is based on identification of ________ characterized by nuclear enlargement, _________ (dark staining), coarse chromatin granules, and variation in nuclear size and shape

More than 80% of LSILs and 100% of HSILs are associated with high-risk HPVs,

with ________ being the most common HPV type in both lesions.

low-grade squamous intraepithelial lesion

Diffuse atypia, loss of maturation, and expansion of the immature basal cells to the epithelial surface

normal squamous epithelium

(choose all that apply)

_____________ - is characterized by proliferation of glandular epithelium composed of malignant endocervical cells with large, hyperchromatic nuclei and relatively mucin-depleted cytoplasm, resulting in a dark appearance of the glands

An invasive nest breaking through the basement membrane of a high-grade intraepithelial lesion.

(HINT: EARLY STAGE)

_____________ - spreads by direct extension to contiguous tissues, including paracervical soft tissue, urinary bladder, ureters (resulting in hydronephrosis), rectum, and vagina.

CERVICAL CARCINOMA

Carcinoma has extended to the pelvic wall. On rectal examination, there is no cancer-free space between the tumor and the pelvic wall. The tumor involves the lower third of the vagina.

CERVICAL CARCINOMA

Carcinoma extends beyond the cervix but not to the pelvic wall. Carcinoma involves the vagina but not the lower third.

An additional important aspect of cervical cancer prevention is vaccination against high-risk oncogenic HPV, which is now recommended for all girls and boys by ______years of age, as well as young men and women up to ____years of age

Cervical LSIL is a productive HPV infection that usually regresses spontaneously but occasionally progresses to _____.

HSIL is characterized by progressive ________ of the cell cycle and increasing cellular atypia. HSIL may progress to invasive carcinoma.

Almost all cervical precursor lesions and cervical carcinomas are caused by high-risk HPV types, most commonly _______

The endometrium undergoes dynamic physiologic and morphologic changes during the _______cycle in response to sex steroid hormones coordinately produced in the _____

Proliferative during Mitosis

Early secretory phase with subnuclear vacuoles

Late secretory exhaustion and predecidual changes

Menstrual endometrium with stromal breakdown

Reduction in cytoplasm and the increase in the nucleus-to-cytoplasm ratio, which occurs as the grade of the lesion increases. This reflects the progressive loss of cellular differentiation on the surface of the lesions from which these cells are exfoliated.

HISTOLOGY OF THE MENSTRUAL CYCLE

The cycle commences with ____, during which the superficial portion of the endometrium, referred to as the ______ is shed.

The endometrial stroma is composed of spindle cells with scant cytoplasm that are also actively proliferating

at _________, endometrial proliferation ceases and differentiation commences in response to the effects of progesterone made by the corpus luteum in the ovary.

at _________, is initially marked by the appearance of secretory vacuoles beneath the nuclei in the glandular epithelium

_________ - in the late secretory phase, due predominantly to ________, are the most significant features.

_________ - down-regulates the expression of estrogen receptor in both the glands and the stroma, and as a result endometrial proliferation is suppressed.

What is the most common cause of abnormal uterine bleeding?

(choose all that apply)

CAUSES OF ABNORMAL UTERINE BLEEDING BY AGE GROUP

(causes)

Dysfunctional uterine bleeding.

Anovulatory cycle.

Anatomic Lesiona (carcinoma, hyperplasia, polyps)

Present in what age group?

Present in what age group?

Anovulatory cycle.

Coagulation disorders.

The most frequent cause of dysfunctional bleeding is anovulation

Failure of ovulation results in ________ endometrial stimulation by estrogens that is unopposed by ________.

Endometriosis is defined by the presence of “ECTOPIC” endometrial tissue at a site INSIDE of the uterus.

What do you see?

Most common sites of endometriosis are within the ___________, but occasionally it is found at distant sites.

Endometriosis commonly results in _________, pelvic pain, and infertility.

Peritoneal and ovarian endometriosis may be a precursor to endometrioid and _________

Endometrial hyperplasia is an important cause of abnormal bleeding and a frequent precursor to the most common type of ____________

Inactivation of the ________ tumor suppressor gene is a common genetic alteration in both endometrial hyperplasias and endometrioid endometrial carcinoma

Endometrial hyperplasia is defined as an ______ in the number of glands relative to the stroma, appreciated as __________, often with abnormal shapes.

It is most commonly caused by unopposed ______stimulation and is an important cause of abnormal vaginal bleeding.

It is divided into typical and atypical hyperplasia based on ____________.

TYPE I & II OF ENDOMETRIAL CARCINOMA

(precursor)

-Hyperplasia

-Serous clear cell mixed mullerian tumor

TYPE I & II OF ENDOMETRIAL CARCINOMA

(clinical setting)

Atrophy and Thin physique.

Unopposed estrogen, obesity, Hypertension, Diabetes.

TYPE I & II OF ENDOMETRIAL CARCINOMA

(Behavior)

Indolent

Spreads via lymphatics

TYPE I & II OF ENDOMETRIAL CARCINOMA

(Mutated Genes)

TP53

PTEN

TYPE I & II OF ENDOMETRIAL CARCINOMA

(age)

65-75

55-65

Endometrial carcinoma is the most common invasive cancer of the female genital tract

Sequencing of the genomes of endometrioid carcinomas has shown that the most common mutations act to increase signaling through the _______pathway

Proliferative Endometrium -> Non-atypical hyperplasia

Aatypical hyperplasia -> Grade 1 uterine endometrioid Carcinoma

Atrophic endometrium -> Serous endometrial intraepithelial carcinoma

Serous endometrial Intraepithelial Carcinoma -> Serous Carcinoma

Endometrial adenocarcinoma presenting as a fungating mass in the fundus of the uterus

Well differentiated (grade 1) endometrioid adenocarcinoma with preserved glandular architecture but lack of intervening stroma.

Moderately differentiated (grade 2) endometrioid adenocarcinoma with glandular architecture admixed with solid areas

Poorly differentiated endometrioid adenocarcinoma with a predominantly solid growth pattern.

Serous endometrial carcinoma is highly associated with disruptive mutations in the ______tumor suppressor gene.

an accumulation of p53 protein in the nucleus.

Serous carcinoma of the endometrium with papillary growth pattern consisting of malignant cells with marked cytologic atypia including high nuclear-to-cytoplasmic ratio, atypical mitotic figures, and hyperchromasia

Strong, diffuse expression of p53 as detected by immunohistochemistry in endometrial intraepithelial carcinoma

Carcinosarcomas (also referred to as malignant mixed müllerian tumors) are mixed ___________and __________tumors

Carcinoma is confined to the corpus uteri itself.

Carcinoma extends outside the true pelvis or involves the mucosa of the bladder or the rectum

Carcinoma extends outside the uterus but not outside the true pelvis

Lymph node metastasis from a carcinosarcoma showing only the epithelial component, as is typically the case.

Micrograph showing both malignant epithelial and stromal component

Stage remains the most important factor in outcome; _________ are much more likely to present at advanced stage and have a decidedly worse prognosis.

Carcinosarcomas are aggressive tumors that resemble ________carcinoma genetically and have _______outcomes with current therapies.

Endometrioid (type ? ) carcinoma is often preceded by atypical hyperplasia and commonly has mutations that upregulate PI3K/ AKT signaling.

Serous (type ? ) carcinoma is associated with serous endometrial intraepithelial carcinoma, and the most common mutations are in TP53. TP53 mutations are also found in precursor lesions

___________ is the most common malignancy of the female genital tract.

Type I tumors are _______and usually indolent; type II tumors are ______ aggressive tumors and have a _____prognosis.

___________ (commonly called fibroid) is perhaps the most common tumor in women

Leiomyoma showing well-differentiated, regular, spindle-shaped smooth muscle cells associated with hyalinization.

The tumor cells are irregular in size and have hyperchromatic nuclei. Numerous mitotic figures are present

Stromal nodules are _____, well-circumscribed tumors.

High-grade _______shows marked atypia and is associated with other gene fusions.

Both low- and high-grade ________are prone to late recurrences.

Leiomyomas are very common benign smooth muscle tumors that cause significant morbidity, but ______prone to malignant transformation.

_______(a malignant smooth muscle tumor) is an uncommon, highly malignant myometrial tumor that usually arises de novo.

___________ - is a complex endocrine disorder characterized by hyperandrogenism, menstrual abnormalities, polycystic ovaries, chronic anovulation, and decreased fertility

Most primary ovarian neoplasms arise from müllerian epithelium.

most ovarian cancers have spread beyond the ovary and fallopian tube by the time of diagnosis.

These cystic neoplasms include the most common malignant ovarian tumors and account for approximately 40% of all cancers of the ovary

Mucinous tumors differ from the serous variety in several ways. The surface of the ovary is rarely involved, and only 5% of _________ and _________ are ______.

_____________ - characteristically demonstrates confluent glandular growth that is now recognized as a form of “expansile” invasion

Mutation of the _____proto-oncogene is a consistent genetic alteration in mucinous tumors of the ovary

15% to 20% of cases, ___________ coexists with endometriosis.

All ovarian carcinomas produce similar clinical manifestations, most commonly ________________ and abdominal enlargement.

Most women with ovarian carcinoma present with high stage disease

Epithelial ovarian tumors are classified into benign, ________, or malignant.

80% of all ovarian epithelial tumors are _____ and occur in _____women. The malignant tumors occur most commonly in _____women and account for approximately 3% of all cancers in women in the United States.

The majority of the malignant epithelial tumors are _________carcinomas, which have a poor prognosis in large part because they are usually detected after they have spread beyond the ovary and/or the fallopian tube

There are three major histologic types of epithelial ovarian tumors: serous, mucinous, and ________, all of which have a benign, borderline, and malignant category.

_______tumors are composed of well-differentiated epithelial cells with minimal proliferation.

_________ tumors show increased cell proliferation, but lack stromal invasion.

________tumors show increased epithelial atypia and are defined by the presence of stromal invasion.

1% of the dermoid cysts undergo malignant transformation, most commonly to ______

Dysgerminoma is the ovarian counterpart of testicular _______

__________are distinguished from mature teratomas by the presence of embryonal or fetal elements, most often consisting of ____________.

Germ cell tumors constitute ________ of ovarian tumors.

The majority are mature cystic teratomas (dermoid cysts) in women of ________.

The remainder occur in young women and children; in these age groups, _________tumors dominate.

Granulosa cell tumors are of clinical importance for two reasons:

These tumors are often functional; they most commonly produce masculinization or defeminization, but a few have estrogenic effects

___________are indolent tumors, but may recur 10 to 20 years after resection of the primary tumor. They are often hormonally active; such tumors are associated with _________, leading to an elevated risk of __________

Fibromas are relatively common benign tumors composed of fibroblasts. They are predominantly _______and are generally hormonally ________.

Pure thecomas are rare but may be hormonally _______.

Sertoli–Leydig cell tumors commonly present with ________; less than 5% recur or metastasize.

Ectopic pregnancy refers to implantation of the fetus in a site other than the normal intrauterine location; the most common site is the _________ (approximately 90% of cases).

Spontaneous abortion, or “miscarriage,” is defined as pregnancy loss before _____weeks of gestation

Tubal pregnancy is the most common cause of _______(blood-filled fallopian tube) and should always be suspected when a tubal hematoma is present

Rupture of a tubal pregnancy is not medical emergency.

Infections in the placenta develop by two pathways:

Preeclampsia is a systemic syndrome characterized by widespread maternal endothelial dysfunction that presents during pregnancy with ______, _______, and _______

(choose all that apply)

Hydatidiform moles are important to recognize because they are associated with an increased risk of persistent _________(invasive mole) or ________

________ - is an infiltrative lesion that penetrates or even perforates the uterine wall.

______comprise less than 2% of gestational trophoblastic neoplasms. They are neoplastic proliferations of ___________, also called___________

__________- usually manifests as irregular vaginal spotting of a bloody, brown fluid. This discharge may appear in the course of an apparently normal pregnancy, after a miscarriage, or after curettage