infection of UPPER genital tract
PID
pelvic inflammatory disease
commonest cause of vaginal discharge in women of reproductive age?
Bacterial vaginosis
Cause of bacterial vaginosis
decreased lactobacilli –> increased pH
–> overgrowth of G- anaerobe
**Gardnerella vaginalis
clue cells
bacterial vaginosis
Commonest curable STD in the world:
Trichomona vaginalis
What kind of bug is T. vaginalis?
flagellated protozoan
white plaques resembling curdled milk
Candida albicans
solitary
PAINLESS
ulceration
Syphilis
low risk HPV genotypes
6
11
high risk HPV genotypes
16
18
condyloma acuminatum
genital warts
koilocytic atypia
HPV 6 or 11
HPV 16 or 18 high risk for:
invasive squamous carcinoma
Two types of “Classic” vulvar dermatoses:
- lichen simplex chronica
- lichen sclerosis
**typically appear white (leukoplakia)
vulvar dermatosis
irritated, HYPERPLASTIC skin
lichen simplex chronica
vulvar dermatosi
Atrophic epidermis (thin)
subepidermal edema
lichen sclerosis
commonest tumefication of the vulva
caused by a duct obstruction
Bartholin cyst (Bartholin gland disease)
Mammary like neoplasm
Hidradenoma papilliferum
Wart due to low risk HPV
Condyloma
VIN (vulvar intraepithilial neoplasia)
reproductive age women
Common (HPV) type
VIN (vulvar intraepithilial neoplasia)
no relation to HPV
post-menopausal women
“Differentiated” type
non-squamous vulvar malignancy
post-menopausal white women
high mortality if > 1 mm thickness
Melanoma
intraepithelial adenocarcinoma
post menopausal white women
Extr-mammary Paget’s disease
Polypoid GRAPE-LIKE tumor
infants/young children
Embryonal rhabdomyosarcoma
endoCERVICAL gland mucous retention cyst
Nabothian
BIG association with Cervical carcinoma
HPV > 95%
Area of cervix most susceptible to HPV infection
transformation zone
immature squamous epithelium
CHief sx of endometrial pathology:
abnormal vaginal bleeding
Typical cause of dysfunctional uterine bleeding in reproductive age women:
anovulation due to adequate estrogen but lack of progesterone
–> no luteal phase –> proliferative phase persists no secretory phase or subsequent shedding of endometrium
Chief cause of vaginal bleeding in post-menopausal women:
endometrial ATROPHY
hyperplastic protrusion of endometrium
endometrial polyp
cause of endometrial hyperplasia:
chronic estrogen excess
histologic risk stratifier for progression to cancer in endometrial hyperplasia:
presence of ATYPIA
commonest GYN cancer in developed world:
endometrial carcinoma
major RF for endometrial carcinoma:
unopposed estrogen states
most common type of endometrial carcinoma:
Type 1– arrises from hyperlasia
**good prog
**usually limited to uterus
endometrial CA that arrises from ATROPHY w/no prior estrogen exposure
Type 2
**SEROUS/clear cell carcinoma
**older patients, poor prog
Endometrial CA w/ cartilage, bone, muscle, fat
mixed Mullerian
ectopic endometrial glands adn stroma OUTSIDE of uterine cavity:
endometriosis
“chocolate cyst”
ovarian endometriosis
endometrial glands present within myometrium:
Adenomyosis
Commonest visceral tumor in women:
Uterine leiomyomas
malignant proliferation of SM from myometrium
atypical nuclei
increased mitoses
necrosis
leiomyosarcoma
menstrual irregularity
hyperandrogenism
enlarged ovaries
insulin resistance/diabetes
PCOS
polycystic ovarian syndrome
Majority of ovarian neoplasms arise from which tissue?
ovarian surface– Mullerian epithelium
Two types of epithilial ovarian tumors:
serous
mucinous
marker for following ovarian CA after dx and tx:
CA-125
What must be ruled out in mucinous borderline ovarian tumors:
mets from Appendix
ovarian germ cell tumor containing:
skin/hair
fat
brain
teeth
etc.
Mature cystic teratoma (dermoid cyst)
good marker for malignant germ cell tumors:
hCG
female equivalent of testicular seminoma
dysgerminoma
neoplasm arising from ovarian stromal cells surrounding oocyte:
sex cord/stromal tumors
commonest cause of neoplastic Estrogen excess:
Granulosa cell tumor
large sex cord tumors associated with ascites and pleural effusion
Fibroma/thecoma – “Meig’s syndrome”
signet ring cells
adenoma from stomach
Krukenberg tumor
mucinous peritoneal carcinomatosis
usually from appendix
pseudomyxoma peritonei
Dx for ectopic pregnancy:
serum hCG (less than 50% expected increase)
transvaginal US
new onset HTN and proteinuria in pregnancy
preeclampsia
placenta develops just proximal to or covering cervical os:
placenta previa
RF for placenta previa:
prior hx
prior C-sec
multiple gestations
partial or complete detachment of placenta during pregnancy:
placental abruption
big RF for placental abruption:
severe preeclampsia
Severe complications of placental abruption:
DIC
fetal asphyxia/death
placental villi implantation in superficial myometrium:
placenta accreta
placental villi implantation penetrates into myometrium:
placenta increta
placental villi penetrates through myometrium:
placenta percreta
increased risk for placenta accreta:
prior C-sec
most common cause of PPH (post-partum hemorrhage)
uterine atony
retained placenta
Read up about gestational trophoblstic neoplasms:
AKA: molar pregnancies
slides 295 –>
and pathoma