Summary FEMALE GENITAL PATHOLOGY STUDY FOR EXAMS WITH UPDATES

FEMALE GENITAL PATHOLOGY STUDY FOR EXAMS WITH UPDATES FEMALE GENITAL TRACT PATHOLOGY VULVA: • Most diseases are inflammatory; tumors are rare. • Uncomfortable and annoying rather than serious • Vulvitis: – Dermatitis, contact and allergic – Infections: STDs such as HPV (condyloma accuminatum & VIN); HSV, N. Gonorrhoea, Treponema pallidum. Candida (not STD) – Infection may obstruct glands and cause “Bartholin cyst” CONDYLOMA ACCUMINATUM: • Wart • HPV 6 & 11 • Elevated white plaques • “Koilocytosis” • No progression to cancer CARCINOMA OF VULVA: 90% SQUAMOUS CELL CARCINOMA VAGINAL PATHOLOGY: • Rarely involved by primary disease; more secondary (infections and tumors) • Congenital anomalies are rare: septate or double vagina part of septate uterus; congenital lateral Gartner duct cyst (persistent Wollfian duct rests) VAGINITIS: • Common transient infections • Candida infections (monilial) vaginitis: common in DM, pregnancy, with AB use and immunodeficiency. “White thrush” • Trichomonas vaginalis: parasitic infection, STD, watery , copious gray-green discharge, can be seen on vaginal (& cervical Pap smears) CERVIX PATHOLOGY: • Cervicitis, cervical polyps and cervical cancer • Cervicitis: common, infectious and noninfectious • Infectious: STDs; Chlamydia Trachomatis (most common), Ureaplasma urealyticum, T. vaginalis, N. gonorrhoea, HSV2 and HPV • Pap smear detection after discharge • HSV infection may affect babies if vaginal delivery CERVICAL NEOPLASIA: • Transformation zone (squamocolumnar junction); most common area • Mostly are HPV associated squamous cell carcinoma • HPV tropism for immature sq epithelium • Cervical intraepithelial neoplasia or squamous intraepithelial neoplasia (old name: dysplasia) RISK FOR CERVICAL CANCER: • Early age of first intercourse • Multiple sexual partners • Male partner with multiple partners • Persistent infection with high risk HPV serotypes (HPV 16 & 18) • HPV resides in the DNA of squamous epithelium and replicates   EARLY DETECTION AND THE PAP TEST: • The pap smear remains the most successful cancer-screening test ever developed • Now, cancer death from cervix dropped dramatically (not of top ten) • Smear (specific) morphology and HPV DNA (sensitive) testing are now used (co-testing) • HPV vaccines: quadrivalent (HPV 6, 11, 16, 18) and more (divalent and 9 valent); are promising preventive measures INVASIVE CERVICAL CARCINOMA: • Squamous (75%), adenocarcinoma & adenosquamous (20%), and small cell NEC • All are HPV associated • Increase incidence of adenocarcinoma (better screening and early detection of squamous) • SqCC peak at age 45 (10-15 years after HPV infection) • Risk factors for invasion: smoking and HIV INVASIVE CERVICAL CANCER: • Often seen in unscreened women: vaginal bleeding, leukorrhea, and dyspareunia • Biopsy dx needed before planning trx. • Grading and depth of invasion are important predictors of stage and prognosis • Depth of invasion 3 mm or more • Spread: pelvic lymph nodes and surrounding structures • Trx: radical hysterectomy + lymph node dissection, RT and CT UTERINE PATHOLOGY: • Endometritis: acute (neutrophilic) or chronic (plasma cells) • Can be part of pelvic inflammatory disease (N. gonorrhoeae or C. trachomatis) • TB: granulomatous endometritis in endemic countries (+ TB salpingitis) or immunocompromised patients • Retained POC and IOUCD associated • Fever, abdominal pain and menstrual abnormalities • Dx and trx: biopsy and antibiotics (removal of IUCD and POC) ADENOMYOSIS: