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This Concept Map, created with IHMC CmapTools, has information related to: Female Lower Genital Tract, Female Genital Tract Vulva Benign Tumors PAPILLARY HIDRADENOMA-most common -like intraductal papilloma of breast -b/c modified apocrine sweat gland -sharply circumscribed nodule -lab majora or folds -ulcerate (like CA) Like sweat gland tumors: -tubular ducts w/ non-cil'd col cells -myoepith cells under epith CONDYLOMA ACUMINATUM-warts -benign raised or wartlike -mostly multiple->coalesce -perineal, vulva, perianal, vag -branching, treelike squamous epith -fibrous stroma -acanthosis, parakeratosis, hyperker, nuclear atypia w/ koilocytosis (HPV) Caused by HPV-6,11 -not precancerous-regress spon'ly, Female Genital Tract Cervix -transforms at menarche -squamous->columnar -if squam->col (EROSION) -can obliterate glands->cysts Inflammations-mostly endocervix BOTH -via gonococci, mycoplasmas, chlamydiae-germinal centers T. vaginalis-epith spongiosis HSV(2)-epith ulcers MORPH-epith spongiosis- -intercellular edema ->leukorrhea ACUTE CERVICITIS -inflam cells, erosion, repair CHRONIC CERVICITIS -can->erosion(squamous)/ulceration then can->dysplasia ENDOCERVICAL POLYPS-2-5% women -innocuous inflam tumors -most in endocervical canal thru os -loose fibromyxomatous stroma -w/ dilated glands ->spotting, Female Genital Tract Vulva More Malignant EXTRAMAMMARY PAGET DZ- also perianal -like breast Paget -pruritic red, crusty, maplike on lab majora -large CLEAR tumor cells in basal epith -mostly confined to epid and appendages ->recur -halo separates from other cells -poor Px w/ ass'd CA (like breast) MALIGNANT MELANOMA-2% of melanomas -10% OF MALIG TUMOR OF VULVA -50-60s -survivalថ% - spreads! -can resemble Paget at first -stains w/ anti-S100 ABs (protein) -no anti-CEA reactivity, no mucopolysaccs, Female Genital Tract Vulva VESTIBULAR ADENITIS -chronic, recurrent, PAIN ->small ulcerations->PAIN -unknown cause Tx-remove affected mucosa, Female Genital Tract Infections PELVIC INFLAMMATORY DZ Gonococcus-most common -Bartholins/other glands ->cervix->tubo-ovarian -adult vag pretty resistant -child-vulvovaginitis -MORPH-inflam after 3-7d -acute supp inflam in muc/submuc -no endometrium involvement -acute supp salpingitis-hyperemic -layered w/ fibrin -can leak out of salpinx -sapingo-oophoritis ->tubo-ovarian abscesses -can spread-> arthritis,purpura -hydrosalpinx w/ proteolytic pus -Tx-resistance - use ceftriaxone Chlamydiae-most common STI Enteric Bacteria-peripartum -C. perfringens, staph, strep -travel from uterus thru lymphatics, not mucosal ->deeper layers-serosa, ligaments -less exudation w/in lumen -bacteremia more freq than gonoc COMPLICATIONS -peritonitis, int obstruction, bacteremia (endocard, mening), -infertility, Female Genital Tract Vulva Non-Neoplastic Epith D/Os LICHEN SCLEROSUS-postmenopause -subepith atrophy, fibrosis, scarring -hydropic degen subepith (hyaline coll) -hyperkeratosis -thinned epidermis, no rete pegs -mononuc infiltate around vessels Causes: genetic, autoimmune, horms ->inc. risk: acute infx, CA LICHEN SIMPLEX CHRONICUS -from scratching an itch - non-specific -SQUAMOUS HYPERPLASIA -epith hyperplasia, hyperkeratosis -mitotic activity in basal/prickle layers -precancerous only if epith ATYPIA =VIN -leukoplakia presentation - Bx all, Female Genital Tract Cervix -transforms at menarche -squamous->columnar -if squam->col (EROSION) -can obliterate glands->cysts 10% Cervical CA include: AdenoCA-endocervical glands Adenosquamous CA -from reserve cells in basal layer Undiff'd CA Clear Cell CA like in vagina, Female Genital Tract Vulva VULVITIS -in conditions affecting hair-bearing skin -psoriasis, eczema, allergic dermatitis -exposure to secretions/moisture -nonspecific causes in: uremia, dyscrasias, DM, malnutrition, Female Genital Tract Infections Lower Genital Tract HERPES SIMPLEX-vulva, vag, cervix -lesions 3-7 days after contact -heal w/in 1-3 wks -latent infx of nerve ganglia -2/3 pts recur - less painful -especially infective while active -red papules->vesicles->ulcers -leukorrhea w/ cerv/vag involvemt -DANGER if transmitted during birth -esp if primary infx or active, Female Genital Tract Cervix -transforms at menarche -squamous->columnar -if squam->col (EROSION) -can obliterate glands->cysts SQUAMOUS CELL CARCINOMA -risks: HPV-16,18, 31, 33 -E6->rapid degradation of p53 -E7->binds RB gene -occurs at any age-can be detected early-PAP MORPH-3 types-fungating*, ulcerating, infiltrative Spreads via direct continuation, LNs, distant->liver, lungs, marrow 95% w/ large cells, keratinizing or non -few are small cell squamous or undiff'd (neuroendocrine, oat cell CA)-HPV 18 Stage I-confined to cervix-?microinvasion II-beyond cervix, upper 2/3 vagina III-to pelvic wall, lower 1/3 vagina IV-extend beyond pelvis, hits bladder, rectum CLINICAL-white patches early -when overt-bleeding, leukorrhea, pain, dysuria -Stage IV-death via urinary obstruction->uremia Prevention - HPV vaccine Tx-cryoTx, laser, wire loop, hysterectomy, XRT, Female Genital Tract Vulva BARTHOLIN GLAND -acute infx->inflam->abscess -infx->obstruction->CYST -3-5 cm diameter -transitional epith (NL) -or squamous metaplasia ->pain, discomfort Tx-excise or marsupialization, Female Genital Tract Vulva VULVAR VESTIBULITIS -inflamed surface mucosa and vestib glands -posterior introitus -small glands in the submucosa -chronic pain in this area- vulvodynia -chronic, recurrent PAIN -involves the glands and mucosa ->produces small ulcerations ->extreme point tenderness -cause unknown Tx-surgical removal of inflamed mucosa -VV, Female Genital Tract Cervix -transforms at menarche -squamous->columnar -if squam->col (EROSION) -can obliterate glands->cysts CERVICAL INTRAEPITH NEOPLASIA -discovered by PAP smear -ass'd w/ HPV -not necessarily going to ->CA -can enter at any CIN phase CIN I-mild-include condyloma acum -koilocytosis-w/ HPV DNA CIN II-koilocytosis in basal layers -anioskaryosis (nucs not same size) -mitotic figures -still diff'ates towards top CIN III-CA in situ-all immature atypia -no surface diff'tion =stage 0 SqCC Begins at squamocol jcn, Female Genital Tract Vagina CONGENITAL ANOMALIES Atresia, absence-VERY RARE Septate/Double-w/ incomp fusion -w/ uterus didelphys Gartner Duct cysts-pretty common -from Wolffian Duct rests -lateral walls of vagina Mucous cysts in proximal vag -mullerian epith, Sq metaplasia Endometriosis-mullerian-derived, Female Genital Tract Vagina Premalignant/Malignant -reproductive age -insidious growth->diff to cure Extension of cervical CA more common VAGINAL INTRAEPITH NEOPLASIA/SqCC -most ass'd w/ HPV -risk-CA in cervix or vulva -upper posterior vagina -epith thickened, dysplastic, plaque -Mets to inguinal or iliac(upper1/3) nodes -Pt-irreg spotting or leukorrhea, fistulas ADENOCARCINOMA-anterior wall -Clear cell adenoCA -15-20yo - MOM had used DES -vacuolated, glycogen-containing cells -precursor: vaginal adenosis (muller. epith) EMBRYONAL RHABDOMYOSARCOMA ɝyo KIDS -"SARCOMA BOTRYOIDES" -polypoid, rounded, bulky, GRAPELIKE -small cells, oval nuclei-tennis racket-like -crowded cambium layer, loose fibromyxomatous -surgery+CTX works -can invade peritoneal cavity, urinary->death, Female Genital Tract Vulva Malignant CARCINOMA-1/8 as common as cervical -2/3 in ᡴyo - OLD WOMEN -85% SqCC 1. HPV-ass'd - preceded/ass'd w/ VIN 2. ScC hyperplasia/Lichen Sclerosus ass'd -DIFFERENTIATED - keratinized -unknown cause, worse Px than (1) -p53 mutation -more invasive w/ keratinization MORPH-firm, indurated, exophytic -pain, pruritus, exudation (2ndary infx) -high mort w/ LN involvement Rare-VERRUCOUS CA-fungating -like condy acum, but local invasion -good Px-just remove VULVAR INTRAEPITH NEOPLASIA 1-3 -carcinoma in situ, Bowen dz -nuc atypia, mitoses, no surface diff'tion -like cervical lesions -LEUKOPLAKIA -women មyo - HPV-16,18 -often multicentric -risk to ->CA w/ age, immunosupp'd, Female Genital Tract Infections MYCOTIC, YEAST (CANDIDA) INFX -10% of women are carriers of fungi -risk: DM, BCP, pregnancy -MORPH-small, white patches -pruritus, leukorrhea TRICHOMONAS VAGINALIS-protozoa -15% of women in STD clinics -purulent discharge, discomfort -fiery red "strawberry" cervix -inflam in mucosa & lamprop only MYCOPLASM spp.- -> spontaneous abortion ->chorioamnionitis GARDNERELLA-gram(-) bacillus -vaginitis cause when no other found -most common cause of vag discharge -fishy smell