Glossary of BLock VII, WeekIV

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Which STD am I?
- small vesicles on vulva that erode to ulcers
- ds DNA virus
- 1-3 wk. incubation period
which three things are candida associated with?
1. diabetes mellitus
2. OCs
3. Pregnancy
which STD is a flagellated ovoid protozoa that has the hallmark symptom of a "strawberry cervix?"
Trichomonas vaginalis
causative agent of syphilis?
Treponema pallidum (spirochete)
mode of transmission of syphilis from mother to fetus?
describe the primary stage of syphilis
chancre (2-6 wks)
describe the secondary stage of syphilis
- appears weeks to months later
- erythemous and macropapular rash
- heals in 2-6 wks
describe the tertiary stage of syphilis
- CV/nervous system damage
- obliterative endocarditis
- CNS damage (tabes dorsalis)
which stain is used to see Treponema pallidum spirochetes?
Warthin-Starry stain
Causative organism of gonorrhea?
Neisseria gonorrhoeae
(gram - diplococcus)
female acute symptoms of gonorrhea?
- salpingitis
four complications of PID?
1. peritonitis
2. adhesions
3. bacteremia
4. infertility
causative agent of chancroid?
Haemophilus ducreyi
(gram neg. bacillus)
common complication of chancroid?
scar formation causing urethral stenosis
causative agent of Lymphogranuloma venereum?
Chlamydia trachomatis
describe the three stages of lymphogranuloma venereum
1. stage one: vesicle
2. stage two: enlarged lymph nodes: may form fistula
3. stage three: scarring, genital elephantiasis, rectal strictures (years later)
causative agent of granuloma inguinale?
Calymatobacterium granulomatis
(gram neg. encapsulated rod)
presentation of granuloma inguinale?
ulcerated painful nodules in genital, inguinal, perianal regions
Gardnerella is caused by? and associated with?
Gardnerella vaginalis
associated with BV
what causes the fishy odor present in a gardnerella infection?
mixing of vaginal discharge with 10% KOH (alkalinizes)
which STD is histologically associated with Clue cells?
Gardnerella (BV)
What are Donovan bodies and which STD are they associated with?
- Donovan Bodies are macrophages that have "swallowed up" bacteria.
- associated with granuloma inguinale
a gynecological mycoplasma infection is associated with? (4)
spontaneous abortion
puerpural fever
what type of bacteria is Chlamydia trachomatis?
Gram negative intracellular rickettsia
symptoms seen in men with chlamydia?
none (asymptomatic)
common complication of Chlamydia?
describe TB as a female genital tract infection
pyosalpinx and hydrosalpinx
TB endometritis in 1/2 of cases
What is actinomycosis associated with?
causative agent of actinomycosis?
Actinomyces israelii
(gram pos rod)
histological characteristic of actinomycosis?
sulfur granules
which parts of the female reproductive tract does actinomyces israelii infect? (3)
uterine tube
broad ligament
which bacteria is responsible for TSS?
strains of Staph aureus
TSS is connected with what 2 things?
tampon use
contraceptive sponge use
in the pathogenesis of PID, gonococcal inflammation begins where?
Bartholins glands
(then spreads up to tubes and ovaries)
How does a gonococcal infx. differ from a non-gonococcal infx. (3)
1. gonococcal infections spare the endometrium, non-gonococcal infections don't.
2. non-GC causes have less exudate but deeper inflammatory response
3. bacteremia more common with non-GC PID
pathogenesis of PID starting at acute suppurative salpingitis?
acute suppurative saplingitis -> salpingo-oophoritis -> tubo-ovarian abcess -> pyosalpinx -> adhesions -> hydrosalpinx
5 possible complications of PID?
1. peritonitis
2. adhesions
3. obstruction
4. bacteremia
5. infertility
what causes a Bartholin cyst?
an obstructed Bartholin's duct
which three bacteria are Bartholin cysts associated with?
1. Staph
2. Chlamydia
3. Anaerobes
in what age group is lichen sclerosis most common?
what is lichen sclerosis associated with?
other autoimmune disorders
which disorder is hyperplastic dystrophy and secondary to pruritis (itching and rubbing)?
Lichen Simplex Chronicus
what is the site of origin in hidradenoma?
aprocrine sweat glands
where do hidradenomas MC appear?
labia majora
are hidradenomas benign or malignant?
what is condyloma acuminatum and what is the MCC?
wartlike lesions
HPV types 6 and 11 are MCC
is condyloma acuminatum precancerous?
(they regress spontaneously)
Most common endometrial carcinoma?
endometriod adenocarcinoma
in the vulva: nuclear atypia in epithelial cells forming a precancerous lesion is known as?
VIN (Vulvar Intraepithelial Neoplasia)
four characteristics of high-grade dysplasia?
1. Increased N/C ratio
2. Loss of polarity (cells become crowded)
3. Mitoses
4. Hyperchromatic nuclei
which two strains of HPV are associated with VIN?
gross presentation of VIN?
white or pigmented plaques on vulva, multicentric presentation
two scary things about VIN?
1. 25% reoccur after excision
2. associated with other squamous neoplasms in lower reproductive tract
in older women, VIN can progress to become?
Squamous Cell Carcinoma (SCC)
2/3 of genital SCCs occur in which age group?
over 60 yrs
verrucous and basal cell carcinomas are variants of SCC: how often do they metastasize?
what exactly is desmoplastic stroma?
reaction of the surrounding stroma to cancer. HARD and fibrinous
extramammary Paget Disease is confined to which parts of the vulva and perianal area? (3)
hair follicles
sweat glands
How does extramammary Paget's differ from mammary Paget's?
mammary Paget's - due to an underlying malignancy
extramammary Paget's - confined
if you are considering a diagnosis of Paget's you also must consider which diagnosis?
prognosis of malignant melanoma?
very aggressive, prognosis is related to depth of invasion
what is the molecular difference between malignant melanoma and Paget's?
1. S100 positive
2. CEA negative
Vaginal Adenosis is associated with?
1. in utero DES exposure
2. increased risk of Clear Cell Carcinoma
where are the tumors of vaginal adenosis most often located?
on the anterior wall
is vaginal adenosis benign or malignant?
treatment for vaginal adenosis?
surgery and radiation
VAIN is associated with? (risk factors for VAIN)?
1. HPV
2. immunosuppression
3. irradiation
4. in utero exposure to DES
5. squamous neoplasia elsewhere in the lower reproductive tract.
VAIN can progress to?
Vaginal Squamous Cell Carcinoma
Vaginal Squamous cell carcinoma is most common in women of what age?
60-70 yrs
what comprises 90% of malignant vaginal CA?
Squamous cell carcinoma
what is a rare vaginal tumor of childhood that is a polypoid mass resembling a bunch of grapes?
Embryonal Rhabdomyosarcoma
other name for embryonal rhabdomysarcoma?
Sarcoma Boytroides
Embryonal Rhabdomyosarcoma consists of what cell type?
primitive spindle rhabdomyoblasts
Embryonal Rhabdomyosarcoma is seen in what age group?
girls less than 4yrs
how is an Embryonal Rhabdomyosarcoma fatal?
can invade locally and cause death by penetrating the peritoneal cavity
treatment for Embryonal Rhabdomyosarcoma?
in the cervix: where does metaplastic transformation occur?
transformation zone
Describe the Schiller iodine test
stains glycogen rich cells brown
glycogen poor cells don't stain
(dysplasia doesn't stain)
describe the change in the location of the transformation zone as you age.
prepubertal - inside cervix
adolescent/early adult - moves outside cervix
postmenopausal - moves back inside cervix
how does an endocervical polyp present?
vaginal bleeding or discharge
are endocervical polyps common?
yes, they are the most common cervical growth
describe the histology of microglandular hyperplasia
closely packed glands with no intervening stroma(a cluster of benign glands)
microglandular hyperplasia is associated with an excess of which hormone?
What are the risk factors for cervical neoplasia? (8)
1. early age of first intercourse
2. multiple sexual partners
3. increased parity
4. male partner with multiple previous partners
5. HPV
6. certain HLA and viral subtypes
7. OCs and nicotine
8. genital infections (chlamydia)
In what type of CIN are koilocytes most often present?
low grade CIN
CIN may progress to?
carcinoma in situ
what is the average time for all grades of dysplasia to progress to carcinoma in situ?
10 yrs
CIN is classified as a?
(because it is so strongly associated with HPV)
at what age does Squamous cell carcinoma of the cervix most often appear?
40-45 yrs
(younger age)
in what 3 ways does SCC of the cervix present?
what defines a microinvasive carcinoma?
no greater than 3mm and no wider than 7mm
how does SCC of the cervix spread?
via lymphatics and direct spread
what is the most common cause of death in SCC of the cervix?
renal failure
are most cervical SCCs well or poorly differentiated?
most are well differentiated
(5% poorly diff./worst prognosis)
in the cervix - an intraepithelial proliferation of columnar (glandular) cells is called?
Adenocarcinoma in situ (AIS)
in 40% of cases, AIS is associated with?
high grade CIN
AIS can progress to?
Invasive adenocarcinoma
(worse prognosis)
Invasive adenocarcinoma looks like?
No stroma, back to back glands
what type of glands would you see in the uterine lining during the proliferative phase?
round glands
multiple layers of cells
what type of glands would you see in the uterine lining during the secretory phase?
coiled glands
single layer of cells
what is characteristic of the histology seen in the menstrual phase?
neutrophils in the stroma
what is a characteristic feature of the uterine lining on day 3 post-ovulation?
subnuclear vacuolization
what is the Arias-Stella reaction?
a benign exxagerated hypersecretory response associated with hCG.
Histological characteristic of the Arias-Stella reaction?
Bulbous nuclei protrude into the gland lumen
when is the Arias-Stella reaction seen?
1. intrauterine pregnancy
2. ectopic pregnancy
3. trophoblastic disease
5 Congenital anomalies of the uterus?
1. agenesis
2. uterus didelphys
3. uterus duplex bicornis
4. bicornate uterus
5. Uterus septus
4 congenital anomalies of the vagina?
1. atresia
2. septate or double vagina
3. Gartner duct cysts
4. imperforate hymen
MC cause of uterine bleeding?
anovulatory cycle
what two times in a woman's life is DUB most common?
which hormone is DUB most often attributed to?
excess estrogen
(promotes building up of endometrium but no sloughing)
DUB due to an inadequate luteal phase often manifests as?
why is there DUB seen with OCs?
there is a discordance between glands and stroma.
(glands are small and round, stroma is decidualized)
a condition involving inflammation of the endometrium and inflammed endometrial glands is called?
Histologically, how can one differentiate between inflammed endometrium and menstrual endometrium?
menstrual endometrium has tortuous glands, whereas the glands seen in endometritis are most commonly proliferative (round).
Histologically, how can one differentiate between acute endometritis and chronic endometritis?
acute - see neutrophils
chronic - see plasma cells
Acute endometritis usually results from?
ascending infection in the cervix (abortion, delivery, instrumentation)
chronic endometritis usually results from/is associated with?
retained products of conception
in endometritis, pyometria is seen when what happens?
cervical stenosis (blocks drainage, get pus in uterus)
define endometriosis
the presence of endometrial glands or stroma in abnormal locations outside the uterus.
what are the top four locations of endometriosis in descending order of frequency?
retrovaginal septum
pelvic peritoneum
three hallmark s/s of endometriosis?
pelvic pain
what is the age group of women most afflicted with endometriosis?
3rd and 4th decade
(affects 10% of these women)
a benign overgrowth of endometrial glands and stroma is called?
endometrial polyp
do endometrial polyps slough during menstruation?
hallmark presenting symptom of endometrial polys?
intermenstrual bleeding
two types of endometrial polyps?
1. functional (looks like surrounding endothelium)
2. hyperplastic (lots of glands)
a benign polyp may progress to?
which drug have endometrial polyps been associated with?
tamoxifen (anti-estrogenic)
define endometrial hyperplasia
hyperplasia of the endometrial glands
endometrial hyperplasia may progress to?
endometrial carcinoma
time frame of the progression of endometrial hyperplasia to endometrial carcinoma?
4-10 yrs
what is the simple most prognostic feature used in endometrial hyperplasia?
cytologic atypia
what do the glands look like in endometrial hyperplasia?
mostly proliferative (round)
which hormone excess is endometrial hyperplasia linked to?
besides excess estrogen: endometrial hyperplasia is associated with what other conditions? (4)
1. menopause
3. granulosa cell tumors
4. cortical stromal hyperplasia
genetic link to endometrial hyperplasia and further progression to endometrial carcinoma?
inactivation of PTEN tumor suppressor gene
three categories of endometrial hyperplasia?
1. simple hyperplasia
2. complex hyperplasia
3. atypical hyperplasia
describe the histological characteristics of:
1. simple hyperplasia
2. complex hyperplasia
3. atypical hyperplasia
1. round glands, minimal complexity and crowding, no cytologic atypia
2. branching glands, more glandular crowding, no cytologic atypia
3. branching glands with nuclear atypia, crowded (little intervening stroma)
about what % of patients with atypical endometrial hyperplasia develop adenocarcinoma?
what are the two treatments for endometrial hyperplasia?
1. progestins
2. hysterectomy (esp. if atypical hyperplasia)
what is the 4th most common cancer in women and the most common gynecological cancer?
endometrial adenocarcinoma
which age group of women are most afflicted by endometrial adenocarcinoma?
postmenopausal women
(median age 63 yrs)
risk factors for endometrial adenocarcinoma?
1. obesity
2. diabetes
3. hypertension
4. infertility
5. prolonged estrogen stimulation (nulliparous, anovulatory cycle)
endometrial adenocarcinoma is associated with an increased risk of what 2 other cancers?
genetic influence in the development of endometrial adenocarcinoma?
inactivation of PTEN gene
describe the FIGO grading differentiation for endometrial adenocarcinoma.
Grade 1: well differentiated, minimal solid areas
Grade 2: moderately differentiated, <50% solid tumor
Grade 3: poorly differentiated, >50% solid tumor
*also, significant nuclear atypia increases grade*
what are the two strains of endometrial adenocarcinoma that have a worse prognosis?
Papillary serous carcinomas and clear cell carcinomas
*automatically considered a grade 3*
#1 presenting symptom of endometrial carcinoma?
vaginal bleeding
an endometrial cancer with malignant stroma AND glands is called?
two former names for carcinosarcoma?
mixed mesodermal tumor
mullerian tumor
carcinosarcomas are derived from what cell type?
multipotential stromal cells
(stroma may differentiate to muscle, cartilage, bone)
when a carcinosarcoma metastasizes it becomes an?
carcinosarcomas are associated with what environmental exposure?
previous radiation therapy
endometrial cancer characterized by benign glands and malignant stroma?
adenosarcomas are most commonly seen in which age group of women?
why is an oophorectomy a treatment for adenosarcomas?
tumor is estrogen sensitive
recurrence rate of adenosarcoma?
are adenosarcomas benign or malignant?
low grade malignant
what is a stromal nodule?
a benign, well circumscribed lesion of endometrial stromal cells located in the myometrium
stromal nodules may progress to?
stromal sarcoma
(rare cancer)
describe a stromal sarcoma
neoplastic endometrial stroma invading muscle bundles of myometrium
mode of metastases in stromal sarcoma?
lymphatic channels
(15% of cases die from metastases)
genetics of stromal sarcoma?
1. translocation t(7;17)(p15;q21)
2. fusion of JAZF1 and JJAZ1 genes
*produces fusion transcript and protein*
what is the most common benign tumor of the female genital tract?
Leiomyomas (fibroids)
how common are leiomyomas?
seen in 75% of females at reproductive age
describe the genetics of leiomyomas
each leiomyoma is monoclonal
which hormone promotes leiomyoma growth?
presenting s/s of a leiomyoma? (4)
1. abnormal bleeding
2. urinary frequency
3. pain
4. infertility
can leiomyomas become malignant?
(usually the benign variant metastasizes to the lung or peritoneum)
treatment for leiomyomas?
myomectomy or hysterectomy
a uterine malignancy of smooth muscle origin is called?
histological characteristics of leiomyosarcoma?
irregular borders
cell atypia
increased mitoses
age group most commonly afflicted with leiomyosarcoma?
>50 yrs
5 year survival rate of leiomyosarcoma?
inactivation of PTEN associated with?
endometrial hyperplasia
endometrial adenocarcinoma
fusion of JAZF1 and JJAZ1 genes associated with?
Stromal Sarcoma
excluding HIV: acute manifestations/symptoms of STDs can be classified in to what three categories?
1. discharge
2. ulcers
3. warts
which two STDs are notorious for causing cervicitis and urethritis?
two STDs responsible for vaginal discharge?
Trichomonas vaginalis
STDs that cause genital ulcers? (5)
1. Syphilis
2. Genital Herpes
3. chancroid
4. lymphogranuloma venereum
5. granuloma inguinale
STD causing warts or papillomas?
two STDs causing PID?
causative bacteria of chancroid?
Haemophilus ducreyi
causative bacteria of granuloma inguinale?
Calymmatobacterium granulomatis
what type of bacteria is Neisseria gonorrhoeae?
gram negative diplococci
besides N. gonorrhoeae, only other gram neg. diplococci?
major reservoir for gonorrhea?
mainly asymptomatic males
group at highest risk for contracting gonorrhea?
young females (teens and early 20s)
metabolism of N. gonorrhoeae?
prefers increased levels of CO2
requires chocolate agar to grow
2 lab diagnostic tests for N. gonorrhoeae?
1. nonmotile
2. oxidase positive
Virulence factors of N. gonorrhoeae? (5)
1. endotoxin (lipooligosaccharide)
2. pili
3. peptidoglycan
4. binding of blocking antibodies
5. IgA1 protease
describe the endotoxin found in N. gonorrhoeae
lopooligosaccharide (shorter saccharide chain than LPS)
still displays lipid A toxicity
functions of pili as a virulence factor for N. gonorrhoeae? (2)
1. avoid phagocytosis
2. adhesion
reason for binding of blocking antibodies as a virulence factor for N. gonorrhoeae?
block so that bactericidal antibodies can't bind
function of IgA1 protease as a virulence factor for N. gonorrhoeae?
degrades IgG, IgA1, IGA2 (Ig's found in genital secretions)
function of peptidoglycan as a virulence factor for N. gonorrhoeae?
induces TNF-a, leading to sloughing of ciliated cells
3 surface components changed by N. gonorrhoeae to evade the immune system?
1. lipooligosaccharide
2. Opa proteins
3. Surface pili
how does lipooligosaccharide help N. gonorrhoeae to evade the immune system? (2)
1. has LOS instead of LPS, therefore compliment can't bind & kill
2. Neisseria binds to sialic acid on LOS. this blocks C3b deposition and makes bacteria look like a RBC
what is notable about sialated strains of N. gonorrhoeae?
because they look like RBCs they are more likely to lead to disseminated gonococcal infections (DGI). called serum resistance
describe opa proteins in their relationship to helping N. gonorrhoeae evade the host immune system
opa (opacity related proteins) cause the bacteria to look opaque. They allow the bacteria to not get engulfed by neutrophils and make an infection more likely to lead to DGI and PID
in relation to genetics, how are opa proteins expressed on the surface of N. gonorrhoeae?
switching occurs. there is a phase variation that results in varied expression of the gene(and new protein expression)
how many opa genes are there total in N. gonorrhoeae?
(variable number are expressed)
how is antigenic variation acheived in the surface pili of N. gonorrhoeae
recombinant exchange leads to formation of different pili allowing N. gonorrhoeae to evade the immune response.
two types of pili genes seen in N. gonorrhoeae?
1. pilE (expressed)
2. pilS (silent)
pili and/or opa facilitate the attachment of N. gonorrhoeae to nonciliated columnar epithelial cells. What surfaces, specifically, do pili bind to? (5)
1. urethra
2. vagina
3. fallopian tube
4. sperm
5. neutrophils
pili and/or opa facilitate the attachment of N. gonorrhoeae to nonciliated columnar epithelial cells. What surfaces, specifically, do opa proteins bind to?
1. cervix
2. urethra
3. adhesion to other gonococci
association between gonorrhea and HIV?
gonorrhea associated with increased transmission of and susceptibility to HIV (incr. shedding of HIV particles in gonorrhea infx.)
Hallmark symptom of men with gonorrhea?
painful, purulent discharge
two locations of infections in a male with gonorrhea?
1. urethritis
2. epididymitis
what is the primary site of a gonorrheal infection in a female?
endocervical canal
s/s of a female gonorrheal infection?
*most asymptomatic*
vaginal discharge
urinary frequency
abdominal pain
menstrual abnormalities
three other locations of local gonococcal infections?
1. rectal
2. pharyngeal
3. conjunctiva
4 primary features of DGI?
1. fever
2. migratory polyarthralgia
3. rash
4. skin lesions
four metastatic gonococcal infections?
1. purulent arthritis
2. perihepatitis
3. endocarditis
4. meningitis
what is the most frequently reported STD in the US?
(~3 million cases annually)
why are beta lactams ineffective in treating chlamydia?
chlamydia has no peptidoglycan
is chlamydia trachomatis intracellular or extracellular?
OBLIGATE intracellular pathogen
(unable to synthesize ATP)
what are the two forms of Chlamydia in its replication cycle?
EB (elementary body) - nonreplicating, infectious
RB (reticulate body)- replicating, noninfectious
5 steps in the developmental cycle of Chlamydia?
1. EB attaches to epithelial cell
2. EB enters via endocytosis
3. EB differentiates to RB
4. RB condenses and forms EB
5. cell ruptures, releases EB
Describe the replication of the RB form of Chlamydia in the host cell.
- RB uses ATP from host
- replicates in vacuole
- forms large cytoplasmic inclusions
what virulence factor does chlamydia produce that induces cytokines?
toxic principle
function of the unique cell wall structure of Chlamydia trachomatis?
inhibits phagolysosome fusion
three main classes of serotypes of Chlamydia?
1. endemic trachoma (A and C)
2. STDs and inclusion conjunctivitis (D and K)
3. lymphogranuloma venereum (L1, L2, L3)
perinatal transmission of chlamydia results in?
neonatal conjunctivitis
in men, a chlamydia infection most commonly presents as what?
*MC symptom is non-gonococcal urethritis (NGU)*
two common complications of chlamydia infections in men?
1. unilateral epididymitis
2. Reiter's Syndrome (post-inflammatory immune response following infection)
does Reiter's syndrome occur in women?
two most common manifestations of chlamydia in women?
*most women with these remain asymptomatic*
which diagnostic test for Chlamydia also tests for gonorrhea?
(detect chlamydial ribosomal RNA - NA probe)
advantage of using ligase chain reaction (LCR) in testing for chlamydia?
can detect in first void urine
which serovars of Chlamydia trachomatis cause lymphogranuloma venereum (LGV)?
the invasive serovars (L1, L2, L3)
compare the presentation of LGV in females vs. males.
females - mostly asymptomatic (can be reservoirs)
males - more likely to have clinically evident infection
How does LGV spread?
spreads via lymphatics
describe the 3 stages of LGV
1. First - small, painless ulcer or papule
2. Second - painful regional lymphadenopathy (buboes), systemic sx.
3. Third - fever, chills, arthralgia, rectal pain, mucopurulent or bloody discharge
in order to diagnose LGV, what must be excluded? (2)
which method is used to diagnose LGV?
serology (PCR most sensitive)
How is syphilis transmitted?
sexually - by direct contact with a primary or secondary lesion.
in what sex and age group is syphilis most common in?
middle aged men
what type of bacteria is treponema pallidum?
gram neg. spirochete
(but NO LPS)
describe the culturing conditions of treponema pallidum
has never been grown on artificial medium
- motile
- microaerophilic (1-4% O2)
two virulence factors for treponema pallidum?
1. surface associated hyaluronidase (aids in tissue destruction and spread)
2. outer membrane weakly antigenic (b/c no LPS)
where does syphilis migrate to and replicate?
subepithelial tissues
how does syphilis enter the systemic circulation?
via the lymphatics
what stage of syphilis is a chancre considered?
what causes a chancre?
cellular defenses at the site of replicating treponemes
what causes secondary syphilis?
systemic spread (2-10wks after chancre)
what causes tertiary syphilis?
tissue destruction caused by host response to presence of treponemal antigens
are chancres infectious?
YES - highly infectious
in what stage of syphilis are condylomata lata seen and what are they?
seen in secondary syphilis
they are highly infectious grey, flattened, wartlike lesions
what is unusual about the rash seen in secondary syphilis?
it is a whole body rash (even on palms and soles)

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