OBGYN PATHO 6

Neisseria gonorrhea

gram negative organism, known to cause PID

Chlamydia trachomatis

Atypical intracellular bacterium

infects epithelial cells —> infection

urine tests and swabs from genital sites

Syphilis

treponema pallidum

sexual and congenital transmission

serologic testing

(+ patient history ofc)

diagnosis of syphilis?

Primary stage of syphilis

single papule undergoes ulceration —> painless chancre

highly contagious

Secondary stage of syphilis

occurs in 25% of untreated syphilis

• rash (involving trunk, extremities, palms and soles of feet)

• highly contagious

Lues maligna

more severe ulcerative form of secondary syphilis

seen in in patients with HIV

secondary syphilis

moth eaten appearance of patchy, scalp hair loss is associated with?

Latent syphilis

contagious, but less than other stages of syphilis (early)

not considered infectious to sexual partners (late)

gumma formation

macrophages attempting to control the disease in untreated syphilis leads to?

Neurosyphilis

rare complication

can occur at any stage

CNS infection

Argyll Robertson pupil

no pupil constriction to light, but constricts for focusing on other obejcts

Neurosyphilis

Argyll Robertson pupil is a sign of?

Exocervix

visible portion of the cervix

Endocervical canal

lined with columnar epithelial cells that produce and secrete mucus

Nabothian cysts

• small, dome shaped nodules that are either translucent or opaque

• caused by trapped mucus in mucosal glands

• benign, most don’t require tx

• RARELY grow large, so they don’t cause obstruction of the cervix

menarchial

A

Age

Location of the squamocolumnar junction (SCJ) varies by?

Menstruating

B

Menopausal

C

Postmenopausal

D

Transformation Zone

where columnar epithelium is being replaced by squamous epithelium (squamous metaplasia)

Transformation Zone

Area most likely to develop into cancer

Transformation Zone

Located between the original SCJ and the new SCJ

Cervical Cancer

readily detected

if detected early —> most easily cured of all reproductive cancers!

ages: 35-44, avg age 50

HPV vaccine

Rates declined in women 20-24, possibly reflecting signs of cancer prevention from what?

Cervical Cancer risk factors

early age at first intercourse

multiple sexual partners

smoking

Hx of STI’s

WSW due to delayed screening

Cervical cancer

Evidence suggests a causal ling between HPV infection and what cancer?

Gardasil

Prevents infetion with HPV subtypes 16, 18, 6 and 11

condyloma accuminata (genital warts)

HPV subtypes 6 and 11 and MC associated with?

HPV 16 and 18

Which 2 HPV strains are responsible for 70% of cervical cancer?

HPV 6 and 11

Two most common benign strains, account for 90% of genital warts

5 years

HPV testing is recommended every?

cervical dysplasia

65 year old with no hx of ——- ——- and the following

can discontinue screening:

• 3 neg pap test results

• 2 neg HPV tests in a row

• 2 neg co-test results in a row within the past 10 years

3 years

Cytology alone every?

5 years

HPV testing plus cytology every?

Primary testing

HPV testing alone, without cervical cytology

Co-testing

HPV and cytology are collected, and results are provided together

Reflex testing

HPV testing performed automatically on a sample when the cytology result returns positive for atypical squamous cells of undetermined significance

Self collection

When access to a speculum examination is limited or for those who are reluctant to undergo a pelvic exam, —— may be used for select HPV tests

Transformation zone

critical area of development of cervical cancer

Carcinoma

Untreated dysplasia can develop into ?

Metaplasia

During ——, newly developed squamous epithelial cells are vulnerable to development of dysplasia

• (reason behind why transformation zone is associated with cancer development)

Colposcopy

follows an abnormal pap test and involves a biospy

premenopausal

Presence of endometrial cells is NORMAL in?

postmenopausal

Presence of endometrial cells is ABNORMAL in

ASC- US (atypical squamous cells of undetermined sginificance)

Most common abnormal pap smear finding? (1 in 15 tests)

cells did not look normal but did not meet criteria for lesion

cancer is unlikely

What are ASC-US?

Repeat pap smear in 6-12 months

If it persists —> colposcopy

If you find ASC-US, how to proceed with care?

Dysplasia

Term for disordered growth of development of cell

Low grade intraepithelial lesions (LGSIL)

• mild dysplasia on surface of cervix

• minor abnormalities observed

• often CIN I on biopsy

High grade squamous intraepithelial lesions

(HGSIL)

• more severe, higher cancer risk

• associated with CIN 2 or CIN 3

• colposcopy

CIN I

• mild dysplasia or atypical changes

• well differentiated

• initial 1/3 of epithelial layer is involved

CIN II

• moderate dysplasia

• initial 2/3 of epithelial layer

• less well-differentiated lesion

CIN III

severe dysplasia

carcinoma in situ

full-thickness involvement

undifferentiated lesion

squamous cell carcinomas

90 % of cerivcal cancers are ?

Glandular lesions

• atypical glandular cells (AGC)

• less common

• needs investigation for glandular intraepithelial neoplasm (GIN) or adenocarcinoma

Koilocytes

abnormal squamous epithelial cells

characterized by a clear, halo-like area (perinuclear

vacuole) surrounding a dense, often hyperchromatic nucleus

Koilocytes

Which cells are strongly associated with HPV?

Abnormal patterns of cell division

Abnormal mitotic figures = ?

Pleomorphism (aka aniskaryosis)

variability in size and shape of cells and their nuclei

Methods for diagnosing cervical cancer

Pap smear (demonstrating SIL)

Colposcopy

Biopsy sample

cervix, vagina, and vulva

In colposcopy:

• Colposcope is used to examine the —-, —- and —-

colposcopy

---

has significant interperformer variability and poor reliability

Methods of removing lesion for early treatment of cervical cancer

• Local cautery

• Electrocautery, cryosurgery, or carbon dioxide laser

• therapy used to treat moderate to severe dysplasia

• limited to the exocervix

Therapeutic conization

If the lesion extends into endocervical canal?

• removes a cone shaped piece of tissue

using scalpel, laser or LEEP

• surgery (hysterectomy), radiation, chemotherapy

Polyps

soft, velvety red lesions that can develop anywhere in the endometrial cavity

Glandular epithelial hyperplasia

Polyps usually arise from —- —- ——, with the tip of the polyp often exhibiting squamous metaplasia.

Polyps

-Usually develop as a result of inflammatory

hyperplasia of the endocervical mucosa

▪Mutations, overexpression of endometrial

aromatase, age related gene mutations KRAS,

PTEN, and TP53

Bleeding

MC presentation of polyp?

Polyp

• Typically asx, may have associated poistcoital bleeding

• Most are benign but should be removed and examined

Risk factors for polyps

• Tamoxifen

• Obesity

• Hormone replacement therapy

• Lynch and cowden syndrome: hereditary cancer predisposition syndromes

autosomal dominant genes

Lynch and cowden syndrome are both?

Oral contraceptives

• Also Levonorgestrel Intrauterine System (LNG IUS)

• use is associated with decreased rates of endometrial polyps

Transvaginal US (TVUS)

first line imaging study of choice for polyps

• followed by sonohysterography or diagnostic hysteroscopy

Staphylococcal Toxic Shock syndrome

rapid onset fever, rash, hypotension, multisystem involvement

Toxin production

— — plays in important role in the patho of STSS.