Medical brain notes 15

  VULVA   Non-Neoplastic Disorders •        Lichen sclerosis  is caused by epidermal thinning and dermal changes which   cause pale skin in postmenopausal women. There is a small risk of progression to squamous cell carcinoma (SCC). •        In  lichen simplex chronicus , a chronic scratch/itch cycle produces the white plaques seen clinically. These plaques are characterized microscopically by squamous cell hyperplasia and dermal inflammation.   Infections •        Human papillomavirus (HPV)  causes warty lesions (condylomata acuminata)   and precursor dysplastic lesions of squamous cell carcinoma called vulvar intraepithelial neoplasia (VIN). Vulvar HPV is commonly subtype 6 and 11 and therefore has low oncogenic potential. •        Herpes simplex virus (HSV) . Most cases of vulvar herpes are caused by HSV-2.   Painless ves...

  VAGINA   •           Vaginal adenosis and clear cell adenocarcinoma  are rare conditions with   increased risk in females exposed to diethylstilbestrol (DES)  in utero .   •           Embryonal rhabdomyosarcoma  (sarcoma botryoides) affects infants and young   children (age <5), in whom it can cause a polypoid, “grapelike,” soft tissue mass that protrudes from the vagina. Microscopically, the mass is character-ized by polypoid epithelial growth with an underlying immature (cambium) proliferation of spindle-shaped tumor cells with rare cross-striations. Tumor cells are positive for desmin.   •           Primary forms of vaginal squamous cell carcinoma  are usually related to HPV   infection; secondary forms are more common and are usually due to extension from a cervical cancer. Treatment is radi...

  CERVIX   Pelvic inflammatory disease (PID)  is an ascending infection (sexually transmitted   disease) from the cervix to the endometrium, fallopian tubes, and pelvic cavity. The infecting organisms are most frequently nongonococcal organisms, including  Chlamydia ,  Mycoplasma hominis  and endogenous flora. Broad-spectrum antibiotics   are therapeutic.   The distribution of disease includes the endometrium (endometritis), fallopian tubes (salpingitis), and pelvic cavity (peritonitis and pelvic abscesses).  Fitz-Hugh–   Curtis syndrome  (perihepatitis) can occur, characterized by “violin-string” adhe-sions between the fallopian tube and liver capsule. Symptoms include the following:   •           Vaginal discharge (cervicitis)   •           Vaginal bleeding and midline abdominal pain (endometritis)   •    ...

  UTERUS Endometritis  is inflammation of the endometrial lining in the uterus. It can be   acute or chronic. •           Acute endometritis  is an ascending infection from the cervix; it is associated   with pregnancy and abortion. •           Chronic endometritis  is associated with PID and intrauterine devices; plasma   cells are seen in the endometrium. Endometriosis  is the presence of endometrial glands and stroma outside the uterus.   It most commonly affects women of reproductive age. Common sites of involvement are the ovaries, ovarian and uterine ligaments, pouch of Douglas, serosa of bowel and urinary bladder, and peritoneal cavity. It can present with chronic pelvic pain, dysmenorrhea and dyspareunia, rectal pain and constipation, abnormal uterine bleeding, or infertility.   Grossly, endometriosis causes red-brown serosal nodules (an...

  OVARY Polycystic ovarian disease  (Stein-Leventhal syndrome) is an endocrine disorder   of unknown etiology showing signs of androgen excess (clinical or biochemical), oligoovulation and/or anovulation, and polycystic ovaries. Accurate diagnosis requires exclusion of other endocrine disorders that might affect reproduction. Patients are usually young women of reproductive age who present with oligomenorrhea or secondary amenorrhea, hirsutism, infertility, or obesity. Treatment is lifestyle change and hormone therapy.   Lab studies show elevated luteinizing hormone (LH), low follicle-stimulating hor-mone (FSH), and elevated testosterone. Gross examination is notable for bilaterally enlarged ovaries with multiple cysts; microscopic examination shows multiple cystic follicles. Epithelial Ovarian Tumors   Epithelial ovarian tumors are the most common form of ovarian tumor. Risk factors include nulliparity, family history, and germline mutations.   Previously,...