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Presentation
Bleeding and grape like mass protruding from vagina
"SARCOMA BOTRY0IDES"
The malignant cells in rhadbomyosarcoma is rhabdomyoblast
Cytoplasmic cross striations in immature cells are characteristics.
Also, desmin and myoglobin +ve cells would indicate muscle cells so rhabdomyosar
coma.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Vaginal Carcinoma
High risk HPV ---> VaIN is predisposing factor
cancer from lower 2/3rd of vagina goes to inguinal nodes.
cancer from upper 1/3rd of the vagina goes to the iliac nodes.
so put these together to make questions.
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------CERVIX = Neck
Divided into exocx and endocx.
very distinct demarcaion between them and different epithelium cover them.
area where demarcation occurs is called the "transformation zone"
usually when person gets HPV 90% of the time it is cleared by the immnune system
,
but when it persists and the immune system cannot fight it then it can lead to C
IN.
Risk of CIN depends on persistence of infection and also types.
VERY HIGH YIELD****
What makes high risk HPV high risk?
2proteins makes it high risk
E6 produced by the high risk HPV results in destruction of p53. (there is no cel
l
repair and therefore damaged cells go to cancer.)
E7 produced by the high risk HPV results in destruction of Rb.
p53 and Rb are tumor suppressor genes.
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------CIN
Koilocytic change,nuclear atypia,increased mitotic activity.
whats the difference between carcinoma and dysplasia?
the answer is reversibility.
CIN 1 (66% of time) and 2 (33% of time) have the potential to reverse. CIN and C
IS very rarely reverse.
Once ovulation occurs the phase changes to secretory phase mediated by progester
one
in order to prepare the endometrium for implantation.
Lack of ovulation---> lack of secretory phase --->eventually pt. presents with b
leeding.
Results in estrogen driven proliferative phase without progesterone mediated
secretory phase.
Common cause of dysfuntional uterine bleeding, seen in menarche and menopause.
------------------------------------------------------------------------------------------------------Acute endometritis
Bacterial infection of endometrium.
Usually related to retained products of conception.
Presents with fever,abnormal uterine bleeding, and pelvic pain.
Chronic endometritis
chronic inflammation = lymphocytes are present but HAVE TO SEE A PLASMA CELL
IN ORDER TO CALL IT A CHRONIC ENDOMETRITIS.***
mcc- tb,pid,iud.
presents w/ infertility,abnormal uterine bleeding and pelvic pain.
infertility and chronic endometritis look for plasma cells.'
-----------------------------------------------------------------------------------------------Endometrial polyp
Hyperplastic protrusion of endometrium.
presents as abnormal uterine bleeding.
****CAN ARISE AS A SIDE EFFECT ON TAMOXIFEN*** b/c of pro estrogenic effect on u
terus.
-------------------------------------------------------------------------------------------------Endometriosis
Endometrial glands and stroma, are misplaced in another location thats called en
dometriosis outiside
the endometrial lining.
presens w/ dysmenorrhea and pelvic pain may cause infertility.pain and dysmenorr
hea b/c even though they are
displaced they still undergo the menstrual cycle.
What causes endometriosis?
1.Retrograde menstruation
2.metaplastic theory- mullerian duct has the ability to develop into multiple di
fferent epithelium (cx,endometrial,etc.)
3.lymphatic dissemination theory - endometrioisis goes thru the lymphatics and d
evelop in elsewhere sites.
mcc site of involvement is the ovaries. = chocolate cysts.
uterine ligament - pelvic pain
pouch of douglas - defecating probs
bladder wall- pain wih urination.
bowel serosa-abdominal pain and adhesions.
fallopian tube mucosa - scarring.
small hemorrhagic areas called as gunpowder lesions!!!
persist