Block 15 Path Female Rep Sys Prt 1

If left untreated, the woman is most likely to develop an ectopic pregnancy. This is because Neisseria gonorrhoeae, the bacteria causing the infection, can lead to pelvic inflammatory disease (PID) if it ascends into the upper genital tract. PID can cause scarring and damage to the fallopian tubes, increasing the risk of ectopic pregnancy. Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, usually in the fallopian tube, and can be life-threatening if not treated promptly. The other options listed are not directly associated with untreated gonorrhea.

Intrauterine DES exposure is the most likely etiologic factor implicated in the development of the shown pathology. DES (diethylstilbestrol) is a synthetic estrogen that was prescribed to pregnant women between the 1940s and 1970s. It was later discovered that DES exposure in utero can lead to various reproductive abnormalities in offspring, including vaginal adenosis. The histologic examination findings of atypical glands lined by large cells with clear cytoplasm and hobnail appearance are consistent with vaginal adenosis, which is a known consequence of intrauterine DES exposure.

Vulvar leukoplakia is a condition characterized by the presence of a white asymptomatic plaque on the vulva. It is not known to progress to cancer in all cases, as stated in the first option. While it is true that vulvar leukoplakia can be associated with underlying malignancy, this is not always the case. Therefore, the correct statement about vulvar leukoplakia is that it is a white asymptomatic plaque.

The pelvic MRI shows a failure of Müllerian ducts to fuse, which is the cause of the patient's recurrent pregnancy loss. This means that the structures responsible for the development of the female reproductive system did not properly come together, leading to fertility issues.

Extramammary Paget disease is the most likely diagnosis for the pruritic lesion on the external genitalia in a 74-year-old woman. This condition typically presents as a red, pruritic, and well-demarcated lesion. Microscopically, it is characterized by the presence of large, pale cells with abundant clear cytoplasm, known as Paget cells. These cells are found in the epidermis and can extend into the underlying dermis. Verrucous carcinoma, lichen simplex chronicus, lichen sclerosus, and squamous cell carcinoma may present with similar symptoms, but they have different histological features.

The image shows inflammation of the Fallopian tube, which is characteristic of salpingitis. Salpingitis is an infection of the Fallopian tube often caused by sexually transmitted infections. It can lead to scarring and blockage of the tubes, which can cause fertility issues. The image does not show any other specific features that would suggest the other conditions listed as options.

The correct answer is Condyloma accuminatum. Condyloma accuminatum is a sexually transmitted infection caused by the human papillomavirus (HPV). It is characterized by multiple raised, cauliflower-like lesions on the vulva. The macro- and micro-presentation of multiple lesions in this case is consistent with condyloma accuminatum. Leukoplakia is a white patch that cannot be scraped off and is not associated with HPV. Verrucous carcinoma and squamous cell carcinoma are types of vulvar cancer, but they typically present as solitary lesions rather than multiple. Condylomata lata are a manifestation of secondary syphilis and present as flat, moist lesions rather than raised, cauliflower-like growths.

Carcinoma in situ refers to a stage of cancer where the cancer cells are confined to the original site and have not invaded nearby tissues or spread to other parts of the body. In this stage, the cells appear obviously malignant, meaning they display clear signs of being cancerous. However, there is minimal stromal invasion, which refers to the invasion of the connective tissue surrounding the epithelial cells. Additionally, there are minimal lymph node metastases, indicating that the cancer cells have not spread to the lymph nodes. Despite the absence of invasion or metastases, there may still be minimal cellular atypia, which refers to abnormal changes in the appearance of the cells.

The most likely reason for the suggestion to repeat cervical cytology in six months is that the lesion seen in the Pap smear has the potential to progress to high-grade squamous intraepithelial lesion (SIL). This is a precancerous condition that has a higher risk of developing into invasive carcinoma if left untreated. Therefore, close monitoring and follow-up are necessary to detect any progression and intervene if needed.

The presence of numerous small-to-medium-sized epithelial cells with enlarged nuclei, accentuated nuclear outline, clumped chromatin, and visible nucleoli on cytologic examination suggests the presence of abnormal cells. This finding is concerning for cervical dysplasia or cervical cancer. Colposcopy, which allows for a magnified examination of the cervix, and cervical biopsy, which involves taking tissue samples for further evaluation, are the most reasonable procedures for further evaluation and management of this patient. Repeat Pap smear in 6 months may not be sufficient to assess the extent of the abnormality, while ablation, conization, and hysterectomy are more invasive procedures that may be considered after the diagnosis is confirmed.

The correct answer is "Proliferative phase endometrium with few cystically dilated glands." This histologic change indicates that the endometrium is in the proliferative phase, which is the phase of the menstrual cycle characterized by growth and thickening of the endometrium. The presence of few cystically dilated glands suggests hyperplasia, which is an abnormal increase in the number of cells. This finding, along with the patient's vaginal bleeding, is consistent with a diagnosis of simple endometrial hyperplasia.

The most likely diagnosis based on the microscopic appearance of the specimen is CIN 2. CIN stands for cervical intraepithelial neoplasia, which is a precancerous condition of the cervix. CIN 2 indicates moderate to marked dysplasia, meaning there are abnormal changes in the cells that line the cervix. This condition has a higher risk of progressing to cervical cancer compared to CIN 1, but it is not as advanced as CIN 3, invasive squamous cell carcinoma, or carcinoma in situ. The presence of atypical squamous epithelial cells suspicious of high grade lesion (ASC-H) on the cytology report also supports the diagnosis of CIN 2.

The histologic findings of small, slightly irregular glands and a few mitotic figures in the glands and stroma suggest anovulatory cycle as the most likely cause of oligomenorrhea and infertility in this woman. Anovulatory cycle refers to a menstrual cycle in which ovulation does not occur, leading to hormonal imbalances and irregularities in the endometrium. This can result in oligomenorrhea (infrequent or irregular periods) and infertility. Other options such as endometrial hyperplasia, endometrial polyp, chronic endometritis, and endometrial carcinoma do not match the histologic findings and are less likely to be the cause.

Leukoplakia is a term used to describe a white patch or plaque on the mucous membranes, including the vulva. It is a clinical diagnosis that can be made based on visual examination without the need for a biopsy. In this case, the elder woman presents with a vulvar disorder that appears as a white lesion, which is consistent with leukoplakia. Therefore, the findings before biopsy would be designated as leukoplakia.

The shown image from a vulvar biopsy represents keratinizing squamous cell carcinoma. This is because the image shows a malignant growth of squamous cells that exhibit keratinization, which is the process of forming a tough, protective layer of protein. This type of carcinoma is characterized by the presence of keratin pearls and intercellular bridges, which can be seen in the image.

Lichen sclerosus is a chronic inflammatory skin condition that commonly affects the genital area. It is characterized by thinning, whitening, and tightening of the skin. Biopsy is often performed to confirm the diagnosis, and the histopathological findings typically show atrophic epidermis, dermal fibrosis, and a lymphocytic infiltrate. Lichen sclerosus is not a premalignant condition, but long-standing cases may have an increased risk of developing squamous cell carcinoma. Therefore, it is important to monitor and manage lichen sclerosus to prevent potential complications.

The presence of giant cells in a Pap smear from an asymptomatic woman suggests an HSV (Herpes Simplex Virus) infection. Giant cells are characteristic of HSV infection and are often seen in Pap smears. HSV infection can cause symptoms such as genital ulcers, but it can also be asymptomatic. Therefore, the presence of giant cells in the absence of symptoms indicates an HSV infection.

The most likely diagnosis in this case is a normal cervix with non-keratinizing squamous epithelium. This is because the patient's physical examination was unremarkable and the Pap smear initially indicated atypical squamous epithelial cells of undermined significance (ASC-US), which is a common finding and often resolves on its own. The repeat smear and subsequent cervical biopsy did not show any cytologic abnormalities, suggesting that the initial finding was likely a false positive. Therefore, the most likely diagnosis is a normal cervix with non-keratinizing squamous epithelium.