Pathology Of Female Reproductive System

Vulvar leukoplakia is a condition characterized by the presence of a white asymptomatic plaque on the vulva. It does not always progress to cancer, as suggested by the first option. While it is associated with underlying malignancy, it does not mean that every case will develop into cancer, as mentioned in the third option. Therefore, the correct statement about vulvar leukoplakia is that it presents as a white asymptomatic plaque.

The image shows inflammation and infection in the Fallopian tube, which is characteristic of salpingitis. Salpingitis is the inflammation of the Fallopian tubes usually caused by a bacterial infection. Symptoms include pelvic pain, fever, and abnormal vaginal discharge. The image shows the typical histological features of salpingitis, such as infiltration of inflammatory cells and destruction of the tubal epithelium. Hydrosalpinx refers to the accumulation of fluid in the Fallopian tube, while ectopic pregnancy refers to the implantation of a fertilized egg outside of the uterus. Adenocarcinoma and clear cell carcinoma are types of cancer and are not indicated by the image.

The correct answer is Condyloma accuminatum. Condyloma accuminatum is a sexually transmitted infection caused by the human papillomavirus (HPV). It is characterized by multiple lesions on the vulva that have a cauliflower-like appearance. These lesions are usually painless and can vary in size. Leukoplakia is a white patch on the vulva that can be caused by chronic irritation or infection. Verrucous carcinoma and squamous cell carcinoma are types of vulvar cancer that present as single lesions rather than multiple lesions. Condylomata lata are a manifestation of secondary syphilis and typically appear as flat, painless, and moist lesions.

If left untreated, the woman is most likely to develop an ectopic pregnancy. Neisseria gonorrhoeae, the bacteria causing the infection, can lead to pelvic inflammatory disease (PID) if it ascends to the upper genital tract. PID can cause scarring and inflammation in 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. It is a potentially life-threatening condition and requires immediate medical intervention.

Leukoplakia is the correct answer because it refers to a condition characterized by thickened, white patches on the mucous membranes, including the vulva. It is often associated with chronic irritation or inflammation and can potentially progress to cancer. Without a biopsy, it is not possible to definitively diagnose the condition, but based on the given information and appearance of the vulvar disorder, leukoplakia is the most appropriate designation.

Carcinoma in situ is a non-invasive form of cancer where the cancer cells are confined to the original site and have not spread to surrounding tissues or organs. It is characterized by the presence of obviously malignant cells that are limited to the epithelial layer of the tissue. There is no invasion into the stroma or lymph node metastases. Additionally, regardless of the presence or absence of stromal invasion or metastases, there is minimal cellular atypia, meaning that the cancer cells still closely resemble normal cells. Therefore, the defining characteristic of carcinoma in situ is the solely intraepithelial accumulation of obviously malignant 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). High-grade SIL is a precancerous condition that has a higher risk of progressing to invasive carcinoma if left untreated. Therefore, close monitoring and follow-up are necessary to detect any progression and initiate appropriate management if needed.

The correct answer is Failure of Müllerian ducts to fuse. This is because the image shows a pelvic MRI, which is used to evaluate the reproductive organs. The Müllerian ducts are responsible for the development of the female reproductive organs, including the uterus, fallopian tubes, and upper part of the vagina. If the Müllerian ducts fail to fuse properly, it can lead to abnormalities in these structures and can result in recurrent pregnancy loss.

The most reasonable procedure in the management of this patient is colposcopy and cervical biopsy. The cytologic examination findings suggest the presence of abnormal cells in the cervix. Colposcopy allows for a more detailed examination of the cervix using a magnifying instrument, which can help identify any abnormal areas. Cervical biopsy is then performed to obtain a tissue sample for further evaluation and to confirm the presence of any precancerous or cancerous changes. This combination of procedures is necessary to assess the extent of the abnormality and guide further management decisions.

Extramammary Paget disease is the most likely diagnosis based on the clinical presentation of a pruritic lesion on the external genitalia. The gross and microscopic appearance of the lesion supports this diagnosis. Verrucous carcinoma is a type of squamous cell carcinoma characterized by a warty growth pattern, which is not seen in this case. Lichen simplex chronicus is a localized area of chronic itching and scratching, but it does not typically present as a distinct lesion. Lichen sclerosus is a chronic inflammatory condition that primarily affects the vulva, but it does not typically present as a pruritic lesion. Squamous cell carcinoma is a possibility, but Extramammary Paget disease is more likely given the specific clinical and histological findings.

The correct answer is "Proliferative phase endometrium with few cystically dilated glands." In simple endometrial hyperplasia, there is an increase in the number of glands in the endometrium, but they are not crowded or showing cytologic atypia. The presence of few cystically dilated glands indicates that the endometrium is in the proliferative phase, which is consistent with the diagnosis of simple endometrial hyperplasia. Atrophic endometrium with cystically dilated glands is more commonly seen in postmenopausal women. Crowded glands with outpouching and cytologic atypia are characteristic of complex endometrial hyperplasia with atypia. Subnuclear vacuolation of the glandular epithelium is seen in Arias-Stella reaction, which is associated with pregnancy or gestational trophoblastic disease. Spiral arteries surrounded by decidual cells are seen in the secretory phase of the menstrual cycle.

The most likely diagnosis based on the given information is CIN 2, which stands for cervical intraepithelial neoplasia grade 2. CIN 2 represents a moderate to marked dysplasia of the cervical epithelium, indicating a precancerous lesion. This diagnosis is supported by the presence of atypical squamous epithelial cells suspicious of high grade lesion on the cytology report. A biopsy would be necessary to confirm the diagnosis and determine the extent of the abnormality.

The shown image from a vulvar biopsy represents keratinizing squamous cell carcinoma. This can be identified by the presence of keratinization, which is the process of hardening and forming a protective layer of keratin on the surface of the skin. Squamous cell carcinoma is a type of skin cancer that arises from the squamous cells in the outermost layer of the skin. The keratinization in the image indicates that the cancer cells have undergone this process, confirming the diagnosis of keratinizing squamous cell carcinoma.

The most likely cause of oligomenorrhea and infertility in this woman is anovulatory cycle. Anovulatory cycle refers to a menstrual cycle in which ovulation does not occur. This can lead to hormonal imbalances and irregularities in the menstrual cycle, resulting in oligomenorrhea (infrequent or irregular menstrual periods) and infertility. The histologic findings of small, slightly irregular glands and a few mitotic figures in the glands and stroma support the diagnosis of anovulatory cycle. Endometrial hyperplasia, endometrial polyp, chronic endometritis, and endometrial carcinoma are less likely causes in this scenario.

Lichen sclerosus is a chronic inflammatory skin condition that primarily affects the genital area. It is characterized by white, shiny, and atrophic skin with itching and discomfort. Biopsy is often taken to confirm the diagnosis, and the histopathological findings typically show thinning of the epidermis, loss of rete ridges, and a band-like lymphocytic infiltrate. The other options listed in the question, such as condyloma accuminatum, vulvar intraepithelial neoplasia, squamous cell carcinoma, and lichen simplex chronicus, are less likely based on the given information.

The histologic examination findings of atypical glands lined by large cells with clear cytoplasm and hobnail appearance are consistent with the pathology seen in patients with intrauterine DES exposure. DES (diethylstilbestrol) is a synthetic estrogen that was used in the past to prevent miscarriages. However, it was later found to be associated with various adverse effects, including an increased risk of vaginal adenocarcinoma in female offspring exposed to DES in utero. Therefore, intrauterine DES exposure is the most likely etiologic factor implicated in the development of the vaginal mass in this patient.

The presence of giant cells in a Pap smear from an asymptomatic woman suggests an HSV (Herpes Simplex Virus) infection. Giant cells are a characteristic feature of HSV infection and are not typically seen in other conditions such as cervical intraepithelial neoplasia or carcinoma. HPV (Human Papillomavirus) infection can cause changes in the cervical cells, but it does not typically present with giant cells. Therefore, the most likely diagnosis based on the given information is HSV infection.

The correct answer is "Normal cervix with non-keratinizing squamous epithelium." This is the most likely diagnosis because the patient's physical examination is unremarkable and the Pap smear report indicates atypical squamous epithelial cells of undermined significance (ASC-US). The repeat smear in six months still shows cytologic abnormalities, but subsequent cervical biopsy reveals a normal cervix with non-keratinizing squamous epithelium. This indicates that there are no significant epithelial changes or dysplasia present.