Diseases of Female Genital Tract

Vulva & Vagina - Outer Defenses

• Physiological Defenses: Key to preventing infections.
  • Normal Flora: Predominantly Lactobacilli (Döderlein's bacilli).
    • Metabolize glycogen (estrogen-dependent) to lactic acid.
    • Maintains acidic vaginal pH (3.8-4.5), inhibiting pathogen growth.
  • Epithelium:
    • Vulva: Keratinized stratified squamous epithelium.
    • Vagina: Non-keratinized stratified squamous epithelium, rich in glycogen (estrogen-dependent).
    • Provides a physical barrier.
  • Secretions: Cervical mucus & vaginal transudate offer a flushing mechanism.
  • Local Immunity: Includes Langerhans cells (APCs) & intraepithelial lymphocytes.

⭐ Estrogen is vital for vaginal health; it promotes glycogen accumulation in vaginal epithelial cells, supporting Lactobacilli and maintaining an acidic pH, crucial for defense against infections like bacterial vaginosis and candidiasis.

Cervix - Gatekeeper's Woes

• Cervicitis:
  • Acute (PMNs), Chronic (lymphocytes).
  • Causes: C. trachomatis (common), N. gonorrhoeae, HSV, T. vaginalis.
• HPV & Pre-cancer:
  • High-risk (HR-HPV): 16, 18, 31, 33; E6 (↓p53), E7 (↓Rb).
  • Low-risk (LR-HPV): 6, 11 → Condyloma.
  • Transformation Zone (TZ): Key site for dysplasia.
  • Koilocytes: HPV effect (perinuclear halo, nuclear atypia).
• Cervical Intraepithelial Neoplasia (CIN):
  • CIN I: Mild dysplasia (lower 1/3 epithelium).
  • CIN II: Moderate (lower 2/3).
  • CIN III/CIS: Severe (full thickness).
• Cervical Cancer:
  • Types: SCC (75%), AdenoCa (20%).
  • Screening: Pap smear, HPV DNA.
  • Prevention: HPV vaccine.
• Benign:
  • Nabothian cysts, Endocervical polyps.

⭐ HR-HPV types 16 & 18 cause ~70% of cervical cancers.

Uterus (Corpus & Endometrium) - Womb Wonders & Worries

• Endometrial Hyperplasia & Carcinoma:
  • Hyperplasia: Unopposed estrogen. PTEN inactivation. Precursor to Type I Ca. EIN classification.
  • Ca Type I: ~80%. Estrogen-dependent. PTEN, KRAS, MSI. Endometrioid. Good prognosis.
  • Ca Type II: ~15%. Estrogen-independent. p53. Serous, clear cell. Aggressive.

• Adenomyosis: Endometrial glands/stroma in myometrium. Menorrhagia, dysmenorrhea, enlarged uterus.
• Leiomyoma (Fibroid): Benign smooth muscle tumor. Most common tumor in women. Estrogen-sensitive. MED12.
  • Locations: Submucosal, Intramural, Subserosal. (📌 Mnemonic: "SIMS")
• Leiomyosarcoma: Malignant. De novo. Necrosis, atypia, >10 mitoses/10 HPF.
• Endometritis:
  • Acute: Bacterial, post-partum/abortion. Neutrophils.
  • Chronic: Plasma cells diagnostic. Causes: PID, IUD, TB.
• Asherman Syndrome: Intrauterine adhesions. Amenorrhea, infertility.

⭐ Endometrial carcinoma is the most common invasive cancer of the female genital tract.

Ovaries & Fallopian Tubes - Eggcellent Adventures & Alarms

• Ovarian Cysts & Tumors:
  • Functional Cysts: Follicular, Corpus Luteum, Theca-Lutein. Usually benign.
  • Surface Epithelial (most common):
    • Serous: Most common malignant. Psammoma bodies. CA-125.
    • Mucinous: Large. Pseudomyxoma peritonei.
    • Endometrioid: Assoc. w/ endometriosis.
    • Brenner: Benign. Coffee-bean nuclei.
  • Germ Cell (younger patients):
    • Teratoma (Dermoid): Most common GCT. Mature (benign). Struma ovarii.
    • Dysgerminoma: LDH, hCG. Radiosensitive. (📌 "D"ysgerminoma = ra"D"iosensitive)
    • Yolk Sac Tumor: AFP. Schiller-Duval bodies.
    • Choriocarcinoma: ↑hCG. Aggressive.
  • Sex Cord-Stromal:
    • Granulosa Cell: Estrogen ↑ (bleeding/precocity). Call-Exner bodies. Inhibin.
    • Sertoli-Leydig: Androgens ↑ (virilization).
    • Fibroma: Solid. Meigs syndrome (fibroma, ascites, hydrothorax).
• Fallopian Tube Pathology:
  • Salpingitis (PID): Inflammation. Hydrosalpinx, pyosalpinx. Infertility risk.
  • Ectopic Pregnancy: Ampulla (most common). Rupture risk.
  • Carcinoma: Rare, serous type. BRCA assoc.

⭐ Meigs syndrome triad: Ovarian fibroma, ascites, and hydrothorax. Resolves with tumor removal.

High‑Yield Points - ⚡ Biggest Takeaways

• HPV infection (types 16, 18) is key in cervical intraepithelial neoplasia (CIN) and cancer.
• Endometriosis: ectopic endometrial tissue; "chocolate cysts" (ovary).
• PCOS: anovulation, hyperandrogenism, polycystic ovaries; ↑ risk of endometrial cancer.
• Leiomyomas (fibroids): most common benign uterine tumor.
• Serous cystadenocarcinoma: most common malignant ovarian epithelial tumor; psammoma bodies.
• Lichen sclerosus: thin, white plaques on vulva; slight ↑ risk of SCC.
• Granulosa cell tumors of ovary often produce estrogen; Call-Exner bodies.