Normal Development and Function of Female Genitourinary System (Robbins 5th Ed., p. 1033-1037) or (Robbins 6th Ed., p. 1036-1038)
1. Define the cervical transformation zone.
2. Review the endometrial and ovarian changes that occur during the menstrual cycle.
Cervix (Robbins 5th Ed., p. 1037-1039, 1045-1053) or (Robbins 6th Ed., p. 1047-1053)
1. Cervical squamous dysplasia and carcinoma:
a. List three risk factors for the development of cervical carcinoma.
b. Explain the role of human papilloma viruses in the pathology of benign and malignant cervical tumors.
2. Recognize the morphologic and biologic spectrum of cervical intraepithelial neoplasia and the various terminologies used in Pap smears and tissue sections, such as "dysplasia," "cervical intraepithelial neoplasia (CIN)," and "squamous intraepithelial lesion."
Vulva, Vagina, and Fallopian Tubes (Robbins 5th Ed., p. 344-346, 1039-1045, 1063-1064) or (Robbins 6th Ed., p. 359-365, 1030-1047, 1065)
1. Define PID (pelvic inflammatory disease); describe its common presentation and sequela.
2. Describe the following female genital infections: syphilis, gonorrhea, chancroid, chlamydia, trichomonas, herpes, and human papilloma virus. List the infections that can affect fetal outcome.
3. Compare condyloma acuminatum and condyloma latum.
4. Define VIN (vulvar intraepithelial neoplasia) and squamous carcinoma, and their relationship.
5. Define extramammary Paget's disease of the vulva.
6. Describe sarcoma botryoides and its usual presentation.
1. (Robbins 5th Ed., p. 1127-1170) or (Robbins 6th Ed., p. 359-365, 1030-1053, 1065)
2. Images 1-3 relate to the scenario. Images 4-6 are related to additional objectives.
A 33-year-old lawyer had postponed pregnancy in her 20's but has now been trying to get pregnant for several years. Her husband had a son during a prior marriage.
She presents to her gynecologist for workup of her infertility. Pertinent history includes: menarche, age 12; coitarche, age 15; eight lifetime sexual partners; cyclic menses regularly every 28 days; no birth control for 2 years; no pelvic exam in 5 years. No IV drug use. Pertinent exam and procedure findings include: a friable, vascular lesion on the anterior cervix , a Pap smear diagnosis of HGSIL (high grade squamous intraepithelial lesion) (Image 1), a cervical biopsy diagnosis of severe dysplasia (CIN III) (Image 2) with flat condyloma (Image 3), blocked (nonpatent) fallopian tubes by hysterosalpingogram, and a microimmunofluorescence test on her cervical mucus positive for Chlamydia trachomatis. She is HIV negative.