Pathology - Vagina and cervix

Question 1

What is the upper 1/3 of the vagina derived from?

Answer 1

Mullerian duct - columnar

Question 2

What happens to the columnar epithelium of the vaginal canal?

Answer 2

Replaced by squamous epithelium from the lower 2/3s (derived from urogenital sinus)

Question 3

What is adenosis?

Answer 3

Focal persistence of columnar epithelium in upper 1/3 of vagina

Question 4

What teratogenic drug is associated with adenosis and therefore clear cell carcinoma?

Answer 4

Diethylstilbestrol (DES)

Question 5

What is clear cell adenocarcinoma associated with?

Answer 5

Vaginal adenosis

Question 6

What is squamous cell carcinoma of the vagina usually secondary to?

Answer 6

Cervical SCC

- Primary rare

Question 7

What is sarcoma botryoides?

Answer 7

Embryonal rhabdomyosarcoma variant

- Malignant mesenchymal proliferation of immature skeletal muscle

Question 8

How does sarcoma botryoides present?

Answer 8

• Females < 4 years old
• Clear grape-like polypoid mass emerging from vagina
• Spindle-shaped cells, desmin +ve

Question 9

What is significant about rhabdomyoblast on histology ?

Answer 9

• Cytoplasmic cross-striations

- Positive IHC staining for desmin (muscle) and myoglobin

Question 10

What is the precursor lesion to vaginal carcinoma?

Answer 10

Vaginal intraepithelial neoplasia

Question 11

Cancer from the lower 2/3s of vagina spreads where?

Answer 11

Inguinal nodes

Question 12

Cancer from the upper 1/3 spreads where?

Answer 12

Regional iliac

Question 13

What does the ‘neck’ of the uterus divide?

Answer 13

Exocervix (squamous) and endocervix (columnar)

Question 14

What is the single line of cells that divide the exo and endocervix called?

Answer 14

Transformation zone

Question 15

What strains of HPV increase the risk of CIN?

Answer 15

16, 18, 31, 33

Question 16

What are the 2 gene products produced by HPV which

Answer 16

E6 and E7

Question 17

What does E6 increase the destruction of? (which can lead to dysplasia etc.)

Answer 17

p53 (inhibits/checks the cell before entering S phase)

Question 18

What does E7 increase the destruction of?

Answer 18

Rb

Question 19

What is CIN characterized by (histology)?

Answer 19

• Koilocytic change (nuclear enlargement - halo cells) - raisin appearance
• Nuclear atypia (abnormal nuclei)
• Increased mitotic activity

Question 20

How can CIN be graded?

Answer 20

Based on extent of immature, dysplastic cells

• First 1/3
• 2nd third
• Last 3rd
• Full way = carcinoma in situ

Question 21

What is the difference between dysplasia and carcinoma in situ?

Answer 21

Reversibility (grade I reverses 66% of the time, grade II 33%)
- CIS will not reverse

Question 22

What does carcinoma in situ become?

Answer 22

Cervical carcinoma

- Invasive carcinoma that arises from cervical epithelium

Question 23

How may cervical carcinoma present?

Answer 23

• Vaginal bleeding (often postcoital)

Question 24

How may CIN (cervical dysplasia) be identified?

Answer 24

Pap smear

Question 25

What other than HPV may be risk factor for developing cervical cancer?

Answer 25

• Smoking

- Immunodeficiency

Question 26

What are the subtypes of cervical cancer?

Answer 26

• Squamous cell (more common)
• Adenocarcinoma
  Both related to HPV

Question 27

Where does cervical cancer classically spread and how does this present?

Answer 27

• Invades through ant uterine wall into the bladder -> blocks ureters causing hydronephrosis (presents with renal failure)

Question 28

After pap smear (screening test) what test is required for diagnosis?

Answer 28

• Colposcopy

and biopsy

Question 29

What are the limitations of the pap smear?

Answer 29

• Inadequate sampling of transformation zone resulting in false negatives
• Limited efficacy in screening for adenocarcinoma

Question 30

Which strains of HPV are covered by the vaccine? and for how long?

Answer 30

Quadrivalent - 6, 11, 16, 18

• Protection lasts up to 5 years
• Pap smears still often necessary