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Reproduction and Sexual Health > vulval and vaginal pathology > Flashcards

vulval and vaginal pathology Flashcards

1
Q

describe features of a normal ectocervix?

A
  • epithelium sitting on a basement membrane and is underpinned by stroma

layers from bottom to top
1. basement membrane
2. basal cells (purple layer)
3. parabasal cells
4. exfoliating cells - these cells are captured during a cervical smear

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2
Q

what cells are captured during a cervical smear?

A
  • exfoliating cells - squamous cells
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3
Q

what lines a normal ectocervix?

A
  • stratified squamous epithelium
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4
Q

what lines a nomal endocervix?

A
  • a single layer of glandular epithelium
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5
Q

what is the most common site to become infected by HPV?

A
  • transformation zone
    -> go on to become CIN or glandular equivalent CGIN
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6
Q

what is another word for transformation zone?

A
  • squamo-columnar junction
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7
Q

what are the 2 main pathologies of the cervix?

A
  • inflammatory
  • neoplastic
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8
Q

what are some examples of inflammatory pathologies in the cervix?

A
  • cervicitis -
  • cervical polyp
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9
Q

what are some examples of neoplastic pathologies in the cervix?

A
  • cervical intraepithelial neoplasia
  • cervical cancer - squamous carcinoma, adenocarcinoma, other rare tumours
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10
Q

what are the risk factors for CIN/cervical cancer?

A
  • high risk HPV - 16,18, 31, 33, 35, 45, 48
  • many sexual partners
  • vulnerability of SC junction in early repro life - age at first intercourse, long term use of oral contraceptives, non-use of barrier contraception
  • smoking 3x risk
  • immunosuppression -> can’t clear virus
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11
Q

what are 2 types of low risk HPV?

A
  • 6 and 11
  • can cause genital warts
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12
Q

what is condyloma acuminatum?

A
  • name given to anogenital warts caused by HPV 6 and 11
  • thickened ‘papillomatous’ squamous epithelium w cytoplasmic vacuolation ‘koilocytosis’ (shrunken nuclei)
  • caused by HPV
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13
Q

what do you see in cytology of a genital wart type presentation w HPV infection

A
  • mild dyskaryosis
  • multinucleation common characteristic in cells affected by HPV infection
  • nuclear enlargement
  • course chromatin in nuclei
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14
Q

what are koilocytes

A
  • halo cells
  • type of epithelial cell that devleops following a HPV infection
  • irregular shaped nuclei, shape or colour
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15
Q

what does CIN: caused by HPV 16 and 18 show on microscopy?

A
  • infected epithelium remains flat but may show koilocytosis, which can be detected in cervical smears
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16
Q

HPV can cause what?

A
  • genital warts: low risk HPV 6 and 11
  • cervical intraepithelial neoplasia: high risk HPV 16 and 18
  • cervical cancer
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17
Q

what do you see on microscopy of a cervical cancer caused by HPV infection?

A
  • invasive squamous carcinoma: virus integrated into host DNA
  • whirls of keratin within tumour
  • squamous cell carcinoma - islands of cells within stroma broken free from BM
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18
Q

what is time line for a HPV infection to become a high grade CIN?

A
  • 6 months -> 3 years
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19
Q

what is the time line for a high grade CIN -> invasive cancer?

A
  • 5 years -> 20 years
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20
Q

what is cumulative prevalence of HPV infection in lifetime?

A
  • 80% cumulative prevalence in lifetime
  • most develop immunity…
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21
Q

where does CIN most often occur?

A
  • transformation zone
  • pre-invasive stage of cervical cancer
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22
Q

what is CIN?

A
  • dysplasia of squamous cells
  • not visible by naked eye but you can get a feel for it on colposcopy
  • detectable on cervical screening
  • asymptomatic
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23
Q

histology of CIN?

A
  • delay in maturation
    immature basal cells occupying more of epithelium or more nuclei in top layers of epithelium
  • nuclear abnormalities
    hyperchromasia (dark)
    inc in nucleocytoplasmic ratio
    pleomorphism (variable looking cells)
  • excess mitotic activity
    situated above basal layers
    abnormal mitotic forms

often koilocytosis (indicating HPV infection)

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24
Q

how is CIN graded?

A

I-III depending on severity on factors including:

delay in maturation
nuclear abnormalities
excess mitotic activity

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25
Q

define CIN I?

A

basal 1/3 of epithelium occupied by abnormal cells

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26
Q

define CIN II

A
  • abnormal cells extend to middle 1/3
  • abnormal miotic figures
27
Q

define CIN III

A
  • abnormal cells occupy full thickness epithelium
  • also called squamous cell carcinoma in situ
  • also can show early stromal invasion
28
Q

majority of malignant cervical tumours are?

A
  • invasive squamous carcinoma
  • 2nd most common female cancer worldwide
29
Q

when are invasive squamous carcinomas usually found: what age and what stage?

A
  • early stage and in younger women
  • however some are rapidly progressive tumours
  • found from pre-existing CIN -> therefore most are preventable by screening
30
Q

what is staging for cervical cancer?

A
  • Figo staging
31
Q

what are some symptoms of invasive carcinoma?

A
  • abnormal bleeding
    post coital
    post menopausal
    brownish or blood stained vaginal discharge
    contact bleeding - friable epithelium
  • pelvic pain
  • haematuria/urinary infections
  • ureteric obstruction/renal failure
32
Q

spread of squamous carcinoma?

A
  • local
  • lymphatic
  • haematogenous
33
Q

how does local spread of squamous carcinoma spread?

A
  • uterine body, vagina, bladder, ureters, rectum
34
Q

lymphatic spread of squamous carcinoma?

A
  • early -> pelvic, para-aortic nodes
35
Q

haematogenous spread of squamous carcinoma?

A
  • late -> liver, lungs, bone
36
Q

what are 2 main classifications of cervical cancer?

A
  • squamous cell carcinoma
  • adenocarcinoma
37
Q

where is SCC of the cervix found?

A

epithelial lining of the ectocervix

38
Q

where is adenocarcinoma of the cervix found?

A
  • cancer of the glands found within the lining of the cervix
39
Q

grading of squamous carcinoma?

A
  • well differentiated
  • moderately differentiated
  • poorly differentiated
  • undifferentiated/anaplastic
40
Q

what does this image show?

A
  • well differentiated squamous carcinoma of the cervix
41
Q

what is cervical glandular intraepithelial neoplasia? (CGIN)

A
  • seen in endocervical epithelium
  • CGIN is preinvasive phase of endocervical adenocarcinoma
  • more difficult to dx on cervical smear than squamous
  • screening less effective
  • can sometimes be associated w CIN
42
Q

in high grade CGIN how much of the gland is involved?

A
  • all of the gland is involved
43
Q

how common is endocervical adenocarcinoma?

A
  • 5-25% of cervical cancers
    > some are increasing in incidence, particularly in young women
44
Q

can cancers of the cervix be mixed?

A
  • yes some are mixed - adenosquamous
45
Q

what is the grading system for HPV-driven disease include VIN (vulvar itraepithelial neoplasia), VaIN (vaginal intraepithelial neoplasia), AIN (anal intraepithelial neoplasia)

A
  • graded 1,2 or 3 based on degree of atypia and maturational disorder
  • grade 3 is equivalent to SCC in situ
46
Q

is VIN (vulval intraepithelial neoplasia) of usual type a precursor of hpv driven SCC?

A
  • yes
    > differentiated VIN (dVIN) is a precurosr of hpv independent vulval SCC. higher risk of invasive malignancy - often has a background of inflammatory dermatoses - lichen sclerosus
47
Q

who is affected by vulvar intraepithelial neoplasia? (VIN)

A
  • often bimodal:
    young women: multifocal, recurrent or persistent causing tx problems
    older women: greater risk of progression to invasive squamous carcinoma
48
Q

what is the most important prognostic factor in vulvar invasive squamous carcinoma?

A
  • if there has been spread to inguinal lymph nodes
49
Q

what is vulvar invasive squamous carcinoma?

A
  • usually elderly women, ulcer or exophytic mass
  • can arise from normal epithelium or VIN
50
Q

surgical treatment for a vulvar invasive squamous carcinoma?

A
  • radical vulvectomy and inguinal lymphadenectomy
51
Q

what is 5 year survival for vulvar invasive squamous carcinoma w no spread to lymph nodes?

A
  • 90%
    > node positive however <60%
52
Q

how does vulvar paget’s disease present?

A
  • crusting rash > often sharp demarcation
  • pruritic/painful
  • tumour cells in epidermis, contain mucin
53
Q

what cells do lesions in primary vulvar paget’s disease arise from?

A
  • intraepidermal glandular cells
  • or pluripotent cells of folliculosebaceous or eccrine units
54
Q

in secondary cases of vulvar paget’s disease where do cells arise from?

A
  • colorectal neoplasms or urothelial neoplasms
55
Q

what is the black circle outlining in the epidermis of the vulva?

A
  • paget cells
  • red line shows BM - therefore this image is non-ivasic pagets disese of the vulva
56
Q

how do you manage paget’s disease of the vulva?

A
  • excision of the lesion
  • can sometimes extend up into the vagina or anus making excision difficult
57
Q

list some infections of the vulva?

A
  • candida - particular DM
  • vulvar warts - HPV6 and 11
  • bartholins glands abscess - blockage of gland duct
58
Q

what are non neoplastic epithelial disorders of the vulva?

A
  • lichen sclerosis
  • other dermatoses: lichen planus, psoriasis
59
Q

what can often occur to vulva in a post-menopausal women causing pain and bleeding?

A
  • atrophy of the vulva
60
Q

candida shows what on cytology?

A
  • hyphae and spores
61
Q

what does a viral wart/condyloma acuninatum show on cytology?

A
  • papillomatous architecture (also characteristic of VIN)
  • koilocytes
62
Q

what does lichen sclerosus et atrophicus show on microscopy?

A
  • epidermis
  • glassy subepithelial hyalinised band
63
Q

name some kind of vaginal pathologies in the vagina?

A
  • benign - polyps, cysts
  • VaIN - vaginal intraepithelial neoplasia. may also have cervical and vulval lesions
  • squamous carcinoma: less common than cervical and vulval counterparts. disease of the elderly, primary tumours are rare
  • melanoma: rare, may appear as a polyp

Reproduction and Sexual Health (29 decks)

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