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2.2 Cellular Pathology > Cervical Pathology > Flashcards

Cervical Pathology Flashcards

1
Q

What is the cervix?
(3)

A

Neck of the womb (Uterus)

Protects sterile environment of uterus

Supports uterus

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2
Q

What are the two main components of the cervix?

A

Ectocervix
Endocervix

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3
Q

What is the ectocervix?

A

Stratified squamous epithelium

Protection against infections and mechanical insult

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4
Q

What is the endocervix?
(4)

A

Glandular epithelium

Crypts can be seen

Honeycomb pattern

Palisade

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5
Q

What cervical specimen types are seen in histology?
(4)

A

LLETZ
LEEP
Cone Biopsy
Resection

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6
Q

How is cervical cancer screening carried out?

A

Brush cervix with plastic broom

Cells washed in a liquid medium

Use liquid based cytology

Vile sent to laboratory for HPV testing (DNA or RNA testing)

We use 6400 DNA testing

Transient HPV infection (HPV DNA) but it hasn’t integrated into host cells -> no risk of developing cancer associated -> need to triage these tests so we don’t have to recall too many women -> this is why we use the morphology assessment

Transient population -> patient clears HPV without treatment

Positive HPV and cytology morphology positive for colposcopy

Positive HPV but negative morphology -> women called back after 12 months

If HPV still persistent then may be sent on for colposcopy

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7
Q

What is a transient population

A

Patient clear HPV without treatment

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8
Q

What does a positive HPV and cytology morphology mean

A

Sent for colposcopy

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9
Q

What does a positive HPV but negative morphology mean

A

Women called back after 12 months

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10
Q

What does a persistent HPV infection mean

A

Woman sent for colposcopy

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11
Q

What happens if assessment of cervix deems changes in cervix

A

If changes are seem then there is removal of cervix tissue via colposcopy for histology

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12
Q

What is colposcopy?
(7)

A

Visualising of the cervix by a colposcopist using a colposcope, tissue may be removed if required. They will perform appropriate treatment.

Colposcopist will visualise the cervix using a colposcope

Application of acetic acid and iodine to define lesion and area of abnormality

Acetic acid shows us regions of more protein in areas of disease

Iodine brings out normal tissue -> normal tissue high in glycogen

Contours are associated with high grade

Frilled edge associated with low grade

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13
Q

What is done in colposcopy

A

Application of acetic acid and Iugol’s Iodine to identify areas and grade of CIN

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14
Q

What is the procedure behind colposcopy?
(5)

A

Laser/Cryocautery -> ablation of abnormal area

Punch biopsy -> removal of small pieces of tissue

LEEP

LLETZ

Cone biopsy -> all involve larger fragment of tissue

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15
Q

What is a LEEP

A

Loop electrosurgical excision procedure

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16
Q

What is LLETZ

A

Large loop excision of transformation zone

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17
Q

What is done with cervical dissections

A

These samples would be inked so you know where the margins are

Every single piece of tissue is processed

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18
Q

Give some examples of cervical pathology
(9)

A

Infections
Endometriosis
Cervical Intraepithelial Neoplasia
Squamous cell carcinoma
Cervical Glandular intraepithelial Neoplasia
Endocervical adenocarcinoma

Adeno-squamous carcinoma
TEM/SMILE
Metastatic

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19
Q

How does cervical pathology present?
(5)

A

Blood
Discharge
Irritation
Irregular contour

Asymptomatic screening
- e.g. Cervical cancer screening programme

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20
Q

Comment on the epidemiology of cervical cancer
(3)

A

4th most common cancer for women worldwide

6th most common for women in Europe

90% of all cases in low/middle income countries

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21
Q

Comment on the cervical cancer epidemiology in Ireland

A

290 cases of cervical cancer diagnosed annually
90 deaths

22
Q

What increases you risk for Cervical Cancer?
(10)

A

Human Papillomavirus
Sexually transmitted infections )HSV, Chlamydia, HIV)
Smoking
Party
Oral contraceptives
Early age of intercourse
Number of sexual partners/high risk partners
Socioeconomic status
Diethylstilbesterol DES
Family history

23
Q

What is metaplasia?
(5)

A

Its not a malignant process in itself

The transformation of one type of epithelium to another

In the cervix, its the transformation of vulnerable glandular epithelium to a protective stratified squamous epithelium

Metaplasia arises in reserve cell population that usually replenish columnar epithelium

Swelling of cervix due to hormones in puberty can release acid which changes glandular epithelium

24
Q

What is the transformation zone?
(3)

A

The area that metaplasia takes place

This is an area of instability

It’s said to ‘precisely define the field of neoplastic potential’

24
Q

What is the transformation zone?
(3)

A

The area that metaplasia takes place

This is an area of instability

It’s said to ‘precisely define the field of neoplastic potential’

25
Q

What is cervical pathology

A

Recognised premalignant/precancerous stage in the development of squamous cell carcinoma of the cervix

26
Q

What is the precancerous stage of cervical pathology?
(3)

A

Cervical Intraepithelial Neoplasia (CIN)

Cells from area of CIN are seen on cytology slide

Morphological features are termed ‘Dyskaryosis’ on cytology

27
Q

What pathology can be seen on cervical smears?
(5)

A

Inflammation and infections

Cervical intraepithelial neoplasia

Invasive squamous cell carcinoma

Cervical Glandular Intraepithelial Neoplasia (CGIN)
- Endometrial/Ovarian/Extra-uterine

Metastatic

28
Q

Give four examples of infections which can be seen on a cervical smear

A

Actinomyces
Candida
Trichomonas vaginalis
Herpes simplex virus II

29
Q

What is Cervical Intraepithelial Neoplasia (CIN)?
(4)

A

Evidence that CIN is a precursor of invasive squamous cell carcinoma in
- patients with CIN who did not receive treatment
- CIN found at the periphery of invasive cancer on histology sections
- cells from CIN show similar morphology to cells from invasive Ca

Spectrum of morphology which is divided into 3 stages and graded as CIN1, CIN2, CIN3

30
Q

How is CIN graded?

A

Assessment of grade is based on the proportion of epithelium replaced by immature, crowded cells with enlarged irregular hyperchromatic nuclei

31
Q

What is CIN1?

A

Mild dysplasia

32
Q

What is CIN2

A

Moderate displase

33
Q

What is CIN3

A

Sever dysplasia

34
Q

What is dyskaryosis?

A

Used to describe all abnormal cells that have appearances which suggest derivation from CIN and invasive carcinoma of the cervix

35
Q

How is dyskaryosis reported?
(3)

A

Using reporting terminology

BSCC (BAC) and Bethesda

Low grade/high grade (squamous intraepithelial lesion)

36
Q

How is dyskaryosis graded?

A

Nuclear abnormalities
Nuclear:cytoplasmic ratio

37
Q

What is the correlation between cytology grade and histological grade

A

Low grade SIL/Dyskaryosis = CIN1

High Grade SIL/Dyskaryosis = CIN2+

38
Q

What are six features of dyskaryosis

A

Abnormal/irregular chromatin pattern
Irregular nuclear membranes
Irregular nuclear contours
Disproportionate nuclear enlargement
Hyper or hypochromasia
Abnormalities in nucleoli

39
Q

What is invasive squamous cell carcinoma
(3)

A

When a lesion has breached the basement membrane

The basement membrane cannot be seen on cervical smears and therefore invasion cannot be reported on cervical cytology

Some features can be seen on cervical smear that may suggest invasion

40
Q

What are some features of invasive squamous cell carcinoma?
(5)

A

Windowing - irregular chromatin distribution causing ‘holes’

Fibre/tadpole/bizarre cells

Keratinisation

Diathesis

Blood

41
Q

What is an endocervical adenocarcinoma?
(4)

A

Two main types: CGIN (AIS) and adenocarcinoma

Cytological features recognised

Association with HPV

Increasing incidence and high incidence in younger women (30s)

42
Q

What are some features of CGIN

A

Supercrowding (loss of normal architecture)
Feathering
Pseudostratification
Rosettes

43
Q

What are some extra-uterine malignancies seen in smears
(4)

A

Ovarian carcinoma
Colorectal
Bladder
Melanoma

44
Q

What is the role of histochemistry in cervical samples?
(3)

A

Limited application

Cytology: Papanicolaou stain

Histology: H+E
- Specialised stains as required: (Connective tissue and infections)

45
Q

Write about immunohistochemistry for cervical pathology
(7)

A

Diagnostic panel:
- Cytokeratins - adeno vs squamous
- p16 - HPV
- Ki67 - proliferation

Metastatic markers

CINTec plus
- dual stain

46
Q

What is Ki67 for?

A

Proliferation

47
Q

What molecular tests are used in cervical pathology?

A

Histology
- chromogenic ISH for HPV

Cytology
- pHPV tests (DNA or RNA)
- Genotyping
- Methylation markers

48
Q

How is cervical pathology treated
(4)

A

Colposcopy procedures

If invasion, may go on for more extensive surgical removal (Trachelectomy, Hysterectomy)

Chemotherapy

Radiotherapy (brachytherapy)

49
Q

Comment on research for cervical pathology

A

Cerviva - research consortium in TCD

Coombe women and infants university hospital

2.2 Cellular Pathology (29 decks)

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