Pathology of Cervix, Vagina, and Vulva 2

Question 1

What is dysplasia and how does it relate to cervical cancer? (important!)

Answer 1

• Invasive cervical carcinoma only arises in the background of squamous dysplasia
  
  • Most cases of mild dysplasia harbor high risk HPV as do almost all cases of moderate/severe dysplasia and invasive carcinoma
  • Squamous dysplasia is 100x more common than invasive carcinoma
• Definition
  
  • dysregulated growth and loss of maturation in squamous epithelium without invasion into the underlying stroma
• Typically progresses from mild to moderate to severe forms before invading through the basement membrane and into the stroma
• Most cases of squamous dysplasia won’t progress and will spontaneously regress without treatment
  
  • it takes years for progress from LSIL to HSIL and years to progress to invasive carcinoma

Question 2

What is the gross appearance of cervical carcinoma?

Answer 2

Exophytic, firable mass on the surface of the cervix

Question 3

What are the microscopic and key findings of a tumor that is squamous cell cervical carcinoma?

Answer 3

• Microscopic appearance
  
  • individual squamous cells
  • infiltrates throgh a cellular and inflammatory (desmoplastic) stroma
• Key features
  
  • intracellular bridges between adjacent tumor cells
    
    • tight junctions - made of desmosomes
  • keratinization which appears as bright orange/pink material either inside or outside the cytoplasm
• 90% of cervical cancers
• HPV infected squamous cells called koilocytes
  
  • ​markedly enlarged with irregular nuclei but abundant cytoplasm
  • wrinkled nuclei and perinuclear clearing

Question 4

What are the important features of adenocarcinoma of the cervix?

Answer 4

• 10% of cervical cancer
• Key features
  
  • gland formation by definition
  • intracellular and extracellular mucin production

Question 5

What are some key findings of dysplasia on histology?

Answer 5

• High nuclear:cytoplasmic ratios
• Somewhat enlarged crowded nuclei with irregular contours
• Mitotic figures above the basal layer
• No invasion of the underlying stroma by definition
• Grading
  
  • abnormal cells confined to bottom 1/3 of epithelium = mild
    
    • Low grade intraepithelial lesion (LSIL) = CIN 1
  • extension to middle 2/3 = moderate
    
    • CIN 2
  • upper 1/3 = high grade
    
    • High grade squamous intraepithelial lesion (HSIL) = CIN 2,3
  • full thickness also called carcinoma in situ

Question 6

What are some other common infecious diseases of the female reproductive tract?

Answer 6

• Syphilis
  
  • Treponema pallidum
  • Primary, secondary, and tertiary stages
• Herpes simplex (HS)
  
  • Type 2 fairly common
  • persists in regional nerve ganglion
  • risk of transmission to fetus

Question 7

Describe the histology of HPV infected cells in the cervix.

Answer 7

• Koilocytes
  
  • cells infected with HPV
  • not dysplastic
• Big cells in the superficial portion of the epithelium
• Big dark crinkled nuclei (raisin-oid), often binucleated
• Perinuclear clear halo