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Clinical Pathology > 46 - Diseases of the female genital system > Flashcards

46 - Diseases of the female genital system Flashcards

1
Q

VIN stands for

A

Vulval intraepithelial neoplasia

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2
Q

CIN stands for

A

Cervical intraepithelial neoplasia

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3
Q

CGIN stands for

A

Cervical glandular intraepithelial neoplasia

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4
Q

VaIN stands for

A

Vaginal intraepithelial neoplasia

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5
Q

AIN stands for

A

Anal intraepithelial neoplasia

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6
Q

HPV virus - genetics and lifecycle

A

Double stranded DNA virus
Circular genome - 7 early genes, 2 late genes

> 100 subtypes
Different types over different tissues

Genital HPVs grouped into low and high oncogenic risk

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7
Q

Low risk HPV numbers

A

6, 11 - linked with genital warts are most common

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8
Q

High risk HPV numbers

A

Associated with high grade pre-invasive and invasive disease: 16, 18

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9
Q

Low risk HPV 6,11

A

Lower genital tract warts

Low grade intraepithelial neoplasias which rarely form lesions

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10
Q

High risk HPV 16, 18

A

High grade ‘IN’s and invasive carcinomas

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11
Q

Low risk vaccine called

A

Gardasil

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12
Q

High risk vaccine called

A

Cervarix

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13
Q

High risk HPV - mode of action

A

Integrates into host chromosomes

Upregulates E6, E7 expression which inactivates p53 and binds to RB1 gene product

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14
Q

What does p53 do?

A

Mediates apoptosis in response to DNA damage which leads to accumulation of genetic damage

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15
Q

What does RB1 do?

A

Tumour suppression gene controls G1/S checkpoint in cell cycle

== dysregulation of cell proliferation

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16
Q

How are VINs stained?

A

Toluidine blue

17
Q

Vulval intraepithelial neoplasia - histology

A

Classical / warty / baseloid:
Graded VIN 1-3
Related to HPV
In young people

Differentiated:
Not graded
Not HPV related
Occurs in chronic dermatoses
Older people
18
Q

Behaviour of VIN

A

50% recur

Progression to invasive carcinoma is 4-7% in treated women and 87% in untreated

19
Q

Most common vulval cancer is

A

Squamous cell (90%)

20
Q

Squamous cell carcinoma in

A

Associated with VIN

21
Q

Squamous cell carcinoma in >70

A

Inflammatory dermatoses in age>70

Due to lichen sclerosus and lichen planus

22
Q

Lymph nodes mets rely on what in vulval squamous cell carcinomas

A

Depth

4mm = 40%

23
Q

Malignant melanoma of the vulva

A 
5% of vulval cancers
Mean age 50-60
Local recurrence in 1/3
Spreads to urethra
Lymph node/haematogenous spread common
Depth of invasion correlates with lymph node involvement
24
Q

Other vulval tumours

A

Paget’s disease

25
Q

Paget’s disease

A

Usually no underlying tumour

5% regional malignant disease - bladder, cervix, rectal

26
Q

What happens to the external os in a post menopausal state?

A

Transitional zone retracts up the canal and pulls up external os

27
Q

What do cervical screening programmes aim to find?

A

Cervical intraepithelial neoplasia

To find pre-invasive stage of cervical squamous cell carcinoma

28
Q

How many CIN types are there?

A

3

29
Q

Which CIN type is most likely to become invasive?

A

CIN 3

30
Q

What do you do if low grade dyskaryosis is found on screening?

A

HPV screening, if positive, refer to colposcopy + Rx

-ve = normal recall

31
Q

What is you have high grade dyskaryosis found on screening?

A

Refer to colposcopy + Rx

32
Q

What is colposcopy?

A

Examination of cervix with low powered stereoscopic microscope

33
Q

What does LLETZ stand for?

A

Large loop excision of the TZ

34
Q

What stain is used in colposcopy?

A

Acetic acid which highlights abnormal epithelium

35
Q

Risk factors for cervical squamous cell carcinoma

A 
High risk HPV is most causative
Multiple sexual partners
Male partner with multiple partners
Young age at first intercourse
High parity
Low socioeco
Smoking
Immunosuppression

Clinical Pathology (65 decks)

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