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Y3 OBS AND GYNAE > Pathology of Cervix, Vulva and Vagina > Flashcards

Pathology of Cervix, Vulva and Vagina Flashcards

1
Q

What is the ectocervix? What epithelium is it composed of?

A

Vaginal portion of the cervix, seen on internal examination

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2
Q

What is the endocervix?

A

Lowermost portion of the uterus

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3
Q

Describe the lining of the ectocervix

A

Non-keratinising stratified squamous epithelium with basal and parabasal cells

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4
Q

Describe the lining of the endocervix

A

Simple columnar epithelium that secretes mucous via cilia

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5
Q

What is the transformation zone? What happens to the position of this zone?

A

Squamocolumnar junction between ectocervical and endocervical epithelia
Alters during menarche, pregnancy and menopause

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6
Q

What is the clinical significance of the transformation zone?

A

Most common place on the cervix for abnormal cells to develop

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7
Q

How does cervical erosion occur?

A

Exposure of delicate endocervical epithelium to acid environment of vagina leads to physiological squamous metaplasia

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8
Q

How are Nabothian follicles formed?

A

When stratified squamous epithelium of the ectocervix grows over the simple columnar epithelium of the endocervix

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9
Q

State the two main types of pathology of the cervix and give examples

A

Inflammatory (cervicitis, polyp)

Neoplastic (CIN, squamous or adenocarcinoma)

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10
Q

What is cervicitis?

A

Non-specific acute or chronic inflammation resulting in subepithelial reactive lymphoid follicles in the cervix

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11
Q

How can cervicitis cause infertility in the long-term?

A

Simultaneous silent fallopian tube damage

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12
Q

What are the most common causes of cervicitis?

A

Commonly, a sexually-transmitted infection
Chlamydia trachomatis
Herpes simplex virus

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13
Q

Cervical polpys are premalignant. True/ False?

A

False

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14
Q

What is a cervical polyp? How do they present?

A

Localised inflammatory outgrowth

Bleeding if ulcerated

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15
Q

List risk factors for neoplastic changes of the cervix

A

Persistence of HPV (many sexual partners)
Vulnerability of SCJ (age of 1st intercourse, use of oral contraceptives, avoidance of barrier contraceptives)
Smoking
Immunosuppression

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16
Q

List the main presentations of HPV, in order of risk

A

Genital warts
Cervical intra-epithelial neoplasia
Cervical cancer

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17
Q

What types of HPV are associated with genital and vulvar warts?

A

Type 6

Type 11

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18
Q

What types of HPV are associated with cervical neoplasia?

A

Type 16

Type 18

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19
Q

Describe the pathological appearance of genital warts

A

Thickened papillomatous squamous epithelium Cytoplasmic vacuolation (koilocytosis)

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20
Q

Describe the pathological appearance of CIN

A

Infected flat epithelium

Signs of koilocytosis

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21
Q

Outline the timeline of progression of HPV to cervical cancer

A

HPV –> CIN: 6 months to 3 years

CIN –> cervical cancer: 5-20 years

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22
Q

What is the main risk factor for progression of HIV to cervical cancer?

A

Persistant exposure to HPV infection

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23
Q

What is cervical intra-epithelial neoplasia?

A

A preinvasive stage of cervical cancer occuring at transformation zone which involves dysplasia of squamous cells

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24
Q

How is CIN typically detected?

A

Asymptomatic

Detected by cervical screening

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25
Q

List the key histological factors that identify the severity of cervical intra-epithelial neoplasia

A

Delay in maturation/differentiation of immature basal cells
Nuclear abnormalities (hyperchromasia, increased N:C ratio, pleomorphism)
Excess mitotic activity above basal layer (abnormal mitotic forms)

26
Q

How is CIN graded?

A

How deep the cell changes go into the surface of the cervix: CIN 1,2,3

27
Q

Describe the pathological appearance of CIN1

A

Basal third of epithelium occupied by abnormal cells

28
Q

Describe the pathological appearance of CIN2

A

Abnormal cells extend to middle third of epithelium

29
Q

Describe the pathological appearance of CIN3

A

Abnormal cells occupy full thickness of epithelium

30
Q

Outline the prevalence of the main types of malignant cervical tumours

A

Invasive squamous carcinomas: 75-95%

Endocervical adenocarcinoma: 5-25%

31
Q

List the stages of invasive squamous carcinoma

A 
1A1: depth up to 3mm, width up to 7mm
1A2: depth up to 5mm, width up to 7mm
1B: confined to cervix
2: spread to adjacent organs
3: Involvement of pelvic wall
4. Distant mets or involvement of rectum or bladder
32
Q

List symptoms of early invasive squamous carcinoma

A

Usually asymptomatic

33
Q

List symptoms of late invasive squamous carcinoma

A

Abnormal bleeding (PCB, PMB, IMB)
Brownish or blood-stained vaginal discharge
Pelvic pain
Haematuria, urinary problems
Ureteric obstruction, acute renal failure

34
Q

List common sites of local spread in SCC

A 
Uterine body
Vagina
Bladder
Ureters
Rectum
35
Q

List common sites of lymphatic spread in SCC

A

Pelvic nodes

Paraortic nodes

36
Q

List common sites of haematogenous spread in SCC

A

Liver
Lungs
Bone

37
Q

What are the grading classifications used in SCC?

A

Well differentiated
Moderately differentiated
Poorly differentiated
Indifferentiated/ anaplastic

38
Q

State the two main types of cervical glandular lesions

A

Cervical glandular intra-epithelial neoplasia (CGIN)

Endocervical adenocarcinoma

39
Q

What is cervical glandular intra-epithelial neoplasia?

A

Preinvasive phase of endocervical adenocarcinoma originating from the endocervical epithelium

40
Q

List risk factors for endocervical adenocarcinoma

A

Young women
Later onset of sexual activity
Smoking
HPV 18

41
Q

Adenocarcinoma and squamous carcinoma of the cervix can occur simultaneously. True/ False?

A

True

Known as adenosquamous carcinomas

42
Q

List management options for cervical cancer

A

Surgery (LLETZ for early cancer, hysterectomy)
Radiotherapy (external beam, brachytherapy)
Chemotherapy (neoadjuvant, concomitant, palliative)

43
Q

List other types of HPV driven disease

A

Vulvar intrapeithelial neoplasia (VIN)
Vaginal intraepithelial neoplasia (VaIN)
Anal intraepithelial neoplasia (AIN)

44
Q

Define the bimodal presentation of VIN

A

Young women: multifocal, recurrent, persistant

Older women: great risk of progression

45
Q

Describe Paget’s disease of the vulva?

A

Skin cancer derived from glandular cells on the skin of the vulva characterised by a red, crusting, itchy rash

46
Q

What is vulvar invasive squamous carcinoma?

A

A well differentiated malignant tumour, typically found in elderly women, presenting as an ulcer or exophytic mass

47
Q

What is an important prognostic factor in vulvar invasive squamous carcinoma?

A

Spread to inguinal lymph nodes

48
Q

Outline the management of vulvar invasive squamous carcinoma

A

Radical vulvectomy

Inguinal lymphadenectomy

49
Q

What infection is a common form of vulvar disease, particularly in diabetics?

A

Candida

50
Q

What is a Bartholin’s gland abscess?

A

Bartholin’s gland, located on either side of the opening of the vagina, becomes obstructed forming a cyst that can become infected and painful

51
Q

List other types of non-neoplastic epithelial disorders that con form on the vulva

A 
Lichen sclerosis (itchy white patches)
Lichen planus (itchy rash)
Psoriasis
52
Q

What group of women typically get vulvar atrophy?

A

Post-menopausal women

53
Q

List the main types of vaginal neoplastic pathology

A

Vaginal intraepithelial neoplasia
Squamous carcinoma
Melanoma

54
Q

What group of women typically get invasive squamous carcinoma of the vagina?

A

Elderly women

55
Q

How might vaginal melanoma present?

A

Pigmented lesion, similar to a polyp

56
Q

What is the first-line treatment for 1A1 disease?

A

Local excision(LLETZ) +/- pelvic lymph node dissection

57
Q

What is the first-line treatment for 1A2-1B1 stage disease?

A

> 2cm, not desiring fertility = hysterectomy
(non-surgical = chemoradiation)
<2cm, desiring fertility = radical trachelectomy

58
Q

What is the first-line treatment for 1B2-2A stage disease?

A

Radical hysterectomy +lymphadenectomy

59
Q

What is the first-line treatment for 2B-4A stage disease?

A

Chemoradiation

60
Q

What is the first-line treatment for 4B stage disease?

A

Combination chemotherapy

61
Q

What is the first-line treatment for a pregnant women at any stage?

A

MDT care

Delivery at 35 weeks

Y3 OBS AND GYNAE (44 decks)

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