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Cervical and Vulval Pathology Flashcards

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1
Q

What are the layers of the normal ectocervix from superficial to deep?

A

Exfoliating cells, superficial cells, intermediate cells, parabasal cells, basal cells, basement membrane

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2
Q

What is the transformation zone of the cervix?

A

Squamocolumnar junction between ectocervical (squamous) and endocervical (columnar) epithelia

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3
Q

What are some examples of times throughout life when the transition zone alters its position?

A

Menarche, pregnancy, menopause = occurs due to physiological response to these events

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4
Q

What occurs during cervical erosion?

A

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

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5
Q

What is a Nabothian follicle?

A

Mucous-filled cyst of cervical surface = usually occur when ectocervical epithelium grows over epithelium of endocervix

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6
Q

What are some features of cervicitis?

A

Often asymptomatic

Can cause infertility due to simultaneous silent fallopian tube damage

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7
Q

What are some causes of cervicitis?

A

Non-specific inflammation, chlamydia trachomatis, herpes simplex

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8
Q

What is follicular cervicitis?

A

Sub-epithelial reactive lymphoid follicles = occur in cervix

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9
Q

What are some features of cervical polyps?

A

Localised inflammatory outgrowth
Cause bleeding if ulcerated
Not premalignant

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10
Q

What are some risk factors for cervical cancer?

A

Persistence of high risk HPV = usually type 16 or 18, multiple sexual partners increase risk
Smoking and immunosuppression
Vulnerability of transition zone in early reproductive life

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11
Q

What are some factors that affect the vulnerability of the transition zone in early reproductive life?

A

Age at first intercourse
Long term use of oral contraceptives
Non-use of barrier contraception

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12
Q

What causes genital warts?

A

Low risk HPV = type 6 or 11

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13
Q

What is condyloma acuminatum?

A

Occurs in genital warts = thickened papillomatous squamous epithelium with cytoplasmic vacuolation (koilocytosis)

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14
Q

What causes cervical intraepithelial neoplasia?

A

High risk HPV = type 16 or 18

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15
Q

What would indicate cervical intraepithelial neoplasia on a smear test?

A

Infected epithelium is flat but shows koilocytosis

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16
Q

What kind of cancer is cervical cancer?

A

Invasive squamous carcinoma = caused by HPV, virus is integrated into host DNA

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17
Q

How long does it take for HPV infection to cause cervical cancer?

A

Takes 6 months-3 years for HPV to become high grade CIN and 5-20 years for high grade CIN to become invasive cancer

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18
Q

What is the prevalence of HPV infection?

A

80% cumulative prevalence in a lifetime

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19
Q

What is cervical intraepithelial neoplasia (CIN)?

A

Pre-invasive stage of cervical cancer = dysplasia of squamous cells

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20
Q

Where does CIN tend to occur?

A

Transformation zone = can involve large area

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21
Q

How is CIN detected?

A

By cervical screening = asymptomatic and not visible to naked eye

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22
Q

What is CIN preceded by?

A

Koilocytosis

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23
Q

What are the three markers used to grade CIN?

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A

Graded I-III = delay in maturation, nuclear abnormalities, excess mitotic activity

24
Q

What nuclear abnormalities can occur in CIN?

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A

Hyperchromasia, pleomorphism, increased nucleocytoplasmic ratio

25
How is a delay in maturation seen and excess mitotic activity in CIN?
Immature basal cells occupying more of epithelium | Mitotic activity situated above layers and abnormal mitotic forms
26
What occurs in CIN grade I?
Basal 1/3 of epithelium occupied by abnormal cells Raised number of mitotic figures in lower 1/3 Surface cells quite mature but nuclei slightly abnormal
27
What occurs in CIN grade II?
Abnormal cells extend to middle 1/3 | Mitoses in middle 1/3 and abnormal mitotic figures
28
What occurs in CIN grade III?
Abnormal cells occupy full thickness of epithelium | Mitoses in upper 1/3
29
What is the rate of progression of CIN?
1% of CIN I progress to invasion 5% of CIN II become invasive >12% of CIN III progress to become invasive
30
How common is invasive cervical squamous carcinoma?
Accounts for 75-95% of malignant cervical tumours | Second most common female cancer
31
What are some features of invasive cervical squamous carcinoma?
Increasingly seen in younger women = often found in early stage Develops from pre-existing CIN = most cases preventable by screening
32
What is stage 1 of invasive cervical squamous cancer?
``` 1A1 = depth of up to 3mm, width up to 7mm 1A2 = depth of up to 5mm, width up to 7mm 1B = confined to cervix ```
33
What are stages 2 and 3 of invasive cervical squamous carcinoma?
``` 2 = spread to adjacent organs 3 = involvement of pelvic wall ```
34
What is stage 4 of invasive cervical squamous carcinoma?
Distant metastases or involvement of rectum or bladder
35
What are the symptoms of invasive cervical squamous carcinoma?
Usually none at microinvasive/early invasive stages Abnormal bleeding = post coital, post menopausal, brownish or blood stained vaginal discharge Pelvic pain, haematuria, UTI, ureteric obstruction, renal failure
36
How does invasive cervical squamous carcinoma spread?
``` Local = uterine body, vagina, bladder, ureters, rectum Lymphatic = early stages, pelvic and para-aortic nodes Haematogenous = late stages, liver, lungs and bone ```
37
How is invasive cervical squamous carcinoma graded?
Well differentiated, moderately differentiated, poorly differentiated, undifferentiated/anaplastic
38
Where does cervical glandular intraepithelial neoplasia (CGIN) originate from?
Endocervical epithelium
39
What are some features of CGIN?
Pre-invasive phase of endocervical adenocarcinoma Screening less effective = more difficult to diagnose on smear than squamous type Sometimes associated with CIN
40
How common in endocervical adenocarcinoma?
5-25% of cervical cancers | Increasing incidence, especially in young women
41
What are some features of endocervical adenocarcinoma?
Some are mixed (adenosquamous) = may arise from common origin cell Worse prognosis than squamous carcinoma
42
What is the epidemiology of endocervical adenocarcinoma?
Higher socioeconomic class, later onset of sexual activity, smoking, HPV type 18
43
What are some rarer HPV-driven diseases?
Vulvar intraepithelial neoplasia (VIN) Vaginal intraepithelial neoplasia (VaIN) Anal intraepithelial neoplasia (AIN)
44
What are some features of vulval intraepithelial neoplasia (VIN)?
Less predictable than CIN but also has three grades | Often associated with HPV and synchronous with CIN and VaIN
45
What is the bimodal incidence of vulval intraepithelial neoplasia?
Young women = often multifocal, recurrent or persistent causing treatment problems Older women = greater risk of progression to invasive squamous carcinoma
46
What are some features of vulvar invasive squamous carcinoma?
Usually present as an ulcer or exophytic mass in elderly woman Can arise from normal epithelium or VIN
47
What grade are most vulvar invasive squamous carcinomas?
Well differentiated = verrucous are extremely well differentiated type
48
What is an important prognostic factor for vulvar invasive squamous carcinomas?
Spread to inguinal lymph nodes
49
How are vulvar invasive squamous carcinomas treated?
Surgical treatment = radical vulvectomy and inguinal lymphadenectomy
50
What is the prognosis of vulvar invasive squamous carcinomas?
90% 5 year survival if node negative | <60% 5 year survival if node positive
51
What are some features of vulvar Paget's disease?
Crusting rash Tumour arising from sweat gland of skin Tumour cells in epidermis = contain mucin Mostly no underlying cancer
52
What are some vulval infections?
Candida = especially diabetics Vulval warts = HPV types 6 and 11 Bartholin's gland abscess = due to blockage of gland duct
53
What are some vulval dermatoses?
Lichen sclerosis, lichen planus, psoriasis
54
What lesions may exist alongside vaginal epithelial neoplasia?
Cervical and vulval epithelial neoplasia
55
What are some vaginal malignancies that can occur?
Squamous carcinoma = less common than cervical and vulval counterparts, usually elderly patients Melanoma = rare, may appear as polyp

Reproduction (62 decks)

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