Cervical Pathology I Flashcards Preview

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Flashcards in Cervical Pathology I Deck (65):
1

transformation zone

of cervix - susceptible to HPV infection, dysplasias, cancer

puberty and pregnancy - eversion** - exposure of endocervical canal

adult - squamous metaplasia** of exposed endocervical canal - creates the transformation zone

post-menopause - inversion** - transformation zone into the endocervical canal again

2

eversion

puberty and pregnancy

3

squamous metaplasia

adult - forms transformation zone

4

inversion

post-menopause

5

lugals

iodine
-turns healthy tissue brown

cervix exam

6

colored lights

to examine cervix

7

acetic acid

to examine cervix

white HPV infection

acetyl white lesion

8

transition zone

cervix-endocervix
SCJ - squamocolumnar junction

9

chronic cervicitis

changing microbiome

10

at puberty with flora

estrogen > formation of glycogen > lactobacilli > lactic acid and peroxide

loss of acidosis - loss of flora and overgrowth of bacteria - cervicitis

11

all infections

may cause changes in squamous mucosa of cervix which may result in atypia on pap smear

12

ASCUS

atypical squamous cells of uncertain significance

problem for path and clinician

13

asymptomatic women, PID, ectopic

chlamydia

14

newborn chlamydia

conjunctivitis
pneumonia
blindness

15

NAAT

nucleic acid amplification test

dx of chlamydia

16

chlamydia over time

more chronic
-may scar fallopian tube

site of ectopic pregnancy**

17

chronic follicular cervicitis

chlamydia trachomatis infection

18

herpes on cervix

blisters/ulcers

19

multinucleated cells with intranuclear ground glass viral inclusions

herpes

20

gonococcus

neisseria gonorrhoeae

gram negative diplococci

thayer martin

21

lesion

any abnormal finding

shorthand - something of interest

22

polyp

any mass causing elevation on epithelial surface

23

sessile

broad based polyp

24

pednuculated

polyp with stalk

25

polyp >5cm

may be called tumor

26

thayer martin

chocolate agar with antibiotics

grows neisseria gonorrhoeae

27

tx of endocervical polyp

polypectomy

can extrude from endocervical canal

28

endocervical gland full of mucus

nabothian cyst

very common - often cause no problems

29

leading cause of cancer death in third world

cervical neoplasms

30

high risk HPV

16 - 60% of cervical cancers
18 - 10%

31

risk for HPV

young first intercourse
multiple partners
immunosuppression
BCPs
smoking

32

HBV

causes hepatocellular carcinoma by inserting into hepatic DNA

33

HPV life cycle

can only infect immature squamous cells
can only replicate in maturing squamous cells

34

proteins of HPV

E6
E7

35

E6

HPV product

binds to p53 and inactivates it

36

E7

HPV product

binds to Rb protein
-prevents binding to E2F
-free E2F binds promoter genes - like c-myc

37

episome

cytoplasmic form of HPV

38

high grade HPV and cancer

inserts into DNA - leading to presence of E6 and E7

39

other locations of HPV squamous cancer

oropharynx, anus, penis, vulva, vagina

40

p53

involved in causing G1 arrest for DNA repair
-G1 to S transition

guardian of genome

LOF p53 - DNA unrepaired

41

hyperP Rb

no inhibition of E2F - cancer

42

hypoP Rb

inhibition of E2F - no transcription

43

CIN

cervical intraepithelial neoplasm

44

CIN I

mild dysplasia
low grade squamous intraepithelial lesion (LSIL)

95% go away

minimal nuclear enlargement above lower third

45

CIN II

moderate dysplasia
high grade SIL

half way nuclear enlargement

46

CIN III

severe dysplasia
high grade SIL

full thickness nuclear enlargement

47

HSIL

need excised

for CIN II and CIN III

48

koilocytic atypia

hallmark of HPV

low grade and high grade

but if this only - low grade

49

Ki 67

marker of cell proliferation

should only be on basal layer of cell

if extends higher - expansion of proliferation zone

50

p16

cell cycle regulator
-cyclin kinase inhibitor

high levels - but cell still proliferates - bc p16 target (Rb) is inactivated by E7

51

HSIL to cancer

10 years - so takes a long time

52

Tx of cervical dysplasia

abnormal pap - follow up coloscopy and cervical biopsy

also removal of dysplastic tissue

53

cervical cancer screening recommendations

age 21 to 65

54

cone bx

area of tissue around cervix is removed and examined

55

majority of cervical cancers

SCC - 80%
15% - adenocarcinoma
5% - adenosquamous carcinoma and small cell

56

peak age of invasive cervical cancer

age 45

57

bleeding after sex

with cervical cancer

58

T2

extends beyond cervix

59

death in cervical cancer

invasion of local structures
-obstruction of ureters - renal failure**

60

tx of cervical cancer

radical hysterectomy

61

keratin pearl

SCC of cervix

62

stage 1

confined to cervix

63

pap smear

10% false negative rate

average lab - misses one every 2 years

combined with HPV DNA test - 99.5% sensitive

no HPV DNA testing in women <30 - high rate of infection

64

tx with abnormal pap

follow up colposcopic exam
-removal of tissue if high grade
-watchful expectantly low grade

65

HPV vaccine

new vaccine covers 6, 11, 16, 18, 31, 33, 45, 52, 58
-called 9v

now vaccinating males