Cervical, vulval and vaginal pathology

Question 1

What type of epithelium lines the endocervix

Answer 1

simple columnar glandular epithelium

Question 2

What type of epithelium lines the ectocervix and with which epithelium is it continuous with

Answer 2

Non-keratinising stratified squamous epithelium

continuous with vaginal epithelium

Question 3

What is the squamo-columnar junction

Answer 3

where squamous and columnar epithelium meet

Question 4

What is the transformation zone TZ

Answer 4

area between original SCJ and new SCJ

Question 5

Why does the SCJ change at menarche

Answer 5

Metaplasia of columnar glandular epithelium to stratified squamous epithelium due to increase in oestrogen and development of vaginal bacterial flora

Question 6

Metaplasia of cervical epithelium is a physiological process, true or false

Answer 6

TRUE

Question 7

Nabothian cysts are pathological, true or false

Answer 7

FALSE, they are entirely benign

Question 8

what are inflammatory causes of cervical pathology

Answer 8

cervicitis

cervical polyps

Question 9

What does CIN stand for

Answer 9

Cervical Intraepithelial Neoplasia

Question 10

Is CIN cancer?

Answer 10

No, it has not yet broken through the basement membrane

Question 11

List risk factors for developing CIN/cancer

Answer 11

many sexual partners - at higher risk of contracting HPV 16+18
early age of 1st intercourse
long term use of oral contraceptives
not using barrier contraception
smoking
immunosuppression - HIV, chemo
not attending cervical screening programme

Question 12

What are condyloma acuminatum more commonly known as and what causes them

Answer 12

Genital warts

HPV 6+11

Question 13

What is koilocytosis

Answer 13

Halo cells seen in HPV infected cells - CIN

Question 14

What is identified on cervical smear

Answer 14

Dyskaryosis

Question 15

What is dyskaryosis

Answer 15

Abnormal nucleus

Question 16

CIN is a pre-invasive stage of squamous cervical cancer, true or false

Answer 16

TRUE

Question 17

What is seen histologically in CIN

Answer 17

delay in differentiation - basal cells occupy more epithelium
nucelar abnormalities
excess mitotic activity
koilocytosis

Question 18

Define CIN I

Answer 18

abnormal cells occupy the basal 1/3rd of the cervical epithelium

Question 19

Define CIN II

Answer 19

abnormal cells extend to and occupy the middle 1/3rd of cervical epithelium

Question 20

Define CIN III

Answer 20

abnormal cells occupy the full thickness of cervical epithelium

Question 21

What is CIN III equivalent to

Answer 21

Carcinoma in situ (CIS)

Question 22

Symptoms of invasive squamous carcinoma

Answer 22

asymptomatic - detected at screening 
abnormal bleeding - post coital, post menopausal, blood stained discharge, contact bleeding 
pelvic pain 
haematuria/UTIs
renal failure/ureteric obstruction

Question 23

How can invasive squamous carcinoma spread

Answer 23

local
lymphatic
haematogenous

Question 24

glandular lesions are more common than squamous lesions, true or false

Answer 24

FALSE, less common

Question 25

Where do glandular lesions originate from

Answer 25

endocervical epithelium

Question 26

What is the precursor for endo-cervical adenocarcinoma

Answer 26

Cervical Glandular Intraepithelial Neoplasia | CGIN

Question 27

Is CGIN/adenocarcinoma easier/harder to pick up ono cervical smear tests

Answer 27

Harder

Question 28

CGIN is usually associated with CIN, true or false

Answer 28

TRUE

Question 29

cervical adenocarcinoma has a better prognosis than squamous carcinoma, true or false

Answer 29

FALSE

Question 30

Risk factors for cervical adenocarcinoma

Answer 30

higher socioeconomic class later onset of sexual activity smoking HPV (18)

Question 31

What are other HPV driven diseases

Answer 31

Vulval VIN Vaginal VaIN Anal AIN

Question 32

VIN can occur in conjunction with CIN and VaIN, true or false

Answer 32

TRUE

Question 33

in which age group is invasive vulvar squamous carcinoma seen

Answer 33

elderly women

Question 34

Vulvar invasive squamous carcinoma can arise from normal epithelium or VIN, true or false

Answer 34

TRUE

Question 35

what is the management of invasive vulvar squamous carcinoma

Answer 35

vulvectomy AND inguinal lymphadenectomy

Question 36

What us vulvar Paget's disease

Answer 36

crusting rash with tumour cells in epidermis

Question 37

What underlying malignancy may be seen in vulvar Paget's disease

Answer 37

tumour of sweat gland in skin

Question 38

What vaginal pathology may be seen

Answer 38

VaIN squamous carcinoma Melanoma