Flashcards in Cervix Deck (29)
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1
lined by hormonally responsive stratified
squamous epithelium (noncornified); post-puberty, mature
cells store glycogen, which supports growth of normal flora
•Ectocervix
2
lined by simple columnar epithelium;
endocervical glands are crypt-like spaces lined by the same
epithelium
•Endocervix
3
Etiology of Acute cervicitis
• Endocervix (not erosion)
• Gonococcal, Chlamydia, Candida,
Trichomonas, Herpes
• Post partum, Post D & C
• Purulent vaginal discharge
4
Etiology of chronic cervicitis
• Non-specific, incidental
• Lymphocytes and plasma cells normally present in
wall
• Granularity, thickening
• Retention (Nabothian) cysts
5
In cervix
• Non-specific response to irritation
• No malignant potential
Squamous metaplasia
6
Signs of Endocervical polyp
Pre-menopausal
• Vaginal spotting
• Dilated endocervical glands, vascularity,
edema, inflammation
• No malignant potential
7
Condyloma accuminatum associated with
STD, HPV 6, 11
8
Lab of Condyloma accuminatum
Papillomatous, koilocytes
9
Seen in 20s-30s can enlarge during pregnancy
Condyloma accuminatum
10
What are the HPV strains associated with CIN
HPV 16, 18, 31, 33, 35, 45 (high risk)
• HPV 6, 11, 40, 54 (low risk)
11
Risk factors for
• Sexual activity at a young age
• Multiple sex partners
• Parity (>7)
• High viral load
• Immunosuppression
• Certain HLA subtypes
• Chlamydial infection
• Smoking
CIN
12
Features of abnormal maturation in CIN
That orderly sequence of maturation from bottom to top of
the epithelium is lost beginning at the basal layer and
progressing until the entire thickness of the epithelium is
involved. Nuclei remain large; cells remain cuboidal;
glycogen is not stored; mitoses above basement membrane.
13
Schiller test
Schiller test – paint cervix with iodine - look for
unstained pale patches
14
pap smear guidlines
Test every 3 years beginning age 21
15
Signs of CIN I
Koilocytic atypia - enlarged hyperchromatic irregular nuclei
16
Signs of CIN II-III
Increased N:C ratio
Pleomorphic, hyperchromatic nuclei
17
Prognosis of CIN I (LSIL)
60% Regress
30% persist
10% to HSIL
18
Prognosis of CIN II-III (HSIL)
30% regress
60% persist
10% ca
19
Most common cause of death for carcinoma of cervix
pyelonephritis, uremia, ureteral obstruction
20
Distant mets of cervix carcinoma
liver, lung, bone marrow
21
HPV association for cervix carcinoma
HPV 16, 18, 31, 33
22
Age cervix carcinoma
30-50 yrs
23
Clinic-
Irregular vaginal bleeding
• Postcoital bleeding
• Vaginal discharge
• Pyometra – due to obstruction
• Colposcopic biopsy
• Surgery and radiation
cervix carcinoma
24
Exophytic cervix carcinoma
Necrotic fungating mass
25
Stage IA
Micro-invasive carcinoma
• Depth =/< 5mm from basement membrane of the
epithelium and Width no more than 7mm
• No lymphatics, blood vessels invasion
• Surgical excision curative- cone biopsy or simple
hysterectomy
• Stage Ia tumours can only be diagnosed in cone biopsies or
hysterectomy specimens
26
Histo
Stage IA micro-invasive carcinoma
• Squamous cell carcinoma - squamous cells with
keratin pearls.
27
Age of adenocarcinoma
4th decade
28
Adenocarcinoma HPV association
16/18
29
