Cervix, Vagina, Vulva

Question 1

Sarcomas arise from which type of tissue?

Answer 1

Mesenchymal

Question 2

Carcinomas arise from which tissue type?

Answer 2

Epithelial

Question 3

What cell types differentiates the cervical transformation zone?

Answer 3

The cervical transformation zone is where the stratified squamous cells of the exocervix abruptly becomes the columnar epithelium of the endocervix.

In the transformation zone, two types of epithelia exist: squamous epithelium with glands behind it

Question 4

What is the clinical relevance of the cervical transformation zone?

Answer 4

It is the site of cervical squamous carcinoma

Question 5

Is HPV a DNA or RNA virus?

Answer 5

DNA

Question 6

What are the 4 high risk subtypes of HPV?

Answer 6

16, 18, 31, 33

Question 7

What are the two common low risk subtypes of HPV?

Answer 7

6, 11

Question 8

People infected with HPV 6 or 11 are at risk for developing which pathology?

Answer 8

Chondyloma (wart)

Question 9

People infected with a high risk HPV (16, 18, 31, 33) are at risk for developing which pathology?

Answer 9

CIN —> invasive cancer

cervical intraepithelial neoplasia

Question 10

List the two HPV oncoproteins and what they bind to (what makes High risk HPV high risk?)

Answer 10

E6 –> p53
E7 –> Rb (holds E2F)

Binding to the tumor suppressor neutralizes their function and they are now pro-tumorigenic

Question 11

HPV promotes a clonal outgrowth of which type of cell in the cervical transition zone?

Answer 11

Squamous cells  (75%)
Glands beneath (adenocarcinomas) - (15%)

Question 12

Which is the characteristic cell of the chondyloma?

Answer 12

Koilocyte

Raisen look with perinuclear halo

Question 13

Differentiate a squamous intraepithelial lesion vs CIN

Answer 13

SIL is simply a scraping of squamous cells from the top layer

CIN staging requires a biopsy to determine how deep atypical cells are found

If the top layer is terrible looking, we can say it is a high grade SIL because in order for the top cells to be atypical, the entire thickness of the epithelium must be atypical

Question 14

What is the outlook for a low SIL/CIN I lesion?

Answer 14

60% regression
30% persist
10% progression to high SIL

Question 15

What is the outlook for a high SIL (CN II /CN III) lesion?

Answer 15

30% regression
60% persist
10% progression to carcinoma, usually within 10 years

Question 16

What are the recommendations for getting Pap smears?

Answer 16

21-65: every 3 years

Or- every 5 years if done along with HPV testing

Question 17

20% of cervical cancers have a somatically acquired mutation of which tumor suppressor gene?

Answer 17

LKB1

Question 18

Other than HPV infections, what are other risk factors for invasive cervical cancer?

Answer 18

smoking, immunodeficiency (AIDS defining illness)

Question 19

WHat is the treatment for cervical cancer?

Answer 19

Hysterectomy, lymph node dissection

Question 20

Other than high risk HPV, name two risk factors for cancer of the vulva

Answer 20

Lichen sclerosis

Non-HPV related

Question 21

WHat is the vulvar presentation of squamous cell carcinoma?

Answer 21

Leukoplakia (white plaque)

Question 22

What is the vaginal presentation of squamous cell carcinoma?

Answer 22

Vaginal bleeding, discharge

Question 23

Which age group is affected by lichen scleorsis?

Answer 23

Post-menopausal

Question 24

Thinning of the epidermis and fibrosis of the dermis describes the histology of which vulvar pathology?

Answer 24

Lichen scleorsis

Question 25

Lichen simplex chronicus is associated with what epidemiology?

Answer 25

Chronic irritation/scratching

Question 26

Hyperplasia of the vulvar epithelium is associated with which vulvar pathology?

Answer 26

Lichen simplex chronicus

Question 27

What is seen on physical exam on someone with lichen simplex chronicus?

Answer 27

Leukoplakia | Thick, leathery skin

Question 28

What is the increased risk of malignancy associated with lichen simplex chronicus?

Answer 28

None

Question 29

What is the risk of progression to squamous cell carcinoma of the vulva in lichen sclerosis?

Answer 29

Small risk of progression to cancer- especially in the elderly

Question 30

What is the hallmark histology of paget's disease?

Answer 30

Intraepidermal proliferation of malignant cells Arises from intraepidermal progenitor cells

Question 31

What are the physical findings associated with paget disease of the vulva

Answer 31

Red, scaly, crusted plaque

Question 32

How do you differentiate melanoma from Paget disease?

Answer 32

PAS stain, Keratin stain PAS+ only for paget disease (mucin staining) Keratin + (only for paget disease)

Question 33

Which drug is associated with increased rates of clear cell adenocarcinoma?

Answer 33

DES- given to mothers to prevent abortions --> increased risk in their female offspring DES --> adenosis (persistence of columnar epithelium in the upper 2/3rds of the vagina ---> increased risk for clear cell adenocarcinoma)

Question 34

What is the precursor lesion to adenocarcinoma of the vagina?

Answer 34

vaginal adenosis -- persistence of columnar epithelium in the upper 1/3 of the vagina (Upper 2/3rds derived from mullerian duct, bottom 1/3 derived from urogenital sinus)

Question 35

Rhabdomyosarcomas are cancer of what precursor cell?

Answer 35

Skeletal muscle

Question 36

What is another name for embryonal rhabdomyosarcoma of the vagina?

Answer 36

Sarcoma botryoides (grape-like mass)

Question 37

What age group presents with embryonal rhabdomyosarcoma?

Answer 37

Children, usually less than 5 years old

Question 38

What is the clinical presentation of an embryonal rhabdomyosarcoma

Answer 38

Bleeding, soft, grape-like masses protruding through the vagina (or penis of males)

Question 39

Name two IHC stains for identification of embryonal rhabdomyosarcomas

Answer 39

Desmin (muscle cell intermediate filament), myogenin (TF of immature skeletal muscle) Both are found in rhabdomyoblasts- tumor cell of origin. They also display cytoplasmic cross-striations

Question 40

Cancer from lower 1/3 of vagina spreads to which lymph nodes?

Answer 40

Inguinal

Question 41

Cancer from the upper 2/3rd of the vagina drain to which lymph nodes?

Answer 41

Regional iliac nodes

Question 42

`Can CIN reverse? Does carcinoma in situ reverse?

Answer 42

CIN- can reverse | Carcinoma in situ- does not reverse

Question 43

Pap smears are great a detecting what type of cancer?

Answer 43

Squamous cell carcinoma of the cervix - NOT adenocarcinoma of the cervix

Question 44

The quadrivalent HPV vaccine covers which 4 serotypes?

Answer 44

6, 11, 16, 18