Diseases of the female genital system 1 Flashcards Preview

Clinical Pathology > Diseases of the female genital system 1 > Flashcards

Flashcards in Diseases of the female genital system 1 Deck (53):
1

What is dysplasia?

- Earliest morphological manifestation of multistage process of neoplasia
- In-situ disease; non-invasive
- Shows cytological features of malignancy, but no invasion
- No invasion = no metastasis = curable
- If left, significant chance of developing invasive malignancy

2

How might smoking be a relevant risk factor in cervical cancer?

Smoking is known to decrease to numbers of antigen presenting cells in cervical epithelium and may effectively cause local Immunosuppression.

3

What are the features of HPV?

- Double stranded DNA viruses
- 7.9kb circular genome, 7 ‘early genes’, 2 ‘late’ genes
- >100 subtypes, based on DNA sequence
- Different types affect different tissues
- Lifecycle linked to epithelial differentiation
- Genital HPVs grouped into low and high oncogenic risk

4

What are the high risk sub-types associated with high-grade pre-invasive and invasive disease?

16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68

5

What percentage of cervical cancers contain HPV?

99.7%

6

What percentage of cervical cancers are caused by 16 and 18?

70%

7

What kind of lesions are caused by 'low risk' HPV 6, 11 etc...

- Lower genital tract warts (condylomas = benign squamous neoplasms), low grade ‘IN’s
- Very rarely in malignant lesions

8

What kind of lesions are produced by 'high risk' 16 and 18?

High grade ‘IN’s and invasive carcinomas

9

What is the function of E6 HPV protein?

- Binds to and inactivates p53.
- p53 mediates apoptosis in response to DNA damage

10

What is the function of E7

- Binds to and inactivates RB1 gene product.
- RB1 is tumour suppressor gene
Controls G1/S checkpoint in cell cycle

11

What are the two pathways to vulval intraepithelial neoplasia?

- Classical/warty/baseloid
- Differentiated VIN

12

What are the relevant features of the classical/warty/baseloid pathway?

- Graded VIN 1-3
- Related to HPV infection
- Younger people

13

What are the features of the differentiated VIN pathway?

- Not graded
- Not HPV related
- Occurs in chronic dermatosesesp. lichen sclerosus
- Older people

14

What is the recurrence rate for VIN?

- 35-50%
- Positive margins predict recurrence
- Progression to invasive Ca in 4-7% treated women and up to 87% of those untreated.

- Invasion more likely to occur in postmenopausal and immunocompromised
- Spontaneous regression may occur particularly in young, postpartum women

15

What is the most common vulval cancer?

squamous cell carcinoma

16

What are the aetiologies of squamous cell carcinoma?

- VIN - associated with HPV
- Associated with inflammatory dermatoses

17

What is the pattern of spread from a vulval squamous cell carcinoma?

- Locally to involve vagina and distal urethra
- To ipsilateral inguinal LNs
- To contralateral inguinal LNs, deep iliofemoral LNs (25% if inguinal nodes +ve)

18

What percentage of vulval cancers are melanoma?

5%

19

What is the pattern of spread from malignant melanoma of the vulva?

- Local recurrence in 1/3, spread to urethra frequent
- Lymph node/haematogenous spread common
- Depth of invasion correlates with LN involvement

20

What percentage of vulval cancers are Extramammary Paget's disease?

5%

21

What is extra-mammary Paget's disease of the vulva?

In-situ adenocarcinoma of squamous mucosa
Tend to recur following excision
Can develop invasive adenocarcinoma

22

What is the macroscopic appearance of Paget's disease of the vulva?

Pruritic/burning/eczematous patch

23

What name is given to the microscopic appearance of Paget's disease of the vulva?

Buck shot

24

In what percentage of women is Paget's disease related to regional malignant disease?

5%

25

What is the transformation zone of the cervix?

The squamocolumnar junction

26

What is the epithelial type of the ectocervix?

Stratified squamous

27

What is the epithilial type of the endocervix?

Columnar

28

Where does CIN occur?

At the transformation zone?

29

Where does the transformation zone lie prior to menarche?

Slightly inside the cervical canal, proximal to the external os.

30

What happens to the transformation zone during menarche?

The cervix everts and the transformation zone is exposed. It now lies outside of the cervical canal, distal to the external os.

31

What happens to the transformation zone during mesopause?

It retracts and lies within the cervical canal again.

32

What is the regression, persistence, progression to CIN III and progression to invasion of CIN I?

- Regression 60%
- Persistence 30 %
- Progression to CIN III 10%
- Progression to invasion 1%

33

What is the regression, persistence, progression to CIN III and progression to invasion of CIN II?

- Regression 40%
- Persistence 40 %
- Progression to CIN III 20%
- Progression to invasion 5%

34

What is the regression, persistence, and progression to invasion of CIN III?

- Regression 33%
- Persistence ~56%
- Progression to invasion 20% - 70%

35

What are the positive features of the cervical screening programme?

- Available test has high sensitivity and specificity
- Test is not harmful
- Defined pre-invasive stage
- Long enough to allow intervention
- Simple, successful treatment

36

Why is there no screening below 25?

- Evidence does not support its use
- High HPV carriage rate, incl high risk types – 70-80% will be eliminated
- Reactive changes produce confusing cytology
- Unnecessary LLETZ procedures can have obstetric consequences

37

What is used in the treatment of CIN?

Colposcopy - large loop excision of the transformation zone (LLETZ)

38

What is the most important causative factor in cervical squamous cell carcinoma?

The contraction of high risk HPV

39

What are the risk factors for cervical squamous cell carcinoma?

- Multiple sexual partners
- Male partner with multiple partners
- Young age at first intercourse
- High parity
- Low socioeconomic group
- Smoking
- Immunosuppression

40

What is are the clinical features of cervical squamous cell carcinoma?

Early
- Bleeding (non-menstrual)
- Discharge

Late
- signs and symptoms due to local spread
- bladder - urinary symptoms
- ureters - hydronephrosis

41

What are the clinical features/presentation of cervical adenocarcinoma?

Same as SCC

42

Is cervical adenocarcinoma related to high risk adenocarcinoma?

Yes

43

What is the precursor to cervical adenocarcinoma?

Cervical glandular intraepithelial neoplasia (CGIN)

44

Why does cervical adenocarcinoma have a worse prognosis, stage for stage, than SCC?

Possibly due to radioresistance

45

What is the FIGO staging for cervical cancer?

I Confined to cervix

II Invades beyond uterus, not to pelvic side wall

III Extends to pelvic wall, lower 1/3 vagina, hydronephrosis

IV Invades bladder or rectum or outside pelvis

46

Where does cervical cancer metastasize to?

- Predictably to pelvic and para-aortic lymph nodes
- Via blood to lungs, bone etc

47

At what cervical cancer stage would you consider radical Rx with surgery or chemoradiotherapy?

II

48

At what cervical cancer stage would you consider palliative Rx?

III

49

What is dyskaryosis?

Abnormal cytologic changes of squamous epithelial cells characterized by hyperchromatic nuclei and/or irregular nuclear chromatin. May progress to neoplastic disease.

50

What happens if the result of a cervical screen shows no dyskaryosis?

HPV test performed - if HPV -ve normal recall, if HPV +ve refer to colposcopy.

51

What happens if the result of a cervical screen shows mild dyskaryosis?

HPV test performed - if HPV -ve normal recall, if HPV +ve refer to colposcopy.

52

What happens if the result of a cervical screen shows moderate dyskaryosis?

Refer for colposcopy + Rx

53

What happens if the result of a cervical screen shows severe dyskaryosis?

Refer for colposcopy + Rx

Decks in Clinical Pathology Class (65):