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SBCP Pathology > Gynaecology: Cervix and vulva > Flashcards

Gynaecology: Cervix and vulva Flashcards

1
Q

Two parts of cervix? What epithelium lines each?

A

Ectocervix: SSNK

Endocervix: Mucin secreting glandular epithelum

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2
Q

Where do ectocervis and endocervis join together?

A

Transformation zone

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3
Q

True/false: Aim of cervical screening is to pick up cancer

A

False, aim is to pick up pre-malignant lesions (cervical intraepithelial neoplasia/CIN)

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4
Q

Result: negative

A

Recall in 3-5 years

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5
Q

Result unsuitable: repear 3 months

A
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6
Q

Result: Borderline nuclear changes

A

Repeat 6 monts

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7
Q

Result: Mild dyskaryosis (CIN 1)

A

Repeat 6 months

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8
Q

Result: Moderate dsykaryosis (CIN2) or multiple CIN1 results

A

Refer to colposcopy

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9
Q

Result: CIN3

A

rEFER TO COLPOSCOPY

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10
Q

What is used to screen smear slides?

A

Cytoscreener, pathologist only reports abnormal smears

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11
Q

Cytology: Enlarged nuceli due to HPV infection

A

Koilocytosis

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12
Q

Difference between CIN and CGIN?

A

CGIN affects cervical glandular epithelium. CIN affects squamous epithelium

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13
Q

Histology: Slightly enlarged basa cell nuclei in cervical SSNK epithelium

A

Koilocytosis (Hallmark of HPV infection)

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14
Q

Histology: Abnormal enlarged nuclei up to lower third of epithelium

A

CIN 1

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15
Q

Histology: Abnormal cells going up half way up the squamous epithelium

A

CIN 2

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16
Q

Histology: Abnormal cells occupying full epithelial thickness. Lots of mitotic figures, crowded nuclei indicating little maturation

A

CIN 3

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17
Q

Different grades of glandular lesions?

A

Low grade CGIN
High grade CGIN

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18
Q

Histology: Lots of nuclei within glandular cells, apoptotic bodies and mitotic figues

A

H grade CGIN

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19
Q

3 management options for pre-invasive lesions?

A
  1. Ablate (freeze or cauterise)
    1. Excise (loop or cone biopsy)
  2. Cytological and colposcopic followup
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20
Q

How long is follow up period for cervical cancer?

A

Close monitoring for 10 years

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21
Q

Risk factors for cervical lesions/cancer?

A
  1. HPV (especially 16 and 18) in over 99% of cancers!!
  2. Other infections eg chlamydia, HSV
  3. Early age of intercourse
  4. Multiple sexual partners
  5. Smoking
  6. OCP(?glandular lesions)
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22
Q

True/false: Cervical erosions are premalignant

A

False, normal physiological change with increased hormone levels

23
Q

Two most common types of cervical cancer

A

Squamous carcinoma (85%)

Adenocarcinoma

24
Q

Stage 1 cervical Ca

A

Microinvasive carcinoma

25
Q

Stage 2 cervical Ca

A

Spread beyond the cervix but not into pelvic side wall

26
Q

Stage 3 cervical Ca

A

Spread to pelvic side wall or lower third of vagina

27
Q

Stage 4 cervical Ca

A

Spread beyond the pelvis

28
Q

Treatment of microinvasive cervical cancer?

A

Cone or loop biopsy and check the margins

Regular smears

If older lady, hysterectomy

29
Q

Tx of Stage 1 tumours larger than microinvasive but confined to cervix

A

Radical hysterectomy (all of the ligaments and the upper vagina are removed in addition to just the uterus as in simple hysterectomy)

Small percentage of patients with radical hysterectomy will get post op chemoradiation (ONLY if close margins or adverse prognostic features)

30
Q

Tx if cancer has spread beyond cervix

A

No surgery

Chemoradiation

31
Q

How is cervical cancer staged?

A

MRI scan

Pelvic exam under anaesthesia

Cytoscopy

32
Q

Adverse prognostic features of cervical cancer?

A

Size

Differentiation

Surgical margins

Lymphovascular spread

Lymph node involvement

33
Q

5 yr survival for stage 1 cervical cancer?

A

90-95%

34
Q

5 yr survival for stage 4 cancer

A

<20%

35
Q

What epithelium lines vulva?

A

Keratinising stratified squamous epithelium

36
Q

Lichen sclerosis and squamous cell hyperplasia are categories of what?

A

Vulval Dystrophy

Present with pain, itching, leukoplakia

37
Q

What can vulval dystrophy progress to ?

A

Invasive squamous carcinoma

38
Q

Histology: Sclerosis/fibrosis within dermis of vulva, with atrophic surface epithelium

A

Lichen sclerosis

39
Q

What virus is associated with VIN?

A

VIN (vulva intraepithelial neoplasia) linked to HPV

40
Q

True/false: VIN less common than CIN

A

True, mostly found while investigating CIN

41
Q

Two types of VIN in vulva?

A

Bowenoid/undifferentiated: younger, associated with HPV, CIN, low risk of invasion

Simplex/differentiated: Rarer, older people, NO HPV ASSOCIATION, higher risk of invasion

42
Q

Two types of vulval INVASIVE squamous carcinoma? (Similar to VIN but don’t confuse them)

A

Bowenoid/undifferentiated: LESS COMMON due to low risk of Bowenoid VIN progressing, younger patients, HPV

Simplex/differentiated: Mosre common, no HPV, associated with lichen sclerosis and squamous cell hyperplasia (vulva dystrophies), older pt

43
Q

Stage 1 Vulval cancer

A

Confined to vulva, <2cm

44
Q

Stage 2 vulval tumour

A

Tumour confined to vulva but >2cm

45
Q

Stage 3 Vulval tumour

A

Spread to lower urethra, vagina, or anus

AND/OR

Lymph node involvement

46
Q

Stage 4 vulval tumour

A

Metastasis including to pelvis

47
Q

Tx of stage 1 vulval cancer?

A

Surgical excision of tumour and inguinal lymph nodes

48
Q

Tx of advanced vulval Ca?

A

Chemoradiation

49
Q

Histology: Adenocarcinoma confined to the squamous epithelium of the vulva

A

Paget’s disease of vulva

Arises in squamous epithelium due to a stem cell becoming glandular.

50
Q

Where does Paget’s disease of vulva come from?

A

Thought to be stem cell

Usually primary but can be secondary from an adenocarcinoma from colon, rectum, bladder, or cervix

51
Q

Symptoms of Paget’s disease of vulva

A

Itch, redness, eczema, ulceration

52
Q

Tx of Paget’s disease of vulva?

A

Surgical excision

Exclude another primary orign

Often reoccurs even if margin is clear

Can become invasive adenocarcinoma

53
Q

What is vaginal adenosis?

A

Presence of galndular epithelium in vagina. Linked to DES drug

SBCP Pathology (24 decks)

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