L68 Flashcards
(31 cards)
Which strain of HPV is linked specifically to GYN adenocarcinomas?
HPV 18
@ exocervix
Which strain of HPV is linked specifically to GYN squamous cell carcinomas?
HPV 16
@ endocervix
What is the mechanism by which HPV is oncogenic?
E6 protein - inactivates p53
E7 protein - inactivates Rb
No regulation in moving from G1 -> s
When you do an HPV DNA screening test, what strains are you looking for?
High risk (16, 18) only - finding low risk strains doesn’t change management
HPV strains in the quadrivalent vaccine
6, 11, 16, 18
When do you start HPV vaccine?
11/12
Give up until 26 - after this, likely already exposed
3 main risk factors for developing cervical carcinoma
- Exposure to HPV
- Immune suppression - can’t resolved HPV infection on your own
- Smoking - “I didn’t smoke it down there doc!”
Describe the dysplastic pre-cursor lesions for cervical carcinoma
CIN 1 = 1/3 thickness
CIN 2 = 2/3
CIN 3 = slightly less than full thickness
CIN 1-3 are dysplastic b/c potential to reverse
CIS = carcinoma in situ = entire thickness
Explain the LSIL vs HSIL histo grading of lesions
LSIL = CIN 1 = see hollowed out cells at upper layers of productive virus HSIL = CIN 2 or 3 = integrated HPV
What is a genital wart caused by HPV called? What do you see on histo?
Condyloma acuminatum
HPV 6/11
1. Papillae looking
2. Koilocytosis
Which gene can you find activated in HSIL caused by HPV?
p16 - normally downreg by Rb but you’ve lost that via E7
What type of cervical cancer (squamous vs adeno) progresses linearly down the CIN -> carcinoma pathway?
Squamous cell = 100% SCC cervical is due to HPV CIN 1 (LSIL) -> 2 -> 3 (HSIL) -> CIS -> carcinoma This is why so well captured by pap screening
Management of LSIL
F/u pap smears
Many regress on own
Management of HSIL
Colposcopy + biopsy
Remove @ transformation zone
TESTQ what are the 5 categories of squamous lesions?
ASC-US // LSIL
ASC-H // HSIL
SCC
F/u for an ASC-US lesion
DNA test for high risk HPV
If positive, colposcopy + biopsy
TESTQ: f/u for ASC-H lesion
Colposcopy + biopsy
Why type of cervical cancer is not best detected by pap smear?
Adenocarcinoma (glandular changes)
Precursor = adenocarcinoma in situ, usually incidental finding after biopsy for HSIL (aka something that did show up on pap)
Who gets pap smears? How often?
> 21, every 3 yrs (every 5 if do HPV testing at same time)
Stop > 65
What histo characteristic defines SCC at cervix?
Invade through basement membrane
What is an endocervical polyp?
BENIGN cervical polyp
What are the 2 benign lesions in the vagina?
Gartner duct cyst
Fibroepithelial polyp
What vaginal cancer would you expect in girls under 5yo?
Embryonal rhabdomyosarcoma = malig immature skeletal muscle “grape-like” mass
Protrudes from vagina
What is the name of a leukoplakia lesion on the vulva that is paper thin? Describe patho process
Lichen sclerosis - post-meno (older) women
Thin epi
Sclerosis dermis
