Pathology: Cervical, Vulvul and Vagina Flashcards Preview

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Flashcards in Pathology: Cervical, Vulvul and Vagina Deck (41)
1

What is the transformation zone

Squamo-columnar junction between ectocervic(squamous) and endocervix (columnar)

2

What is cervical erosion

Exposure of delicate endocervical epithelium to acid environment of vagina leads to physiological squamous metaplasia

3

What is a nabothian follicle (cyst)

a mucus-filled cyst on the surface of the cervix. They are most often caused when stratified squamous epithelium of the ectocervix (toward the vagina) grows over the simple columnar epithelium of the endocervix (toward the uterus).

4

What can cause inflammatory pathology of the cervix

Cervicitis
Cervical polyp- can bleed, not premalignant

5

What can cause cervicitis

Follicular cervicitis- sub epithelial reactive lymphoid follicles present
Infection - chlamydia or herpes simplex

6

What neoplasms affect the cervix

CIN
Cancer- squamous carcinoma or adenocarcinoma

7

What is the cause of 70 percent of cervical cancer

HPV 16 and 18

8

What are the factors the increase risk of cervical cancer

Persistant high risk HPV infection - 16, 18, 31, 33, 35
Many sexual partners increases this risk
Vunerability of SC junction in early reproductive life - age at first intercourse, long term use of oral contraceptive, not using barrier contraception
Smoking
Immunosuppresion eg HIV

9

What HPV types are 'low risk' and cause genital warts

6 and 11

10

What is the pathological appearances of genital warts (aka condyloma acuminatum)

thickened "papillomatous" squamous epithelium with cytoplasmic vacuolation (“koilocytosis”).

11

What is the pathological appearance of CIN

Infected epithelium remains flat, but may shows koilocytosis, which can be detected in cervical smears

12

At what point does the cell become invasive squamous carcinoma

when virus fully integrated into the host DNA

13

In what time frame does HPV infection become high grade CIN

6 mths to 3 yrs

14

In what time frame does high grade CIN become invasive cancer

5-20 yrs

15

What is the lifetime risk of acquiring HPV infection

80 percent - most people develop immunity and clear their HPV

Persistent HPV increase cancer risk

16

What are the features of CIN

Pre-invasive stage of cervical cancer
Occurs at the transformation zone.
Can involve large area.
Dysplasia of squamous cells
Not visible by naked eye
Asymptomatic
Detectable by cervical screening

17

What histological feature indicated HPVinfection

koilocytosis

18

What cell features may koilocytes have

Koilocytes may have the following cellular changes:
-Nuclear enlargement (two to three times normal size) ie increases nucleocytoplasmic ratio
-Irregularity of the nuclear membrane contour
-A darker than normal staining pattern in the nucleus, known as Hyperchromasia
-A clear area around the nucleus, known as a perinuclear halo

19

What are the three histological features of CIN

-Problem with maturation
-Nuclear abnormalities - koilocytes
-Excess mitosis

20

What percentage of CIN 1 progress to invasion

1 percent

21

What percentage of CIN2 progress to cervical cancer

5 percent

22

What percentage of CIN 3 progress to cancer

more than 12 percent

23

What is the most common type of malignant cervical tumours

Squamous cell - 95 percent

Develop from CIN

24

What age group are most likely to get cervical cancer

women in their 30s and forties

25

What is stage 1A1 squamous cell cervical cancer

depth up to 3mm, width up to 7mm

26

Stage 1A2

depth up to 5mm, width up to 7mm

27

Stag 1B

confined to cervic

28

Stage 2

adjacent organ spread ef vagina, uterus

29

Stage 3

Involvement of pelvic wall

30

Stage 4

distant mets or rectum/bladder involvement

31

list the symptoms of cervical cancer

Post coital or post menopausal bleeding
Brown or blood stained vaginal discharge
Content bleeding - friable epithelium
Pelvic pian
Haematuria/utis
Ureteris obstruction/renal failure

Often Asymtomatic

32

Which lymph nodes with cervical cancer first spread to

Pelvic the para aortic

33

What is CGIN

Cervical glandular intraepithelial neoplasi
Origin from endocervix
The preinvasive phase of endocervical ADENOCARCINOMA

34

What is the problem with CGIN

Screening less effective because it is difficult to see on smear

Can be associated with CIN

35

What type of cervical cancer has a worse prognosis

ndocervical adenocarcinoma

36

Name other HPV mediated diseases

VIN
VaIN
AIN
Often synchronous

37

What is the epidemiology of VIN

Bimodal
Young and older women ( more likely to become invasive in older women)

38

Are vulvar invasive squamous carcinomas always HPV related

no, can arise from normal epithelium

39

What is the most important prognostic indicator in vulval cancer

inguinal lymph node invasion

40

What is vulvar pagets disease

rare, slow-growing, usually noninvasive intraepithelial (in the skin) adenocarcinoma outside the mammary gland and includes Paget's disease of the vulva

41

What are the symptoms of vulvar pagets

Crustin rash
Mucin containing tumour cells
Arises from sweat gland