Pathology of the Cervix, Vulva and Vagina Flashcards Preview

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Flashcards in Pathology of the Cervix, Vulva and Vagina Deck (46):
1

What is the Transformation zone (TZ)?

Squamo-columnar junction between ectocervical (squamous) and endocervical (columnar) epithelia

2

What physiological things can alter the position of the TZ?

Menarche
Pregnancy
Menopause

3

What is cervical erosion?

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

4

What is Cervicitis?

Often asymptomatic
Can lead to infertility due to simultaneous silent fallopian tube damage

5

What is follicular cervicitis?

Sub. epithelial reactive lymphoid follicles present in cervix

6

What is Chlamydia trachomatis?

STI

7

What is a Cervical polyp?

Localised inflam outgrowth
Cause of bleeding if ulcerated
Not premalignant

8

What are types of cervical cancer?

Squamous carcinoma
Adenocarcinoma
Cervical Intraepithelial Neoplasia

9

What are risk factors for CIN/cervical cancer?

HPV
Age at first intercourse
Long term oral contraceptive
Non-use of barrier contraception
Smoking
Immunosuppresion

10

What HPV cause genital warts?

6 and 11

11

What are genital warts?

Condyloma acuminatum: thickened papilomatous squamous epithelium with cytoplasmic vacuolation (koilocytosis)

12

What HPV causes CIN?

16 and 18

13

WHat is CIN?

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

14

What is cervical cancer?

Invasive squamous carcinoma: virus integrated into host DNA

15

Describe CIN?

Pre-invasive stage of cervical cancer
Occurs at the TZ
Can involve large areas
Dysplasia of squamous cells
Not visible to naked eye
Asymptomatic
Detectable on cervical smear

16

Describe CIN I

basal 1/3 of epithelium occupied by abnormal cells
Raised numbers of mitotic figures in lower 1/3
Surface cells quite mature, but nuclei slightly abnormal

17

Describe CIN II

Abnormal cells extend to middle 1/3
Mitoses in middle 1/3
Abnormal mitotic figures

18

Describe CIN III

Abnormal cells occupy full thickness of epithelium
Mitoses, often abnormal, in upper 1/3

19

Describe Invasive Squamous Carcinoma (ISC)

75-95% of malignant cervical tumours
2nd commonest female cancer
Develop from pre-existing CIN so should be preventable by screening

20

What is the 5 year survival rate for cervical cancer in Scotland?

70.1%

21

What is stage 1A1 ISC?

depth up to 3mm, width up to 7mm

22

What is stage 1A2 ISC?

depth up to 5mm
width up to 7mm
Low risk of metastases

23

What is stage 1B ISC?

Confined to the cervix

24

What is stage 2 ISC?

Spread to adjacent organs (vagina, uterus etc.)

25

What is stage 3 ISC?

Involvement of pelvic wall

26

What is stage 4 ISC?

Distant metastases or involvement of rectum or bladder

27

What are symptoms of invasive carcinoma?

usually none at microinvasive and early invasive stages (detected at screening)
Abnormal bleeding
Pelvic plain
Haematuria/Urinary infections
Ureteric obstruction/Renal failire

28

Describe the bleeding seen in invasive carcinoma?

Post coital
Post-menopausal
Brownish or blood stained vaginal discharge
Contact bleeding - friable epithelium

29

Where does squamous carcinoma metastasise to via local spread?

Uterine body
Vagina
Bladder
Ureters
Rectum

30

Where does squamous carcinoma metastasise to via lymphatic spread? (early)

Pelvic
para-aortic nodes

31

Where does squamous carcinoma metastasise to via haematogenous spread? (late)

Liver
Lungs
Bone

32

How is squamous carcinoma graded?

Well differentiated
Moderately differentiated
Poorly differentiated
Undifferentiated / anaplastic

33

What is CGIN?

Cervical Glandular Intraepithelial Neoplasm

34

Describe Cervical Glandular Intraepithelial Neoplasm

Origin from endocervical epithelium
Preinvasive phase of endocervical adenocarcinoma
Screening less effective
Can be assoc. with CIN

35

What has a worse prognosis; Squamous carcinoma or Endocervical adenocarcinoma?

Endocervical adenocarcinoma

36

What are risk factors for Adenocarcinoma?

Higher S.E. class
Later onset sexual activity
Smoking
HPV, esp. 18

37

Name 3 other HPV driven diseases

Vulvar Intraepithelial Neoplasia (VIN)
Vaginal Intraepithelial Neoplasia (VaIN)
Anal Intraepithelial Neoplasia (AIN)

38

What does Vulvar Intraepithelial Neoplasia have an association with?

Paget's disease

39

Describe VIN in young women?

Often multifocal
Recurrent or persistent causing treatment problems

40

Describe VIN in older women?

Greater risk of progression to invasive squamous carcinoma

41

What is VIN often synchronous with?

Cervical and vaginal neoplasia (CIN and VaIN)

42

Describe Vulvular Invasive Squamous carcinoma

Usually elderly women
Ulcer or exophytic mass
Can arise from normal epithelium or VIN

43

Where does Vulvular Invasive Squamous carcinoma spread to?

Inguinal lymph nodes

44

What is the treatment of Vulvular Invasive Squamous carcinoma?

Surgical - radical vulvectomy and inguinal lymphadecnectomy

45

What is the 5 year survival of Vulvular Invasive Squamous carcinoma for node +ve and node -ve?

Node +ve = <60%
Node -ve = 90%

46

Describe Vulvar Paget's disease

Crusting rash
Tumour cells in epidermis, contain mucin
Mostly no underlying cancer, tumour arises from sweat gland in skin