Flashcards in Pathology of the cervix, vulva and vagina Deck (33):
1
layers from the top to the bottom of a normal ectocervix
exfoliating cells
superficial cells
intermediate cells
parabasal cells
basal cells
basement membrane
2
what is the transition zone in the cervix and what happens to it during life
squamo columnar junction between squamous and columnar epithelium
alters during life as a physiological response to menarche, pregnancy, menopause
3
what is cervical erosion
exposure of delicate endocervical epithelium to acid environment of vagina leads to physiological squamous metaplasia
4
what is a nabothian follicle/cyst
endocervical glands that have expanded into mucous cysts and can form assess or polyps
5
where does the transition zone sit in children and during pre monarchy and where does it go after puberty
what happens to it after menopause
sits higher up
moves out of the endocervix onto the surface of the cervix
retracts after menopause up the cervical canal
6
symptoms of cervicitis and what can it lead to and why
often asymptomatic
can lead to infertility due to simultaneous silent fallopian tube damage
7
what is cervicitis
non specific acute/chronic inflammation
8
what is follicular cervicitis
sub epithelial reactive lymphoid follicles present in the cervix
9
what is a cervical polyp
what can it lead to to
is it malignant
localised inflammatory growth
cause of bleeding if ulcerated
no and not pre malignant either - benign
10
what does cervical intraepithelial neoplasia lead to
commonest precursor for squamous cervical carcinoma
11
types of HPV involved in cervical cancer
16 and 18
12
risk factors for CIN/cervical cancer
HPV 16 and 18
vulnerability of SC junction in early repro life - age at first intercourse, long term use of oral contraceptives, non use of barrier contraception
smoking 3x risk
immunosuppression
13
HPV 6 and 11 can lead to what
condyloma acuminatum - thickened papillomatous squamous epithelium with cytoplasmic vacuolation (koliocytosis)
14
HPV 16 and 18 can lead to what
cervical intraepithelial neoplasia CIN
infected epithelium remains flat but may show koliocytosis which can be detected in cervical smears
15
what else can HPV cause
cervical cancer - invasive squamous carcinoma - virus integrated into host DNA
16
time taken for a HPV infection to become high grade CIN
time taken for high CIN to become invasive cancer
6 months - 3 years
5-20 years
17
prevalence of HPV infection in 15-25 y olds
25-35
>35
most people develop what
what increases the risk of disease
30-50%
10-20%
5-15%
immunity
persistance
18
CIN is what
were does it occur
what does it involve
cells
can it be seen
symptoms/signs
what is done to detect it
pre invasive stage of cervicle cancer
occurs at transformation zone
can involve large area
zsyplasia of squamous cells
not visible by naked eye
asymp
detectable by screening
19
what are the stages the cells go through to become cancerous
normal squamous epithelium
koilocytosis
CIN 1
CIN 2
CIN 3
20
histology of CIN shows what
delay in maturation/differential - immature basal cells occupying more of the epithelium
nuclear abnormality - hyperchromasia, increased nucleocytoplasmic ration, pleomorphism
excess mitotic activity - situated above basal layer, abnormal mitotic forms
21
CIN I
CIN II
CIN III
basal 1/3 epithelium occupied by abnormal cells - raised number of mitotic figures in lower 1/3
surface cells mature but nuclei slightly abnormal
abnormal cells extend to middle 1/3 - mitosis in middle 1/3, abnormal mitotic figures
abnormal cells occupy full thickness of epithelium - mitosis, often abnormal in upper 1/3
22
invasive squamous carcinoma is what percentage of malignant cervical tumours
how common is it
who is common in
develops from what and why is this useful
75-95%
2nd most commonest female cancer
increasingly detected in younger women, often found in early stage, some are ra[idly progressive tumours
developer form pre existing CIN therefore most cases should be preventable by screening
23
invasive squamous cancer
stage 1a1
1a2
1b
2
3
4
depth up to 3mm, width up to 7mm
depth up to 5mm, width up to 7mm. low risk of lymph mets
confined to cervix
spread to adjacent structures
involvement of pelvic wall
distant mets or involvement of rectum or bladder
24
symptoms of of invasive carcinoma
abnormal bleeding - post coitus, post menopausal, brownish or blood stained vaginal discharge, contact bleeding
pelvic pain
haematuria/UTIs
ureteric obstruction /renal failure
25
local spread of squamous carcinoma
lymphatic spread
haematogenous spread
uterine body, vagina, bladder, ureters, rectum
(early) pelvic, para aortic nodes
(late) - liver, lungs, bone
26
grading of invasive squamous carcinoma
well differentiated
moderately differentiated
poorly differentiated
undifferentiated/anaplastic
27
cervical glandular intra epithelial neoplasia origin
what is it
diagnosis compared to squamous cancer
screening
assoc with what
from endocervical epithelium
preinvasice phase of endocervical adenocarcinoma
more difficult to diagnose on a cervical smear than squamous
screening is less effective
sometimes assoc with CIN
28
endocervical adenocarcinoma is what percentage of cervical cancers
who
type
prognosis
5-25%
young women
mixed - adeno and squamous - adenosquamous?
worse prognosis than squamous
29
epidemiology of adenocarcinoma
later onset of sexual activity
smoking HPV 18 esp
30
vulvuar intra epithelial neoplasia
HPV linked but not always
pagets disease
31
two types of VIN
young - multifocal, recurrent or persistent treatment problems
older - greater risk of progression to invasive squamous carcinoma
32
vulvar invasive squamous carcinoma who
where from
mostly are what
spread
treatment
elderly, ulcer/exophytic mass
normal epithelium or form VIN
well differentiated
inguinal LNs
surgical - radical vulvectomy and inguinal lymphadenectomy
33