Pathology of the cervix, vulva and vagina Flashcards Preview

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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

vulvar pages disease has what kind of rash
tumour cells where

crusting rash
epidermis, contain mucin
mostly no underlying cancer, tumour arises from sweat glands in skin