Pathology of the cervix, vulva and vagina

Question 1

layers from the top to the bottom of a normal ectocervix

Answer 1

exfoliating cells
superficial cells
intermediate cells
parabasal cells
basal cells
basement membrane

Question 2

what is the transition zone in the cervix and what happens to it during life

Answer 2

squamo columnar junction between squamous and columnar epithelium

alters during life as a physiological response to menarche, pregnancy, menopause

Question 3

what is cervical erosion

Answer 3

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

Question 4

what is a nabothian follicle/cyst

Answer 4

endocervical glands that have expanded into mucous cysts and can form assess or polyps

Question 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

Answer 5

sits higher up
moves out of the endocervix onto the surface of the cervix
retracts after menopause up the cervical canal

Question 6

symptoms of cervicitis and what can it lead to and why

Answer 6

often asymptomatic

can lead to infertility due to simultaneous silent fallopian tube damage

Question 7

what is cervicitis

Answer 7

non specific acute/chronic inflammation

Question 8

what is follicular cervicitis

Answer 8

sub epithelial reactive lymphoid follicles present in the cervix

Question 9

what is a cervical polyp
what can it lead to to
is it malignant

Answer 9

localised inflammatory growth
cause of bleeding if ulcerated
no and not pre malignant either - benign

Question 10

what does cervical intraepithelial neoplasia lead to

Answer 10

commonest precursor for squamous cervical carcinoma

Question 11

types of HPV involved in cervical cancer

Answer 11

16 and 18

Question 12

risk factors for CIN/cervical cancer

Answer 12

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

Question 13

HPV 6 and 11 can lead to what

Answer 13

condyloma acuminatum - thickened papillomatous squamous epithelium with cytoplasmic vacuolation (koliocytosis)

Question 14

HPV 16 and 18 can lead to what

Answer 14

cervical intraepithelial neoplasia CIN

infected epithelium remains flat but may show koliocytosis which can be detected in cervical smears

Question 15

what else can HPV cause

Answer 15

cervical cancer - invasive squamous carcinoma - virus integrated into host DNA

Question 16

time taken for a HPV infection to become high grade CIN

time taken for high CIN to become invasive cancer

Answer 16

6 months - 3 years

5-20 years

Question 17

prevalence of HPV infection in 15-25 y olds
25-35
>35
most people develop what 
what increases the risk of disease

Answer 17

30-50%
10-20%
5-15%
immunity
persistance

Question 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

Answer 18

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

Question 19

what are the stages the cells go through to become cancerous

Answer 19

normal squamous epithelium 
koilocytosis 
CIN 1
CIN 2
CIN 3

Question 20

histology of CIN shows what

Answer 20

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

Question 21

CIN I
CIN II
CIN III

Answer 21

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

Question 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

Answer 22

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

Question 23

invasive squamous cancer
stage 1a1
1a2
1b
2
3
4

Answer 23

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

Question 24

symptoms of of invasive carcinoma

Answer 24

abnormal bleeding - post coitus, post menopausal, brownish or blood stained vaginal discharge, contact bleeding

pelvic pain

haematuria/UTIs

ureteric obstruction /renal failure

Question 25

local spread of squamous carcinoma lymphatic spread haematogenous spread

Answer 25

uterine body, vagina, bladder, ureters, rectum (early) pelvic, para aortic nodes (late) - liver, lungs, bone

Question 26

grading of invasive squamous carcinoma

Answer 26

well differentiated moderately differentiated poorly differentiated undifferentiated/anaplastic

Question 27

``` cervical glandular intra epithelial neoplasia origin what is it diagnosis compared to squamous cancer screening assoc with what ```

Answer 27

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

Question 28

endocervical adenocarcinoma is what percentage of cervical cancers who type prognosis

Answer 28

5-25% young women mixed - adeno and squamous - adenosquamous? worse prognosis than squamous

Question 29

epidemiology of adenocarcinoma

Answer 29

later onset of sexual activity | smoking HPV 18 esp

Question 30

vulvuar intra epithelial neoplasia

Answer 30

HPV linked but not always | pagets disease

Question 31

two types of VIN

Answer 31

young - multifocal, recurrent or persistent treatment problems older - greater risk of progression to invasive squamous carcinoma

Question 32

``` vulvar invasive squamous carcinoma who where from mostly are what spread treatment ```

Answer 32

``` elderly, ulcer/exophytic mass normal epithelium or form VIN well differentiated inguinal LNs surgical - radical vulvectomy and inguinal lymphadenectomy ```

Question 33

vulvar pages disease has what kind of rash | tumour cells where

Answer 33

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