Pathology of the Cervix, Vulva and Vagina

Question 1

What are the cell layers of the normal ectocervix?

Answer 1

exfoliating; superficial; intermediate; parabasal; basal; basement membrane

Question 2

What type of epithlium is ectocervical?

Answer 2

squamous

Question 3

What type of epithelium is the endocervical epithelia?

Answer 3

columnar

Question 4

What does the position of TZ change in response to?

Answer 4

menarche; pregnnayc; menopause

Question 5

What si the transformation zone?

Answer 5

squamou-columnar junction between ectocervical and endocevical epithelia

Question 6

What is a cervical erosion?

Answer 6

exposure of delicate endocervical epithelium to acid environemnt of vagina leads to physiologyical squamous metaplasia

Question 7

Why can cervicitis lead to infertility?

Answer 7

pt is often asymptomatic and can often have simultaneous silent fallopian tube damage

Question 8

What folllicular cervicitis?

Answer 8

sub epithelial reactive lymphoid follicles present in cervix

Question 9

What are hte cases of cervicitis?

Answer 9

chlamydia and HSV

Question 10

What is a cervical polyp?

Answer 10

localised inflammatory outgrowth

Question 11

What is the prognosis of a cervical polyp?

Answer 11

not premalignant

Question 12

When can cervical polyps cause bleeding?

Answer 12

if ulcerate

Question 13

What are the types of cervical caner?

Answer 13

squamous carcinoma; adenocarcinoma

Question 14

What are hte risk factors for CIN and cervical cancer?

Answer 14

high risk HPV (16 and 18)- many partenrs increases this risk; vulnerability of SC junction in early repro life; smoking; immunosuppression

Question 15

What can cahnge the vulnerability of the SC junction in early repro life?

Answer 15

age at first intercourse; long term use of COP’;non-use of barrier contraception

Question 16

What types of HPV cause genital warts?

Answer 16

6 and 11

Question 17

What other name are genital warts known by?

Answer 17

condyloma acuminatum

Question 18

Dscribe the histopathology of genital warts?

Answer 18

thickened papillomatous squamous peithlium with cytoplasmic vaculoation====koilocytosis

Question 19

What is seen on histopathology with cervical intraepithelial neoplasia?

Answer 19

infection epithelium reamins flat but may show koilocytosis which can be detected in cervical smears

Question 20

What causes invasive squamous carcinoma?

Answer 20

virus has integrated into host DNA

Question 21

How long does it take HPV infection to become a high grade CIN?

Answer 21

6 months - 3years

Question 22

How long does it take a high grade CIN to become an invasive cancer?

Answer 22

5-20 years

Question 23

What is the cumulative prevalence of HPV infection?

Answer 23

80%

Question 24

What is CIN?

Answer 24

pre-invasive stage of cervical cancer

Question 25

Where does cervical intraepithelial neoplasia?

Answer 25

transformtion zone

Question 26

what factors are invovled in grading CIN on histology?

Answer 26

delay in maturation/differentiation; nuclear abnormalities; excess mitotic activity

Question 27

What is seen with a delay in maturation.differentiation?

Answer 27

immature basal cells occupying more of epithelium

Question 28

What nuclear abnormalties are seen in CIN?

Answer 28

hyperchomasia; increased nucleocytoplasmic ratio; pleomorphism

Question 29

What is excess mitotic activity?

Answer 29

situated above basal layers; abnormal mitotic forms

Question 30

What is CIN 1 defined as?

Answer 30

basal 1/3rd of epithlium occupied by abnormal cells; surface cells uite mature but nuclei slightly abnormal

Question 31

What is CIN2 defined as?

Answer 31

abnormal cells extend to middle 1/3rd

Question 32

What is CIN3 deinfed as?

Answer 32

abnormal cells occupy full thickenss of epithlium

Question 33

What isthe most common type of cervical cancer?

Answer 33

invasive squmous carcinoma

Question 34

What does invasive squmoua carinoma develop from?

Answer 34

pre-existing CIN

Question 35

What is stage 1A1 of invasive squamous carcinoma of cervix ?

Answer 35

depth upto 3mm; width upto 7mm

Question 36

What is stage 1A2 of invasive squamous carinoma of cervix?

Answer 36

depth upto 5mm, width upto 7mm

Question 37

What is stage 1B of invasive squmous carcinoma of hte cervix?

Answer 37

confined to cervix

Question 38

Waht is stage 2 of invasive squmous carcinoma of hte cervix?

Answer 38

spread to adjacent organs

Question 39

What is stage 3 of invasive squmous carcinoma of hte cervix?

Answer 39

involvemtn fo pelvic wall

Question 40

What is stage 4 of invasive squmous carcinoma of hte cervix?

Answer 40

distant mets or involvemtn of rectum or bladder

Question 41

What are the symtpoms of invasive carinoma of the ervix?

Answer 41

abnormal bleeding; pelvic pain; haematuria/UTIs; ureteric obstruction/renal failure

Question 42

What type of abnormal bleeding can you get with cervical cancer?

Answer 42

post-coital; post-menopausal; brownish or blood stained vaginal discharge; contact bleeding-friable epithelium

Question 43

What is the local spread of squmous cervical carcinoma?

Answer 43

uterine body; vagina; bladder; uretersl rectum

Question 44

What is the early spread of squmous carcinoma of the cervix?

Answer 44

lymphatic--pelvic and para-aortic nodes

Question 45

What is hte late spread of cervical squmous carcinoma?

Answer 45

haematogenous

Question 46

What does cervical glandular intraepithelial neoplasia originate from?

Answer 46

endocervical epithelium

Question 47

What is CGIN the preinvasive phase for?

Answer 47

endocervical adenocarcinoma

Question 48

What is the prognosis of adenocarinoma vs squmous carinoma of the cervix?

Answer 48

worse compared to squamosu

Question 49

What are the RF for adenocarincoma of the cervix?

Answer 49

higher SE class; later onset of sexual activity; smoking; esp. HPV 18

Question 50

What are the other pelvic HPV driven disease?

Answer 50

vulvar intraepithelial neoplasia; vaginal intraepithelial neoplasia; anal intraepithelial neoplasia

Question 51

What is vulval intraepithelial neoplasia like in young women?

Answer 51

often multifocal, recurrent or persisten causing treatment problems

Question 52

what is vulvar intraepithelial neoplasia like in old women?

Answer 52

greater risk of pgression to invasive squamous carcinoma

Question 53

What nodes does vulvar invasive squamous carcinoma ten to spread to?

Answer 53

inguinal lymph ndoes

Question 54

What is the most important prognostic factor in vulvar invasive squmous carcinoma?

Answer 54

spread to inguinal nodes

Question 55

Who gets vulvar invasive squmoua carcinoma?

Answer 55

elderly women

Question 56

What is the appearnace of vulvar squmoua carcinoma?

Answer 56

ulcer or exophytic mass

Question 57

What does vulvar squmous carcinoma arise from?

Answer 57

normal epithelium or VIN

Question 58

What is seen with vulvar Paget's disease?

Answer 58

crusting rash

Question 59

What is found within the vulvar Paget's disease?

Answer 59

mucin

Question 60

What does the tumour in vulvar pagets disease arise from?

Answer 60

sweat gland in skin

Question 61

What may be foudn if a patient has vaginal intraepithelaila neoplasia?

Answer 61

also have cervical and vulval lesions

Question 62

How may melanomain the vagina appear?

Answer 62

polyp