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Pathoma 13. Female Genital System and Gestational Pathology > 13.3 Cervix > Flashcards

13.3 Cervix Flashcards

1
Q

What type of cell is located in the endocervix (3 words)

A

Simple Columnar epithelium

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2
Q

What type of cell is located in the exocervix (3 words)

A

non-keratinized stratified Squamous

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3
Q

Where does HPV preferentiially infect

A

the transformation zone

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4
Q

What normally happens to HPV infx

A

immune system clears it

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5
Q

What happens in persistent HPV infx

A

increased risk for cervical dysplasia

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6
Q

What is another name for cervical dysplasia

A

Cervial intraepithelial Neoplasia

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7
Q

What are the low risk HPV types and what do they cuase

A

6, 11 cause condylomas of lower reproductive tract

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8
Q

What are the high risk HPV types and what do they cuase

A

16, 18, 31, 33

they cause carcinomas

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9
Q

What 2 proteins do high risk HPV strains produceq

A

E6, E7

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10
Q

What does E6 do that makes them high risk

A

E6 knocks out p53 (a tumor suppressor gene)

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11
Q

What does E7 do that makes them high risk

A

E7 knocks out Rb (a tumor suppressor gene)

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12
Q

What does p53 do in the cell to prevent uncontrolled growth

A

it induces p21 to inaCTIVATE CDKs–> hypophosphorylation (and activation) of Rb

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13
Q

What does Rb do to prevent uncontrolled cell growth

A

Rb normally binds (thus inactivating) E2F ( a transription factor that prevents the progression to G1/S phase

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14
Q

what 4 things chcize CIN

A
  1. koilocytic change
  2. disordered cellular maturation
  3. nuclear atypia
  4. increased mitosis
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15
Q

What criteria decides CIN staging?

A

the amount (thickness) of epithelial involvment by dysplastic cells

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16
Q

CIN I, II, III involve how much of thickness of epithelium of cervix each?

A 
I = 1/3
II = 2/3
III = almost all
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17
Q

What does CIN III progress to?

A

Carcinoma in Situ

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18
Q

How is carcinoma in situ defined

A

full thickness of epithelium is dysplastic

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19
Q

what differentiates dysplasia from carcinoma ?

A

Reversibility!!!

20
Q

What does Carcinoma In Situ progress to?

A

Invasive SqCC

21
Q

Does all CIN progres always? Why or why not?

A

No, lower stage usually regresses, CIN III usually progresses

22
Q

What defines invasive carcinoma

A

invades BM

23
Q

define cervical carcinoma

A

invasive carcinoma of cervical epithelium

24
Q

what is MC age for cervical carcinoma and why

A

40-50 yo bc women usually get HPV in 20s and it takes 20-30 yrs to develop cervical carcinoma

25
Q

What are 2 c;lassic presentations of cervical carcinoma

A

post-coital vaginal bleeding and cervical discharge

26
Q

what is highest risk factor for cervical carcinoma

A

HPV infx (16, 18, 31, 33)

27
Q

Secondary risk factors for cervical carcinoma (2)

A

smoking, immunodeficiency

28
Q

What illness does cervical carcinoma define?

A

cervical carcinoma is an AIDs-defining illness (if HIV+ has cervical carcinoma it means they now have AIDs)

29
Q

What are the two subtypes of cervical carcinoma and what is each of them associated with?

A

SqCC - 80%
Adenocarcinoma -15%
BOTH are related to HPV infx

30
Q

How does cervical carcinoma usually cause death? (4 steps)

A
  1. it invades antrior uterine wall into bladder
  2. blocks ureters
  3. causes Hydronephrosis
  4. which leads to postrenal failure –> death
31
Q

when does cervical carcinoma screening start?

A

age 21

32
Q

how long does it take to prgress from CIN I–> cervical carcinoma

A

10-20 years

33
Q

What is the gold standard for cervical carcinoma screening?

A

PAP smear

34
Q

What cells are analyzed in PAP smear

A

transformation zone cells

35
Q

what 2 chcs distinguish high grade dysplasia in a PAP smear?

A

High Nucleus:cytoplasm ratio (big nucleus)

hyperchromatic (dark) nuclei

36
Q

is PAP smear effective?

A

yes- it is the most successful screening test ever developed

37
Q

Why is PAP so effective? (2)

A

20-year window to catch dysplasia

uniform progression from CIN –> cervical carcinoma

38
Q

what 2 things follow a + PAP (abnormal)

A

colposcopy

biopsy

39
Q

what is colposcopy?

A

visualization of cervix with magnifying glass and acid

40
Q

What are 2 limitations of the PAP smear

A

flase negative due to inadequate sampling

can’t find adenocarcinoma

41
Q

why can’t PAP find adenocarcinoma

A

adenocarcinoma doesn’t follow the same progression

42
Q

what strains does the quadrivalent HPV vaccine cover

A

6, 11, 16, 18

43
Q

what do Abs against HPV 6 and 11 prevent

A

condylomas

44
Q

what do Abs against HPV 16 and 18 prevent (2)

A

CIN and carcinoma

45
Q

how long does HPV vaccine last

A

5 years

46
Q

Are PAPs still necessary after vaccine and why?

A

yes- doesn;t cover strains 31, 33 and others

Pathoma 13. Female Genital System and Gestational Pathology (7 decks)

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