211b vulva, cervix path

Question 1

cervix

Answer 1

neck portion of uterus - protrudes into vagina

Question 2

vagina

Answer 2

muscular tube

Question 3

vulva

Answer 3

external genitalia

Question 4

cervical maturation

Answer 4

2 zones - exposed to vagina = ecto; similar stratified squamous epi like vagina

endocervical canal - at birth is columnar epi (glandular, mucin producing) –>

at puberty - shape of cervix changes – canal pulges out into vagina with columnar, glandular epi –> acid changes epi (metaplasia) –> squamous epi change (transformation zone)

Question 5

where does cervical path take place?

Answer 5

transition zone - squamous epi (metaplasia) from columnar epi that bulged out during puberty

Question 6

cervical histo

Answer 6

submucosa - ct and vessels

epi on top w/ basal layer –> smaller with less cytoplasm (higher nuc to cyto ratio) –> proliferative compartment –> cells mature outward

mucosa different than skin – no sweat, no hair, no keratin layer

Question 7

endocervix histo

Answer 7

single layer of columnar cells that produce mucin with endocervical glands of invaginations

Question 8

transformation zone

Answer 8

endocervical mucosa that becomes squamous mucosa

endocervical glands invaginations that have squamous epithelium on top

features of both

Question 9

cervical histo key points

Answer 9

squamous + glandular components

transformation from glandular to squamous at puberty –> where pathology occurs

Question 10

cervical cancer - who gets it? risks?

Answer 10

younger, healthier women - 45 y/o
multiple sexual partners**
early sex**
high parity**
smoking 

high risk HPV exposure risk factors

Question 11

cervical cancer pathology

Answer 11

ectocervical face - yellow, tan mucosa is normal; orange mass –> cancer

epithelium cells infiltrate into the stroma (past the BM)

2 cancer types: squamous (80%) and adenocarcinoma (minority)

Question 12

squamous cell carcinoma - how do we ID in cervical cancer?

Answer 12

keratinization - dense pink material in and outside of cells

intracellular bridges - thin connections between individual tumor cells (desmosomes)

Question 13

adenocarcinoma cervical cancer id?

Answer 13

forms glands

mucin production - special stain

Question 14

what causes all cervical cancer

Answer 14

high risk HPV infection (16,18,31,33)

Question 15

what leads to cervical cancer (squamous)?

Answer 15

dysplasia - CIN (cervical intraepithelial neoplasia) –> 3 grades (CIN I, II, III)

Question 16

what drives dysplasia?

Answer 16

high risk HPV

Question 17

CIN vs invasive carcinoma

Answer 17

CIN much more common than invasive squamous cell carcinoma –> much cases will resolve spontaneously (only 1% of CIN leads to cancer)

CIN I–>III–> cancer takes years

Question 18

CIN histo with HPV infection

Answer 18

surface - koilocytes (big epi cells with lots of cyto, infected with HPV, big dark nuclei, binucleation, perinuclear clearing –> halo)

dysplastic cell - nuclei are big, irregular with a high nuclear to cytoplasmic ratio

different - koilocytes at surface, dysplastic at basal later; koilocyters lots of cyto, dysplastic little cyto;

Question 19

CIN vs carcinoma

Answer 19

carcinoma - invades BM

Question 20

CIN I vs II/III

Answer 20

II/III extend to surface

Question 21

when does CIN peak?

Answer 21

mid 20’s - HPV is STD so related to sexual active

Question 22

HPV - high risk types

Answer 22

16, 18, 31, 33 –> integrate into host chromosomes

low risk are 6,11 –> don’t integrate

Question 23

HPV mechanism

Answer 23

proteins
E6 - degrades p53 (guardian of genome - fixes damages, stops cell cycle, apoptosis if not fixable)

E7 - binds Rb gene (Rb binds E2F until P by CDK4/cyclin D; if E2F free –> upregulates p16 –> cell cycle)

Question 24

pap test

Answer 24

screening, requires confirmation via biopsy, not 100% sensitive but repeating testing will probably catch due to long natural hx

Question 25

condyloma

Answer 25

genital warts from low risk HPV (6, 11)

not pre-malg

path: koilocytes, thicker epi (acanthosis), papillary projects covered w/ epi

Question 26

lichen simplex chronicus

Answer 26

anywhere on skin

due to chronic irritation (itching)

induces squamous hyperplasia, hyperkeratosis -> thick epi

not-pre malg

Question 27

lichen sclerosis - who? what is it? why? risk?

Answer 27

older patients

thinning, atrophy of epidermis; bands of lymphocytes

due to autoimmune or low E

can lead to invasive squamous cell carcinoma

Question 28

vulvar squamous cell carcinoma

Answer 28

less commonly assoicated with HPV (30%)

2 pathways

1) HPV driven
2) differentiated VIN pathyway –> associated with p53 mutation, lichen scelerosis –> older women

Question 29

vulvar paget’s disease

Answer 29

malignant glandular cells percolating through epidermis

Question 30

herpes simplex

Answer 30

painful papule vesicle ulcer; heals in 1-3 weeks, persists in regional nerve ganglion

pink inclusion

3M’s - moulding, multinucleated, margination

Question 31

syphilis

Answer 31

corckscrew - treponema pallidum (spirochete) – use dark field microscopy–> lots of plasma cells around blood vessels (affects vessels)

involves blood vessels (involves aorta)

primary, secondary, tertiary

parimary - chancre
sec - condyloma lata
ter - aorta