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MD1 - Reproduction Block > 6. Cervical HPV dysplasia carcinoma > Flashcards

6. Cervical HPV dysplasia carcinoma Flashcards

1
Q

What is the definition of Dysplasia?

A

Abnormality of development

In pathology, most commonly to denote pre-cancerous lesions

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2
Q

<p>What is the epidemiology of HPV?</p>

A

<p>Carcinoma at penis, vulva and anus have varying levels of HPV</p>

<p>But all Cervical cancer has relationship to HPV</p>

<p></p>

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3
Q

How is Cervical intraepithelial neoplasia 1 (CIN) similar to HPV infection?

A

They mean the same thing

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4
Q

CIN2 and CIN3 are?

A

Pre-cancers

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5
Q

Histological grading such as CIN1/2/3 are obtained via what method?

A

Made from biopsy

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6
Q

<p>What are the stages of cytological grading? and what histological grading do they correspond to?</p>

A

<p>- Low grade squamous intraepithelial lesion (CIN1)</p>

<p>- High grade squamous intraepithelial lesion (CIN2/3)</p>

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7
Q

<p>What is HSC?</p>

A

<p></p>

<p>HSC (High grade squamous intraepithelial lesions) = Precancerous condition in cervices, proportion HPV 16 and 18 is higher.</p>

<p></p>

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8
Q

<p>What is SCC ?</p>

A

<p></p>

<p>SCC (Squamous cell carcinoma) = ever HIGHER 16 and 18</p>

<p>Adenocarcinoma = Proportion of HPV 18 is higher > 16</p>

<p></p>

<p></p>

<p></p>

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9
Q

<p>What is the estimated life time risk of HPV? and what is the peak age?</p>

A

<p>Estimated life time risk of getting HPV is 50-80%</p>

<p>Peak is in the younger years (20-24), transmission is by sexual intercourse and ano-genital skin contact.</p>

<p>Penetration isn't specifically required.</p>

<p>Condoms are only partly useful.</p>

<p></p>

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10
Q

<p>What genes are expressed by HPV?</p>

A

<p></p>

<p>Prefix E = Expressed early in the infection, often cell regulatory protein. Them most important one is E6 and E7 which interact with p53 and Retinablastoma respectively.</p>

<p></p>

<p>Prefix L = Encode for capsid proteins.</p>

<p></p>

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11
Q

<p>What is the life cycle of HPV?</p>

A

<p></p>

<p>The HPV requires a fully differentiating squamous cells.</p>

<p>Infection takes place in parabasal cells.</p>

<p>Early genes are expressed, modify the cell cycle.</p>

<p>Once the infected squamous epithelium reaches the most superficial layers this is where the capsid proteins are produced in abundance and particle are assembled and shed at the surface of the epithelium</p>

<p>Takes 2-3 weeks for cycle to occur in the epithelium</p>

<p></p>

<p>HPV use the DNA machinery of cell. E6 and E7 are central to this. Creates permissive environment for cancer.</p>

<p>Low grade lesions can be associated with numerous subtypes.</p>

<p></p>

<p>But the higher risk serotype integrate their DNA into the cells. Increased expression of E6 and E7 through the epithelium. The complete viral replication cycle is lost and the production of capsid protein doesn't occur. The whole epithelial compartment becomes proliferating with no differentiation. This is the environment that the further hits that go on to carcinogenesis will occur.</p>

<p></p>

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12
Q

<p>Why are only a small proportion of HPV infection become associated with cancer?</p>

A

<p></p>

<p>Most infections are subclinical and transient, we have cell mediated immune response and seroconversion response that eliminate HPV from vast majority of people.</p>

<p></p>

<p>Most people go on to clear it completely (DNA -ve)</p>

<p></p>

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13
Q

<p>Do most people clear HPV?</p>

<p></p>

A

<p>For Low grade group, most people clear HPV. A proportion of people with High grade also CAN get rid of infection without any medical intervention.</p>

<p></p>

<p>Process from going from Low to High grade takes years.</p>

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14
Q

<p>What is the transformation zone and how is it relevant to HPV?</p>

A

<p></p>

<p>Transition between endocervical epithelium and squamous epithelium in the ectocervix</p>

<p></p>

<p>At times of puberty the glandular epithelium pouts out into the vaginal environment and undergo metaplasia (glandular --> Squamous epithelium)</p>

<p>As its undergoing metaplasia it is most vulnerable to HPV and dysplasia</p>

<p></p>

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15
Q

<p>What is cervical condyloma?</p>

A

<p></p>

<p>Condyloma = Wart but not necessarily pre-neoplastic.</p>

<p></p>

<p>Thickening of epithelium &amp; Papilomatosis (Fingerlike projections)</p>

<p></p>

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16
Q

<p>What is flat condyloma?</p>

A

<p>The usual patern of condyloma</p>

<p>- Nucleus is Pleomorphic</p>

17
Q

<p>What are the histological features of CIN1</p>

A

<p></p>

<p>CIN 1 is the same as HPV infection</p>

<p>The only difference is you get large disordered parabasal cells</p>

<p></p>

18
Q

<p>What are the histological features of CIN2?</p>

A

<p></p>

<p>True pre-neoplastic lesions,</p>

<p>Only 1% will have a high grade lesions.</p>

<p></p>

<p>Can progress to carcinoma.</p>

<p>If you look at the cervics you won't see any difference you need special stain to see It from biopsy</p>

<p>More nuclear enlargement</p>

<p>Disorder</p>

<p>Lack of maturation</p>

<p>Dysplastic features extend 1/2 to 2/3 of the epithelium</p>

<p></p>

19
Q

<p>What are the histological features of CIN3?</p>

A

<p></p>

<p>No maturation</p>

<p>Dysplastic features extend through the epithelium</p>

<p></p>

20
Q

<p>What are the histological features of Squamous cell carcinoma?</p>

A

<p>Cells have invaded through the basement membrane with irregularly shaped islands of malignant cells.</p>

21
Q

<p>What is the macroscopicfeatures of Adenocarcinoma in situ?</p>

A

<p>No macroscopic features in pre-neoplastic syndrome</p>

22
Q

<p>What is the histologic features of adenocarcinoma</p>

A

<p>- Glandular differentiation</p>

<p>- Cribiform structures</p>

<p>- Papillary infolding into gland</p>

23
Q

<p>What are the CYTOlogic features of Low Grade Squamous Intraepithelial lesion?</p>

A

<p></p>

<p>Binucleation</p>

<p>Sharp nuclear cave</p>

<p></p>

24
Q

<p>What are the CYTOlogic features of high grade squamous intraepithelial lesion (HSIL)</p>

A

<p>High nuclear to cytoplasm ratio</p>

25
Q

<p>What are the cytologic featues of Adenocarcinoma in situ?</p>

A

<p>Nucleus are darker</p>

<p>Crowded</p>

<p>More pleomorphic</p>

26
Q

<p>What are the NHMRC guidelines ?</p>

A

<p>What is the difference between Reactive and Dysplastic changes?</p>

27
Q

<p>What are the clinical managements?</p>

A 
<ul>
	<li>Colposcopy</li>
	<li>Biopsy +/- repeat cytology</li>
	<li>Treatment
	<ul>
		<li>Laser ablation<br>
		Laser Excision</li>
		<li>Surgery</li>
	</ul>
	</li>
	<li>Prevention
	<ul>
		<li>Gardasil (protection from 6, 11, 16, 18) 3x doses</li>
	</ul>
	</li>
	<li>Therapeutic</li>
</ul>

MD1 - Reproduction Block (15 decks)

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