CBL - Cervix and myometrium

Question 1

What should be done when a cervical swab shows moderate dyskarysosis?

Answer 1

Refer the patient for a colposcopy

Question 2

What is the most common reason for dyskaryosis on a cervical swab?

Answer 2

As this implies abnormal nuclei, the most likely reason is significant cervical intraepithelial neoplasia or CIN
- this is the pre-malignant lesion which can be treated before it becomes cancer

Question 3

What are some of the signs of a HPV infection?

Answer 3

White cervical mucosa after application of 5% acetic acid

Koliocytes are seen on biopsy (clearing around the nucleus)

Question 4

Which cells in the cervix does a virus invade to cause koliocytes?

Answer 4

Epithelial cells of the squamous mucosa.

Question 5

What is the most appropriate treatment for CIN II?

Answer 5

Loop excision of the transformation zone (LETZ)

Question 6

What is the function of a LETZ biopsy?

Answer 6

Treatment of abnormal epithelium and allows full assessment of the lesion by histopathology, confirmation of CIN and assessment of excision (to make sure there is no invasive cancer)

Question 7

Cervical smears are no longer done via ‘pap smears’, what is the name for the new ‘smear’?

Answer 7

Liquid based cytology (LBC)

Question 8

Which parts of the female reproductive track are covered in non-keratinising stratified squamous epithelium?

Answer 8

Vagina and the ectocervix

Question 9

Describe the appearance of non-keratinising stratified squamous epithelium.

Answer 9

As cells migrate and mature (differentiate) towards the epithelial surface, they accumulate glycogen
- gives a basket weave appearance (characteristic)

Question 10

What size is the normal zone of proliferation compared to the zone of differentiation in the cervix?

Answer 10

Very narrow (quater of the size roughly)

Question 11

Where are stem cells present in the epithelial layer of the ectocervix?

Answer 11

Basal layer of the epithelium (just above the basement membrane)
- basal layer includes stem cells and doesn’t proliferation very rapidly (Lies below the proliferation layer)

Question 12

What is the epithelium that covers the endocervix?

Answer 12

Simple columnar covers the surface and glands of the endocervix

Question 13

What is the name of the epithelium between the endo and exocervix?

Answer 13

Transformation zone - this is where HPV infection and CIN are most often found

Question 14

How large does the proliferation zone become in CIN 1, 2 and 3 respectively?

Answer 14

CIN1 - one third of the thickness of the epithelium
CIN2 - two thirds of the thickness of the epithelium
CIN3 - the whole of the thickness thickness of the epithelium

Question 15

Describe some of the histopathological aspects of a moderately differentiated invasive squamous carcinoma.

Answer 15

Irregular islands of cells
Invading down (not confined to epithelial compartment)

Question 16

Which HPV types most commonly cause cancer?

Answer 16

16 and 18

- most HPV infections never cause cancer

Question 17

What is the definition of a polyp.

Answer 17

An overgrowth on a surface causing a protrusion from that surface
- can be benign or malignant

Question 18

What type of endometrial mass has the appearance of watered silk?

Answer 18

Leiomyoma (fibroid tumour)

Question 19

What is a leiomyoma?

Answer 19

A benign smooth muscle tumour

- histologically looks like smooth muscle bundles

Question 20

Why do more smooth muscle fibroids occur in the GU tract than the GI tract?

Answer 20

Hormones

Question 21

What cytogenetic abnormalities support the neoplastic characteristics of leiomyomas?

Answer 21

Trisomy 12 (translocation 12->14)
- occurs in 40% of cases

Question 22

What is the name given to a smooth muscle tumour that is necrotic, has high atypical or bizarre cell and is undergoing unusually numerous and abnormal mitosis?

Answer 22

Leiomyosarcoma - malignant tumour of the smooth muscle