Cervical and vaginal pathology

Question 1

Area of the cervix in contact with the vagina

Answer 1

Ectocervix

Question 2

Area of the cervix lining the cervical canal

Answer 2

Endocervix

Question 3

What type epithelium are the ecto and endocervix?

Answer 3

Ecto- stratified squamous

Endo- simple ciliated columnar

Question 4

Where does almost all cervical neoplasia arise?

Answer 4

The transformation zone

Question 5

Which process occurs in the transformation zone in response to eversion of the squamocolumnar junction into the vagina?

Answer 5

Squamous metaplasia (needed to protect from the acidic environment of the vagina)

Question 6

When might cervicitis cause infertility?

Answer 6

If accompanied by salpingitis- can impair tubal patency

Question 7

What infections can cause cervicitis? (2)

Answer 7

Herpes; chlamydia

Question 8

Whar pathological feature may be seen in chlamydial cervicitis?

Answer 8

Sub epithelial lymphoid follicles (follicular cervicitis)

Question 9

Non pre-malignant, inflammatory cause of abnormal bleeding

Answer 9

Cervical polyp

Question 10

What is cervical intraepithelial neoplasia (CIN)?

Answer 10

Precursor to invasive squamous carcinoma of cervix- contained within epithelium

Question 11

How is CIN graded?

Answer 11

CIN 1-3 (based on how many thirds of the mucosa show neoplastic change)

Question 12

How are cells within the cervix identified as being neoplastic? (4)

Answer 12

Classic features of neoplastic cells: nuclear hyperchromasia, pleomorphism, abnormal mitoses, loss of epithelial polarity

Question 13

Which serotypes of HPV are responsible for around 70% of cervical cancers?

Answer 13

16 and 18

Question 14

Risk factors for CIN/Cervical cancer (4)

Answer 14

Persistence of high-risk HPV serotypes
Long term COC use
Smoking
Immunosuppression

Question 15

What proportion of CIN 3 develop into invasive squamous carcinoma of the cervix?

Answer 15

Around 12%

Question 16

Describe the staging system used for squamous carcinoma of the cervix

Answer 16

Stage 1 (A1, A2, B)- confined to cervix
Stage 2- adjacent organs e.g. uterus, upper vagina
Stage 3- spread to pelvic wall
Stage 4- spread to rectum/bladder, distant metastases

Question 17

Symptoms of squamous carcinoma of cervix (5)

Answer 17

Usually none in/before microinvasive stage
Abnormal bleeding
Pelvic pain
Haematuria
Ureteric obstruction

Question 18

What is the pre-invasive phase of adenoarcinoma of cervix?

Answer 18

Cervical glandular intraepithelial neoplasia (CGIN)

Question 19

Epidemiology of adenocarcinoma of cervix

Answer 19

Higher SE status; smokers;HPV particularly 18; later onset of sexual activity

Question 20

What is the commonest type of carcinoma of vulva and what does it develop from?

Answer 20

Squamous cell carcinoma. Develops from vulval intraepithelial neoplasia (VIN)

Question 21

Describe the bimodal distribution of VIN

Answer 21

Young women

Older women- greater risk of progression

Question 22

What is the most important factor in the prognosis of carcinoma of vulva?

Answer 22

+/- spread to inguinal lymph nodes

Question 23

What is Pagets disease of the vulva?

Answer 23

Rare, slow-growing tumour which presents as a crusting rash