Cervical and vaginal pathology Flashcards
Area of the cervix in contact with the vagina
Ectocervix
Area of the cervix lining the cervical canal
Endocervix
What type epithelium are the ecto and endocervix?
Ecto- stratified squamous
Endo- simple ciliated columnar
Where does almost all cervical neoplasia arise?
The transformation zone
Which process occurs in the transformation zone in response to eversion of the squamocolumnar junction into the vagina?
Squamous metaplasia (needed to protect from the acidic environment of the vagina)
When might cervicitis cause infertility?
If accompanied by salpingitis- can impair tubal patency
What infections can cause cervicitis? (2)
Herpes; chlamydia
Whar pathological feature may be seen in chlamydial cervicitis?
Sub epithelial lymphoid follicles (follicular cervicitis)
Non pre-malignant, inflammatory cause of abnormal bleeding
Cervical polyp
What is cervical intraepithelial neoplasia (CIN)?
Precursor to invasive squamous carcinoma of cervix- contained within epithelium
How is CIN graded?
CIN 1-3 (based on how many thirds of the mucosa show neoplastic change)
How are cells within the cervix identified as being neoplastic? (4)
Classic features of neoplastic cells: nuclear hyperchromasia, pleomorphism, abnormal mitoses, loss of epithelial polarity
Which serotypes of HPV are responsible for around 70% of cervical cancers?
16 and 18
Risk factors for CIN/Cervical cancer (4)
Persistence of high-risk HPV serotypes
Long term COC use
Smoking
Immunosuppression
What proportion of CIN 3 develop into invasive squamous carcinoma of the cervix?
Around 12%
Describe the staging system used for squamous carcinoma of the cervix
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
Symptoms of squamous carcinoma of cervix (5)
Usually none in/before microinvasive stage Abnormal bleeding Pelvic pain Haematuria Ureteric obstruction
What is the pre-invasive phase of adenoarcinoma of cervix?
Cervical glandular intraepithelial neoplasia (CGIN)
Epidemiology of adenocarcinoma of cervix
Higher SE status; smokers;HPV particularly 18; later onset of sexual activity
What is the commonest type of carcinoma of vulva and what does it develop from?
Squamous cell carcinoma. Develops from vulval intraepithelial neoplasia (VIN)
Describe the bimodal distribution of VIN
Young women
Older women- greater risk of progression
What is the most important factor in the prognosis of carcinoma of vulva?
+/- spread to inguinal lymph nodes
What is Pagets disease of the vulva?
Rare, slow-growing tumour which presents as a crusting rash
