Cervical and vulval pathology

Question 1

what is dysplasia

Answer 1

earliest morphological manifestation of multistage process of neoplasia

Question 2

what are the highest risk HPV groups and what % of cervical cancer has these groups?

Answer 2

16 and 18 and associated with 70% of cervical cancers

Question 3

what signs and symptoms are associated with HPV 6,11?

Answer 3

these are low risk for cervical cancer. associated with lower genital tract warts. unsightly, painful, bleeding.

Question 4

what’s the treatment for genital warts

Answer 4

topical creams/liquids, cryotherapy or surgical ablation depending on size.

Question 5

what are the two vaccines for the HPV vaccination programme?

Answer 5

Gardasil and Cervarix

Question 6

what HPV’s does Gardasil vaccinate from?

Answer 6

6, 11, 16 and 18

Question 7

what HPV’s does Cervarix vaccinate from?

Answer 7

16,18

Question 8

what is the mode of action for high risk HPV?

Answer 8

1. high risk HPVs integrate into host genome => up regulation of E6,E7 expression.
2. E6 binds to and inactivates p53
3. E7 binds to RB1 Gene product
4. p53 mediates apoptosis in response to DNA damage
5. RB1 is a tumour suppressor gene: it controls G1/S cell cycle checkpoint
6. accumulation of genetic damage
7. dysregulation of cell proliferation

Question 9

what is the transformation zone in terms of cervical pathology?

Answer 9

physiological area of squamous metaplasia

Question 10

what is colposcopy?

Answer 10

is the examination of the cervix with a low powered stereoscopic microscope

Question 11

what are the risk factors for cervical squamous cell carcinoma?

Answer 11

• high risk HPV
• multiple sexual partners
• male partner with multiple partners
• young age at first intercourse
• high parity
• low socioeconomic group
• smoking
• immunosuppression

Question 12

what is the normal case of those with classical/warty/basaloid VIN?

Answer 12

• Usually graded VIN 1-3
• related to HPV infection
• younger women

Question 13

what is the normal case of those with differentiated VIN?

Answer 13

• not graded
• not HPV related
• occurs in chronic dermatoses esp. lichen sclerosis
• older women

Question 14

what is the behaviour of VIN?

Answer 14

35-50% recur

• positive margins predict recurrence
• progression to invasive carcinoma in 4-7% of treated women and up to 87% of those untreated
• invasion more likely to occur in postmenopausal/immunocompromised

Question 15

what is vulval squamous cell carcinoma associated with?

Answer 15

associated with VIN

associated with inflammatory dermatoses

Question 16

what does pagets disease of the vulva look like?

Answer 16

looks like eczema in a ‘buckshot’ pattern

Question 17

where do the malignant cells in paget’s disease of the vulva arise from?

Answer 17

the glandular malignant cells arise in the intra-epidermal portion of the sweat ducts

Question 18

why when diagnosing malignant melanoma of the vulva is histology needed?

Answer 18

it is needed because some melanomas are not heavily pigmented, they may have no pigment at all. the histology can show the melanoma even if its a melanotic melanoma

Question 19

what % of vulva cancers are malignant melanomas?

Answer 19

5% of vulval cancers

Question 20

what is the mean age of those who get malignant melanomas

Answer 20

50-60 years old

Question 21

does malignant melanomas of the vulvas spread commonly and if so where to?

Answer 21

commonly spread to the urethra, lymph node/haematogenous spread also common

Question 22

what % of vulval cancers are Paget’s disease and what is the mean age group of these patients?

Answer 22

5% of vulval cancer are caused by Paget’s disease and the mean age group is 80

Question 23

what does paget’s disease commonly develop into

Answer 23

develops commonly into invasive adenocarcinoma