Cervical and vulval pathology Flashcards
what is dysplasia
earliest morphological manifestation of multistage process of neoplasia
what are the highest risk HPV groups and what % of cervical cancer has these groups?
16 and 18 and associated with 70% of cervical cancers
what signs and symptoms are associated with HPV 6,11?
these are low risk for cervical cancer. associated with lower genital tract warts. unsightly, painful, bleeding.
what’s the treatment for genital warts
topical creams/liquids, cryotherapy or surgical ablation depending on size.
what are the two vaccines for the HPV vaccination programme?
Gardasil and Cervarix
what HPV’s does Gardasil vaccinate from?
6, 11, 16 and 18
what HPV’s does Cervarix vaccinate from?
16,18
what is the mode of action for high risk HPV?
- high risk HPVs integrate into host genome => up regulation of E6,E7 expression.
- E6 binds to and inactivates p53
- E7 binds to RB1 Gene product
- p53 mediates apoptosis in response to DNA damage
- RB1 is a tumour suppressor gene: it controls G1/S cell cycle checkpoint
- accumulation of genetic damage
- dysregulation of cell proliferation
what is the transformation zone in terms of cervical pathology?
physiological area of squamous metaplasia
what is colposcopy?
is the examination of the cervix with a low powered stereoscopic microscope
what are the risk factors for cervical squamous cell carcinoma?
- high risk HPV
- multiple sexual partners
- male partner with multiple partners
- young age at first intercourse
- high parity
- low socioeconomic group
- smoking
- immunosuppression
what is the normal case of those with classical/warty/basaloid VIN?
- Usually graded VIN 1-3
- related to HPV infection
- younger women
what is the normal case of those with differentiated VIN?
- not graded
- not HPV related
- occurs in chronic dermatoses esp. lichen sclerosis
- older women
what is the behaviour of VIN?
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
what is vulval squamous cell carcinoma associated with?
associated with VIN
associated with inflammatory dermatoses
what does pagets disease of the vulva look like?
looks like eczema in a ‘buckshot’ pattern
where do the malignant cells in paget’s disease of the vulva arise from?
the glandular malignant cells arise in the intra-epidermal portion of the sweat ducts
why when diagnosing malignant melanoma of the vulva is histology needed?
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
what % of vulva cancers are malignant melanomas?
5% of vulval cancers
what is the mean age of those who get malignant melanomas
50-60 years old
does malignant melanomas of the vulvas spread commonly and if so where to?
commonly spread to the urethra, lymph node/haematogenous spread also common
what % of vulval cancers are Paget’s disease and what is the mean age group of these patients?
5% of vulval cancer are caused by Paget’s disease and the mean age group is 80
what does paget’s disease commonly develop into
develops commonly into invasive adenocarcinoma
