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Reproduction > Cervical and Vulval Pathology > Flashcards

Cervical and Vulval Pathology Flashcards

1
Q

What are the layers of the normal ectocervix from superficial to deep?

A

Exfoliating cells, superficial cells, intermediate cells, parabasal cells, basal cells, basement membrane

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2
Q

What is the transformation zone of the cervix?

A

Squamocolumnar junction between ectocervical (squamous) and endocervical (columnar) epithelia

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3
Q

What are some examples of times throughout life when the transition zone alters its position?

A

Menarche, pregnancy, menopause = occurs due to physiological response to these events

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4
Q

What occurs during cervical erosion?

A

Exposure of endocervical epithelium to acid environment of vagina = leads to physiological squamous metaplasia

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5
Q

What is a Nabothian follicle?

A

Mucous-filled cyst of cervical surface = usually occur when ectocervical epithelium grows over epithelium of endocervix

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6
Q

What are some features of cervicitis?

A

Often asymptomatic

Can cause infertility due to simultaneous silent fallopian tube damage

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7
Q

What are some causes of cervicitis?

A

Non-specific inflammation, chlamydia trachomatis, herpes simplex

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8
Q

What is follicular cervicitis?

A

Sub-epithelial reactive lymphoid follicles = occur in cervix

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9
Q

What are some features of cervical polyps?

A

Localised inflammatory outgrowth
Cause bleeding if ulcerated
Not premalignant

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10
Q

What are some risk factors for cervical cancer?

A

Persistence of high risk HPV = usually type 16 or 18, multiple sexual partners increase risk
Smoking and immunosuppression
Vulnerability of transition zone in early reproductive life

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11
Q

What are some factors that affect the vulnerability of the transition zone in early reproductive life?

A

Age at first intercourse
Long term use of oral contraceptives
Non-use of barrier contraception

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12
Q

What causes genital warts?

A

Low risk HPV = type 6 or 11

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13
Q

What is condyloma acuminatum?

A

Occurs in genital warts = thickened papillomatous squamous epithelium with cytoplasmic vacuolation (koilocytosis)

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14
Q

What causes cervical intraepithelial neoplasia?

A

High risk HPV = type 16 or 18

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15
Q

What would indicate cervical intraepithelial neoplasia on a smear test?

A

Infected epithelium is flat but shows koilocytosis

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16
Q

What kind of cancer is cervical cancer?

A

Invasive squamous carcinoma = caused by HPV, virus is integrated into host DNA

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17
Q

How long does it take for HPV infection to cause cervical cancer?

A

Takes 6 months-3 years for HPV to become high grade CIN and 5-20 years for high grade CIN to become invasive cancer

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18
Q

What is the prevalence of HPV infection?

A

80% cumulative prevalence in a lifetime

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19
Q

What is cervical intraepithelial neoplasia (CIN)?

A

Pre-invasive stage of cervical cancer = dysplasia of squamous cells

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20
Q

Where does CIN tend to occur?

A

Transformation zone = can involve large area

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21
Q

How is CIN detected?

A

By cervical screening = asymptomatic and not visible to naked eye

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22
Q

What is CIN preceded by?

A

Koilocytosis

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23
Q

What are the three markers used to grade CIN?

A

Graded I-III = delay in maturation, nuclear abnormalities, excess mitotic activity

24
Q

What nuclear abnormalities can occur in CIN?

A

Hyperchromasia, pleomorphism, increased nucleocytoplasmic ratio

25
Q

How is a delay in maturation seen and excess mitotic activity in CIN?

A

Immature basal cells occupying more of epithelium

Mitotic activity situated above layers and abnormal mitotic forms

26
Q

What occurs in CIN grade I?

A

Basal 1/3 of epithelium occupied by abnormal cells
Raised number of mitotic figures in lower 1/3
Surface cells quite mature but nuclei slightly abnormal

27
Q

What occurs in CIN grade II?

A

Abnormal cells extend to middle 1/3

Mitoses in middle 1/3 and abnormal mitotic figures

28
Q

What occurs in CIN grade III?

A

Abnormal cells occupy full thickness of epithelium

Mitoses in upper 1/3

29
Q

What is the rate of progression of CIN?

A

1% of CIN I progress to invasion
5% of CIN II become invasive
>12% of CIN III progress to become invasive

30
Q

How common is invasive cervical squamous carcinoma?

A

Accounts for 75-95% of malignant cervical tumours

Second most common female cancer

31
Q

What are some features of invasive cervical squamous carcinoma?

A

Increasingly seen in younger women = often found in early stage
Develops from pre-existing CIN = most cases preventable by screening

32
Q

What is stage 1 of invasive cervical squamous cancer?

A 
1A1 = depth of up to 3mm, width up to 7mm
1A2 = depth of up to 5mm, width up to 7mm
1B = confined to cervix
33
Q

What are stages 2 and 3 of invasive cervical squamous carcinoma?

A 
2 = spread to adjacent organs
3 = involvement of pelvic wall
34
Q

What is stage 4 of invasive cervical squamous carcinoma?

A

Distant metastases or involvement of rectum or bladder

35
Q

What are the symptoms of invasive cervical squamous carcinoma?

A

Usually none at microinvasive/early invasive stages
Abnormal bleeding = post coital, post menopausal, brownish or blood stained vaginal discharge
Pelvic pain, haematuria, UTI, ureteric obstruction, renal failure

36
Q

How does invasive cervical squamous carcinoma spread?

A 
Local = uterine body, vagina, bladder, ureters, rectum
Lymphatic = early stages, pelvic and para-aortic nodes
Haematogenous = late stages, liver, lungs and bone
37
Q

How is invasive cervical squamous carcinoma graded?

A

Well differentiated, moderately differentiated, poorly differentiated, undifferentiated/anaplastic

38
Q

Where does cervical glandular intraepithelial neoplasia (CGIN) originate from?

A

Endocervical epithelium

39
Q

What are some features of CGIN?

A

Pre-invasive phase of endocervical adenocarcinoma
Screening less effective = more difficult to diagnose on smear than squamous type
Sometimes associated with CIN

40
Q

How common in endocervical adenocarcinoma?

A

5-25% of cervical cancers

Increasing incidence, especially in young women

41
Q

What are some features of endocervical adenocarcinoma?

A

Some are mixed (adenosquamous) = may arise from common origin cell
Worse prognosis than squamous carcinoma

42
Q

What is the epidemiology of endocervical adenocarcinoma?

A

Higher socioeconomic class, later onset of sexual activity, smoking, HPV type 18

43
Q

What are some rarer HPV-driven diseases?

A

Vulvar intraepithelial neoplasia (VIN)
Vaginal intraepithelial neoplasia (VaIN)
Anal intraepithelial neoplasia (AIN)

44
Q

What are some features of vulval intraepithelial neoplasia (VIN)?

A

Less predictable than CIN but also has three grades

Often associated with HPV and synchronous with CIN and VaIN

45
Q

What is the bimodal incidence of vulval intraepithelial neoplasia?

A

Young women = often multifocal, recurrent or persistent causing treatment problems
Older women = greater risk of progression to invasive squamous carcinoma

46
Q

What are some features of vulvar invasive squamous carcinoma?

A

Usually present as an ulcer or exophytic mass in elderly woman
Can arise from normal epithelium or VIN

47
Q

What grade are most vulvar invasive squamous carcinomas?

A

Well differentiated = verrucous are extremely well differentiated type

48
Q

What is an important prognostic factor for vulvar invasive squamous carcinomas?

A

Spread to inguinal lymph nodes

49
Q

How are vulvar invasive squamous carcinomas treated?

A

Surgical treatment = radical vulvectomy and inguinal lymphadenectomy

50
Q

What is the prognosis of vulvar invasive squamous carcinomas?

A

90% 5 year survival if node negative

<60% 5 year survival if node positive

51
Q

What are some features of vulvar Paget’s disease?

A

Crusting rash
Tumour arising from sweat gland of skin
Tumour cells in epidermis = contain mucin
Mostly no underlying cancer

52
Q

What are some vulval infections?

A

Candida = especially diabetics
Vulval warts = HPV types 6 and 11
Bartholin’s gland abscess = due to blockage of gland duct

53
Q

What are some vulval dermatoses?

A

Lichen sclerosis, lichen planus, psoriasis

54
Q

What lesions may exist alongside vaginal epithelial neoplasia?

A

Cervical and vulval epithelial neoplasia

55
Q

What are some vaginal malignancies that can occur?

A

Squamous carcinoma = less common than cervical and vulval counterparts, usually elderly patients
Melanoma = rare, may appear as polyp

Reproduction (62 decks)

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