Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Yr 2 - EMS > Cervical and Vulval Pathology > Flashcards

Cervical and Vulval Pathology Flashcards

1
Q

What are condyloma acuminatum?

A

Genital warts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is LSIL?

A

The tissue that covers your cervix is made up of squamous cells. Low-grade squamous intraepithelial lesion (LSIL) is a common abnormal result on a Pap test. It’s also known as mild dysplasia. LSIL means that your cervical cells show mild abnormalities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Are genital warts a form of LSIL?

A

Yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Different shapes of genital warts?

A
  • Exophytic - Flat - Papillary - Occasionally inverted
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is HPV?

A

HPV is the name of a very common group of viruses. They do not cause any problems in most people, but some types can cause genital warts or cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is CIN?

A

Cervical intraepithelial neoplasia (CIN) is a precancerous condition in which abnormal cells grow on the surface of the cervix (not cancer but may become cancer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the risk factors of CIN for females?

A
  • HPV infection
  • First coitus <17 yrs age
  • Multiple sexual partners
  • Long term OCP use
  • Early first pregnancy
  • High parity
  • Low socio-economic status
  • STD’s: Herpes, gonorrhea, chlamydia
  • Smoking
  • Immunosuppression, including HIV seropositivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the most important risk factor for CIN in females?

A

HPV infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the risk factors of HPV for males?

A
  • Penile warts
  • Multiple sexual partners
  • Cervical cancer (or CIN) in previous partner
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 2 types of HPV?

A
  • Cancer causing types (high risk)
  • Non-cancer causing types (low risk)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the low risk HPVs?

A

HPV 6 and HPV 11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the high risk HPVs?

A

HPV 16 and HPV 18

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can the non-cancer causing types of HPV cause?

A

90% of anogenital warts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What can the cancer causing types of HPV cause?

A

>75% of cervical cancer >50% of vaginal and vulvar cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the purpose of the cervical screening programme (NHSCSP)?

A

To reduce the incidence of, and mortality from, cervical cancer through a systematic, quality assured population-based screening programme for eligible women.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When are females first invited for a cervical screening?

A

25

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How frequently are women screened between the ages of 25-49?

A

Every 3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How frequently are women screened between the ages of 50-64?

A

Every 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How frequently are women screened between the ages of 65+?

A

Not had cervical screening since 50yrs of age OR follow up of recent abnormal cytology sample.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does the NHSCSP screen for?

A

Primary human papillomavirus (HPV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does the NHSCSP work?

A

Liquid based cytology to detect abnormalities of cervix.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

If abnormalities are found during the NHSCSP, what is the patient referred for?

A

Colposcopy to diagnose cervical intraepithelial neoplasia (CIN) and to differentiate high-grade lesions from low-grade abnormalities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When did the HPV vaccination in England begin?

A

Sep 2008 for girls 12-13 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What 2 vaccines are given for HPV?

A
  • Cervarix (HPV types 16/18) : 2008 - 2012
  • Gardasil (HPV types 6/11/16/18) : since Sep 2012
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What HPV types does Gardasil target?

A

Low AND high risk HPV types (6/11/16/18)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Is the HPV vaccine offered to boys?

A

Yes - ages 12-13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What has been the major recent change in primary HPV screening?

A

Primary hr-HPV testing has replaced primary cytology (2019)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What does hr-HPV stand for?

A

High risk HPV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Why has hr-HPV testing replaced primary cytology (smear)?

A

Evidence shows HPV testing is a better way of identifying women at risk of cervical cancer than the cytology (smear) test that examines cells under a microscope.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is a colposcopy?

A

A colposcopy is a simple procedure used to look at the cervix. It’s often done if cervical screening finds abnormal cells in your cervix.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is the transformation zone (TZ)?

A

Area between original and new SCJ (squamous columnar junction) where the columnar epithelium has been and/or is being replaced by new metaplastic squamous epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is the SCJ?

A

The squamo-columnar junction (SCJ) of the cervix refers to a transitional area between squamous epithelium of the vagina and the columnar epithelium of the endocervix.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

How does the SCJ change with age?

A

This shifts in location through age from being more external to internal.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the TZ prone to?

A

Oncogenic effects of HPV –> is the site of CIN development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the site of CIN development?

A

Transformation zone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Describe difference in obtaining cells between a female in her reproductive age and a female in her menopausal age

A
  • Transformation zone cells can be obtained from surface of cervix
  • Endocervical brush needed to sample the endocervical cells due to SCJ moving higher up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is liquid based cytology?

A

A new method of preparing cervical samples for cytological examination. It involves making a suspension of cells from the sample and this is used to produce a thin layer of cells on a slide.

38
Q

Pap smear appearances

A
39
Q

What is CIN1?

A

Low grade dysplasia

40
Q

What is CIN2 and CIN3?

A

High grade dysplasia

41
Q

Natural progression of HPV infection

A

Progression of normal cells after the HPV infection from CIN1 –> CIN2 –> CIN3 –> invasive malignancy (carcinoma)

42
Q

What is dyskaryosis?

A

Dyskaryosis means abnormal nucleus and refers to the abnormal epithelial cell which may be found in cervical sample. It is graded from low to high grade based on degree of abnormality.

43
Q

New vs old protocol for cervical screening?

A

Old: only referred for HPV testing if displayed dyskaryosis, referred straight to colposcopy if high grade dyskaryosis

New: primarily tested for HR-HPV test

44
Q

What are precursor lesions in the cervix? How are they identified?

A
  • CIN
  • Asymptomatic lesions
  • Identified in cytology then referred to colposcopy
    • ​They can then be identified by visual examination after 3-5% acetic acid application
45
Q

LSIL vs HSIL?

A

HSIL is an acronym for high grade squamous intraepithelial lesion, and LSIL means low grade squamous intraepithelial lesion

46
Q

What are the morphological features of CIN1?

A
  • Maturation is seen in upper 2/3 of epithelium.
  • Some degree of nuclear abnormality full thickness epithelium; more in basal 1/3rd
  • Normal MF’s may be increased; abnormal mitosis supports diagnosis

N.B. to call anything CIN you have to have presence of nuclear abnormality

47
Q

Morphological features of CIN II?

A
  • Cytoplasmic maturation is seen in upper 1/3 of epithelium.
  • Nuclear atypia more marked than CIN1
  • MF’s increased; atypical mitosis common.
48
Q

Morphological features of CIN III?

A
  • Maturation may be absent or confined only to superficial layers.
  • Nuclear atypia is severe, through full epithelial thickness.
  • MF’s are seen at all levels of epithelium.
49
Q

Describe dyskaryosis in CIN 1?

A

LSIL –> low grade CIN –> mild dysplasia/dyskaryosis

50
Q

Describe dyskaryosis in CIN 2?

A

High grade CIN –> HSIL –> moderate dysplasia/dyskaryosis

51
Q

Describe dyskaryosis in CIN 3?

A

High grade CIN –> HSIL –> severe dysplasia/dyskaryosis

52
Q

What is p16? What is it used as a diagnostic marker of?

A

p16 is a tumor suppressor protein –> Block positive p16 expression is a sensitive and specific diagnostic marker of a transforming HRHPV infection

53
Q

Where would you expect to see positive p16?

A

In cervical squamous lesions, p16 is positive in most high-grade cervical intraepithelial neoplasia (CIN) and in some cases of low-grade CIN

54
Q

What is the % of CIN I that a) regress b) progress to cancer?

A

a) 60% regression
b) <1% progression to cancer

55
Q

Treatment of CIN?

A

A large loop excision of the transformation zone (LLETZ) is the most common way of removing cervical tissue to treat pre-cancerous changes of the cervix.

ALSO CALLED Loop electrosurgical excision procedure (LEEP) –> This technique uses a small, electrically charged wire loop to remove tissue (transformation zone).

These samples are then analysed.

56
Q

Describe stage 1 (T1) of cervical squamous carcinoma. What can stage 1 be subdivided into?

A

Tumour is confined to the cervix. Can be subdivided into 1a and 1b.

57
Q

How can stage T1a of cervical squamous carcinoma be diagnosed? How about T1b?

A
  • T1a - Only by microscopy
  • T1b - Clinically visible lesion
58
Q

What can T1a of cervical carcinoma then be subdivided into? What causes this differentiation?

A

T1a1 and T1a2 –> difference in stromal invasion and horizontal spread

59
Q

Describe basement membrane in stage 1a1 or 1a2 tumours

A

Absence of sharply defined basement membrane

60
Q

Staging of cervical cancer

A
61
Q

What is CGIN?

A

Cervical glandular intra-epithelial neoplasia: an abnormality of the glandular cells. It’s much less common that CIN, but it’s similar. It’s a pre-cancerous abnormality.

62
Q

What are the 2 categories of glandular neoplasia?

A
  • L-CGIN: not reported
  • H-CGIN - corresponds to AIS (adenocarcinoma in-situ)
63
Q
A
64
Q

Where does CGIN usually occur?

A

At or close to TZ

65
Q

What do glandular cells show dring CGIN?

A

Glandular cells show mucin depletion, nuclear stratification, atypia, hyperchromasia, MF’s and apoptosis (non-luminal aspect of the gland).

Can involve both surface and crypt epithelium.

66
Q

What are the positive stains for CGIN?

A
  • p16
  • Ki67 increased
67
Q

What is Ki67?

A

The expression of Ki67 is strongly associated with tumor cell proliferation and growth, and is widely used in routine pathological investigation as a proliferation marker.

68
Q

What is an adenocarcinoma?

A

Cancer that begins in glandular (secretory) cells.

69
Q

Where is the tumour confined to in stage 1 of an early invasive adenocarcinoma?

A

T1: Tumour confined to the cervix

70
Q

Describe invasive glandular / adenocarcinoma

A
  • Obvious infiltrative pattern.
  • Architectural complexity despite absence of obvious destructive invasion or stromal response.
  • Buds with squamoid appearance emanating from glands involved with CGIN.
71
Q

What are some other types of cervical tumours?

A
  • Adenosquamous carcinoma
  • Adenoid basal carcinoma
  • Adenoid cystic carcinoma
  • Neuroendocrine tumours
  • Metastatic lesions
72
Q

What is VIN?

A

Vulvar intraepithelial neoplasia, also known as VIN, is a non-invasive squamous lesion and precursor of squamous cell carcinoma (SCC) of the vulva.

73
Q

What are the 2 main types of VIN?

A
  • uVIN: usual type / undifferentiated
  • dVIN: differentiated type
74
Q

How is uVIN graded?

A

Graded 1-3 (similar to CIN)

75
Q

What is uVIN related to?

A

HPV

76
Q

Who is uVIN more common in?

A

Younger women (<40)

77
Q

How is dVIN graded?

A

Not graded

78
Q

Is dVIN HPV related?

A

No

79
Q

Who is dVIN more common in?

A

Older women

80
Q

What is the recurrence of uVIN related to?

A
  • Recurs after local Rx in 50% cases.
  • Recurrence correlated to smoking, multifocality and positive margins.
81
Q

How often is progression of uVIN to SCC seen?

A
  • Progression to SCC in 5-6% of treated women
  • Progression to SCC in 10-15% of untreated women
82
Q

Who is spontaneous regression of uVIN most likely in?

A

Pregnant or post partum women

83
Q

Does dVIN carry a greater or lesser risk of a progression to invasive SCC?

A

Greater risk of progression: 1/3 of dVIN lesions progressed and within a short period (mean 28 months).

84
Q

What is vulval squamous cell carcinoma associated with?

A
  • Associated with VIN (msot common)
  • Can also be associated with inflammatory dermatosis like Lichen sclerosus.
85
Q

What is a multifocal lesion?

A

A lesion arising from or having many locations

86
Q

Where is the tumour confined to in stage 1 of vulval carcinoma?

A

Tumour confined to the vulva: split into 1a and 1b depending on stromal invasion and size

87
Q

What is Paget’s disease of the vulva (extramammary)?

A
  • Paget’s disease of the vulva is an unusual kind of skin cancer (1% of vulval cancers) that arises from glandular cells
  • Pruritus (itch); burning; eczematous patch
  • Mean age - 7th decade
  • This disease appears as a red, velvety area with white islands of tissue on the vulva. At times it may be pink, and occasionally there are moist, oozing ulcerations that bleed easily.
88
Q

What else must you look for in Paget’s disease of the vulva?

A

30% patients have synchronous or metachronous internal carcinoma, most commonly of breast or genitourinary system.

89
Q

Other types of vulval tumours?

A
  • Adenocarcinoma
  • Basal cell carcinoma
  • Merkel cell tumour
  • Malignant melanoma
  • Sarcomas
  • Metastasis
90
Q

What conditions can dVIN be related to?

A

Chronic inflammatory diseases –> Lichen sclerosus

91
Q

Which types of HPV cause 90% of genital warts?

A

HPV6 & HPV11

Yr 2 - EMS (60 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions