Cervical Neoplasia Flashcards
1
Q
Squamocolumnar junction in normal cervix
A
- Squamous and columnar epithelium meet
- Cells susceptible to HPV infection
- Precancerous lesions and Cervical CA development
2
Q
Transformation zone in normal cervix
A
- Columnar epithelium is replaced by squamous epithelium
3
Q
Squamocolumnar junction histologically shows
A
- Mature, glycogenized squamous epithelium
- Immature squamous metaplastic cells
- Columnar endocervical glandular epithelium
4
Q
Endocervical polyps (benign)
A
- Inflammatory tumors
- Vaginal “spotting” or bleeding
- Located endocervical canal
- Ectocervical locations
- Endocervical polyps
- Small and large (up to 5-cm)
5
Q
Endocervical polyps (benign) morphology
A
- Loose fibromyxomatous stroma
- Mucus-secreting endocervical glands
- Squamous metaplasia
6
Q
Nabothian cysts (also called mucinous retention cysts or epithelial cysts)
A
- Translucent or opaque, whitish to yellow, measure up to 3 to 4 cm in diameter
- Squamous metaplasia and inflammation may block a gland orifice
- Endocervical columnar cells continue to secrete but are covered by squamous epithelium, forming a mucinous retention cyst
7
Q
Papanicolauo Cytological Test (PAP test or smear)
A
- Detection of cervical precancerous conditions
8
Q
Pathogenesis of sexually transmitted agent causing cervical cancer
A
- Human Papilloma Virus (HPV)
- Oncogenic DNA virus
9
Q
HPV / Cervical CA mechanism of transformation
A
- E6 and E7 viral product expression
- E6 Protein (Anti-apoptotic) degrades p53 and BAX
- E7 Protein (Pro-mitotic) inactivates the CDKIs p21
Degrades RB-E2F
10
Q
HPV with low oncologic potential (and locations)
A
- HPV 6, 11
- Perineal
- Perianal
- Vulvar
- (Condyloma Acuminatum)
11
Q
HPV with high oncologic potential
A
- Vulvar / vaginal lesions (VIN and SCCA)
12
Q
High risk HPV types
A
- Cervical Dysplasia and CA
- HPV 16 (most carcinogenic)
- Sufficient Evidence
(18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59)
13
Q
HPV low risk types
A
- Condyloma Acuminatum
- HPV 6, 11
- (42, 44…)
14
Q
What makes high risk type of HPV
A
- Viral genome incorportaion
15
Q
What makes low risk type of HPV
A
- Viral genome episome in cytoplasm
16
Q
Other factors encouraging low risk types of HPV
A
- E7 poor binding affinity to RB
- E6 fail to bind to p53
17
Q
Microbial carcinogenesis viral infectivity (cervical cells)
A
- Basal cells
- Immature squamous cells
- Immature metaplastic cells
- Cells at squamocolumnar junction
18
Q
Koilocytic Atypia
A
- Seen in maturing squamous cells
- Viral replication continues in mature populations
19
Q
Cervical neoplasia development
A
Normal –> metaplastic –> dysplasia –> CA
20
Q
Risk factors associated with cervical neoplasia
A
- Early age at 1st intercourse
- Multiple sex partners / males with multiple partners
- High parity
- Persistent detection of a high risk HPV
- OCP
- Genital infections
- Immunosupression
- Nicotine use
21
Q
Progression of cervical neoplasia to cancer
A
- 90% of HPV infections cleared within 2 years
- 50% of HPV infections are cleared within 8 months
- Duration of infection depends on HPV type
- Persistent infection correlates with development of precancerous lesions
22
Q
Precancerous/cancerous classification
A
- Mild dysplasia
- Moderate dysplasia
- Severe dysplasia
- Carcinoma in situ
23
Q
Mild dysplasia
A
- Cervical intraepithelial neoplasia (CIN) I
- Low grade squamous intraepithelial lesion (LGSIL)
24
Q
Moderate dysplasia
A
- Cervical intraepithelial neoplasia (CIN) II
- High grade squamous intraepithelial lesion (HGSIL)
25
Severe dysplasia
- Cervical intraepithelial neoplasia (CIN) III
| - High grade squamous intraepithelial lesion (HGSIL)
26
Carcinoma in situ
- Cervical intraepithelial neoplasia (CIN) III
| - High grade squamous intraepithelial lesion (HGSIL)
27
Normal cervical epithelium
- Stratified squamous epithelium
28
CIN Grade I (LGSIL)
- Nuclear enlargement
- Viral cytopathic effect
- Koilocytotic atypia
29
CIN Grade II (HGSIL)
- Increased atypia
- Increased N/C ratio
- Variation in nuclear size
- Loss of polarity
- Increased and abnormal mitotic figures
- Hyperchromasia
30
CIN Grade III (HGSIL)
- “Flip Affect”
| - Invasion
31
Cervical neoplasia immunohistochemical sitaining / Dx
- In situ hybridization
| - Immunoperoxidase Stains
32
Atypical Squamous Cells of Undetermined Significance (ASCUS)
- Slightly abnormal squamous cells
| - Changes don't clearly suggest that precancerous cells are present
33
Options when Atypical Squamous Cells of Undetermined Significance (ASCUS) are present
- Test for human papillomavirus (HPV) infection
| - Repeat the Pap test in one year
34
Atypical Squamous Cells of Undetermined Significance (ASCUS) histological findings
- Cervical cells with abundant cytoplasm showing a “pulled-out” or streaming effect
- Nuclei exhibit pleomorphism and some cells have multiple nuclei and prominent nucleoli
- Changes indicate a reparative reaction, nuclear pleomorphism supports ASC-US
- In favor of a reactive process is the generally fine granularity of the chromatin pattern
35
Atypical glandular cells
- Women will have more serious lesions
- High-grade preinvasive squamous disease
- Adenocarcinoma in situ
- Adenocarcinoma or invasive cancers from sites other than the cervix
- Colposcopic examination is recommended
36
Atypical glandular cells findings
- Abnormal cells that come from glands in the walls of the cervix (the lower, narrow end of the uterus)
37
Cervical neoplasia clinical course
- Screening at age 21 or 3 yrs after intercourse
- Abnormal PAP
- Colposcopy shows acetic acid (Aceto-white)
38
Cervical neoplasia staging
- Stage 0
- Stage I
- Stage II
- Stage III
- Stage IV
39
Stage 0 cervical neoplasia
- Carcinoma in situ (CIN III)
40
Stage I cervical neoplasia
- Carcinoma confined to the cervix
41
Stage II cervical neoplasia
- Carcinoma extends beyond the cervix
42
Stage III cervical neoplasia
- Carcinoma has extended onto pelvic wall
43
Stage IV cervical neoplasia
- Carcinoma has extended beyond the true pelvis
44
Metastatic complications with cervical neoplasia
- Contiguous Structures
| - Local and distant lymph nodes (liver, lungs, bone marrow)
45
Cervical neoplasia sampling and biopsy techniques
- Cytology (PAP Smear)
| - Colposcopy (punch BX)
46
Treatment (CIN II and III no invasion)
- Cone Bx
- Cold knife excision
- LEEP (Loop Electrosurgical Excisional Procedure)
47
Invasive CA treatment
- TAH
| - Radiation / chemotherapy (advanced)
48
SCCA of cervix characteristics
- Fungating (or exophytic)
- Ulcerating
- Infiltrative
49
SCCA of cervix histological findings
- Well-differentiated
- Moderately differentiated
- Poorly differentiated
50
Adenocarcinoma of cervix
- Intraepithelial glandular neoplasm
| - Adenocarcinoma in situ
51
Adenosquamous CA of cervix
- Mixed glandular and squamous patterns
| - Basal layer origin of endocervix
