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Pathology I > Cervical Neoplasia > Flashcards

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
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2
Q

Transformation zone in normal cervix

A
  • Columnar epithelium is replaced by squamous epithelium
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3
Q

Squamocolumnar junction histologically shows

A
  • Mature, glycogenized squamous epithelium
  • Immature squamous metaplastic cells
  • Columnar endocervical glandular epithelium
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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)
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5
Q

Endocervical polyps (benign) morphology

A
  • Loose fibromyxomatous stroma
  • Mucus-secreting endocervical glands
  • Squamous metaplasia
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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
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7
Q

Papanicolauo Cytological Test (PAP test or smear)

A
  • Detection of cervical precancerous conditions
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8
Q

Pathogenesis of sexually transmitted agent causing cervical cancer

A
  • Human Papilloma Virus (HPV)

- Oncogenic DNA virus

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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
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10
Q

HPV with low oncologic potential (and locations)

A
  • HPV 6, 11
  • Perineal
  • Perianal
  • Vulvar
  • (Condyloma Acuminatum)
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11
Q

HPV with high oncologic potential

A
  • Vulvar / vaginal lesions (VIN and SCCA)
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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)
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13
Q

HPV low risk types

A
  • Condyloma Acuminatum
  • HPV 6, 11
  • (42, 44…)
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14
Q

What makes high risk type of HPV

A
  • Viral genome incorportaion
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15
Q

What makes low risk type of HPV

A
  • Viral genome episome in cytoplasm
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16
Q

Other factors encouraging low risk types of HPV

A
  • E7 poor binding affinity to RB

- E6 fail to bind to p53

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17
Q

Microbial carcinogenesis viral infectivity (cervical cells)

A
  • Basal cells
  • Immature squamous cells
  • Immature metaplastic cells
  • Cells at squamocolumnar junction
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18
Q

Koilocytic Atypia

A
  • Seen in maturing squamous cells

- Viral replication continues in mature populations

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19
Q

Cervical neoplasia development

A

Normal –> metaplastic –> dysplasia –> CA

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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
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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
Q

Severe dysplasia

A
  • Cervical intraepithelial neoplasia (CIN) III

- High grade squamous intraepithelial lesion (HGSIL)

26
Q

Carcinoma in situ

A
  • Cervical intraepithelial neoplasia (CIN) III

- High grade squamous intraepithelial lesion (HGSIL)

27
Q

Normal cervical epithelium

A
  • Stratified squamous epithelium
28
Q

CIN Grade I (LGSIL)

A
  • Nuclear enlargement
  • Viral cytopathic effect
  • Koilocytotic atypia
29
Q

CIN Grade II (HGSIL)

A
  • Increased atypia
  • Increased N/C ratio
  • Variation in nuclear size
  • Loss of polarity
  • Increased and abnormal mitotic figures
  • Hyperchromasia
30
Q

CIN Grade III (HGSIL)

A
  • “Flip Affect”

- Invasion

31
Q

Cervical neoplasia immunohistochemical sitaining / Dx

A
  • In situ hybridization

- Immunoperoxidase Stains

32
Q

Atypical Squamous Cells of Undetermined Significance (ASCUS)

A
  • Slightly abnormal squamous cells

- Changes don’t clearly suggest that precancerous cells are present

33
Q

Options when Atypical Squamous Cells of Undetermined Significance (ASCUS) are present

A
  • Test for human papillomavirus (HPV) infection

- Repeat the Pap test in one year

34
Q

Atypical Squamous Cells of Undetermined Significance (ASCUS) histological findings

A
  • 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
Q

Atypical glandular cells

A
  • 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
Q

Atypical glandular cells findings

A
  • Abnormal cells that come from glands in the walls of the cervix (the lower, narrow end of the uterus)
37
Q

Cervical neoplasia clinical course

A
  • Screening at age 21 or 3 yrs after intercourse
  • Abnormal PAP
  • Colposcopy shows acetic acid (Aceto-white)
38
Q

Cervical neoplasia staging

A
  • Stage 0
  • Stage I
  • Stage II
  • Stage III
  • Stage IV
39
Q

Stage 0 cervical neoplasia

A
  • Carcinoma in situ (CIN III)
40
Q

Stage I cervical neoplasia

A
  • Carcinoma confined to the cervix
41
Q

Stage II cervical neoplasia

A
  • Carcinoma extends beyond the cervix
42
Q

Stage III cervical neoplasia

A
  • Carcinoma has extended onto pelvic wall
43
Q

Stage IV cervical neoplasia

A
  • Carcinoma has extended beyond the true pelvis
44
Q

Metastatic complications with cervical neoplasia

A
  • Contiguous Structures

- Local and distant lymph nodes (liver, lungs, bone marrow)

45
Q

Cervical neoplasia sampling and biopsy techniques

A
  • Cytology (PAP Smear)

- Colposcopy (punch BX)

46
Q

Treatment (CIN II and III no invasion)

A
  • Cone Bx
  • Cold knife excision
  • LEEP (Loop Electrosurgical Excisional Procedure)
47
Q

Invasive CA treatment

A
  • TAH

- Radiation / chemotherapy (advanced)

48
Q

SCCA of cervix characteristics

A
  • Fungating (or exophytic)
  • Ulcerating
  • Infiltrative
49
Q

SCCA of cervix histological findings

A
  • Well-differentiated
  • Moderately differentiated
  • Poorly differentiated
50
Q

Adenocarcinoma of cervix

A
  • Intraepithelial glandular neoplasm

- Adenocarcinoma in situ

51
Q

Adenosquamous CA of cervix

A
  • Mixed glandular and squamous patterns

- Basal layer origin of endocervix

Pathology I (9 decks)

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