Cervical Path And Gyn Cytology

Question 1

What are the inflammatory conditions of the cervix?

Answer 1

Acute and chronic cervicitis
Due to altered of the vaginal pH causes by overgrowth of other bacteria
No clinical significance if mild

Question 2

What are endocervical polyps?

Answer 2

Common, benign exophytic growth arising within endocervical canal
Can vary from small sessile bumps to large masses
Excision or curettage is curative

Question 3

What is the characteristic of an endocervical polyp?

Answer 3

Loose, fibromyxoid stroma covered by mucus secreting endocervical glands

Question 4

What are the HPV types?

Answer 4

Type 6 and 11- Benign tumors (condylomata acuminata)

Type 16 and 18- malignant tumors

Question 5

Where does HPV infection occur?

Answer 5

HPVs infect immature basal cells in the transition zone

Break in the surface of mature cells allows access to immature basal cells

Question 6

What are the two oncoproteins associated with HPV?

Answer 6

E6

E7

Question 7

What is the role of E6?

Answer 7

Binds to p53 and causes its degradation
P53 is an inhibitor of cell growth
Upregulates telomerase expression- no apoptosis

Question 8

What is the role of E7?

Answer 8

Binds to the activated retinoblastoma protein (rb) causing its degradation
Activated rb is anti Proliferative
Binds to p21 and p27 enhancing cell cycle progression

Question 9

What is dysplasia?

Answer 9

Disordered growth and maturation
Begins at the basal layer snd extends upwards
Nuclei are hyperchromatic with irregular nuclear outlines

Question 10

What is carcinoma in situ?

Answer 10

Full thickness dysplasia with no maturation but no invasion

Question 11

What are the types of cervical intraepithelial neoplasia (CIN)?

Answer 11

Low grade squamous intraepithelial lesion

High grade squamous intraepithelial lesion

Question 12

What are the characteristics of the LSIL?

Answer 12

Associated with a productive HPV infection
High level of viral replication
Do not progress directly to invasive carcinoma
60% regress, 30% persist, 10% progress to high grade

Question 13

What are the characteristics of HSIL?

Answer 13

Progressive deregulation of the cell cycle leading to increased cellular proliferation, decreased and arrest maturation
Low rate of viral replication
Treated as high risk for progression to carcinoma

Question 14

What special stains aid in diagnosis ?

Answer 14

P16 immunohistochemical stain shows brown staining of both cytoplasm and nuclei
Characteristic of HSIL and HPV associated squamous cell carcinoma

Question 15

Who are most affected by cervical carcinoma?

Answer 15

Middle aged women , women around 45 years old
Most are squamous cell carcinoma
There is an increase incidence in those who are sexually active early in life
HPV is the biggest risk factor

Question 16

How does the cells and nuclear cytoplasmic ratio change in different lesions?

Answer 16

As the lesions go from low grade to high grade
Cells become smaller
Nuclear cytoplasmic ratio increases

Question 17

How to prevent cervical cancer?

Answer 17

Vaccination protect for up to 10 years
All protect against type 16 and 18
Newest vaccine protects against 9 of the most common types of HPV