Cervical Pathology Flashcards
6 Common Infections (hallmarks of ea)
1- Chlamydia trachomatis - follicular cervicitis; red on exam
2- Candida - white cottage-cheese like d/c, fungal pseudohyphae and budding yeast
3- Trichomonas vaginalis - frothy, green/yellow d/c; strawberry cervix; pear shaped protozoa w/ flagella
4- Gardnerella - bacterial vaginosis, white/gray vaginal d/c w/ fishy odor; clue cells
5- HSV - clears vesicles; 3 M’s - multinucleated, molding, margination of chromatin
6- HPV - condylomas (warts), dysplasia, carcinomas, koilocytic change
Overview of Cervical Cancer Categories
- 70% squamous cell (from ectocervix)
- *CIN –> invasive squamous cell carcinoma
- 25% adenocarcinoma (from endocervix)
- *adenocarcinoma in situ –> invasive adenocarcinoma
- 3-5% adenosquamous carcinoma
10 Risk Factors for Cervical Cancer
- Early age first intercourse
- Mult sex partners
- Male partner w/ multiple past partners
- Cancer-associated HPV
- High viral load of HPV
- Certain HLA and viral subtypes
- Genital infections
- Nicotine exposure
- Altered immune status
- Inc parity
Pap Smear v. Biopsy for Cervix
Pap = cytology (CELLS)
- LSIL - looking for larger nuclei, raisin-like nuclei and halos on specific cells of cytology; DNA has not integrated yet; 60% regress and 30% persist
- Correlates w/ CIN I or II
- HSIL - no halos but even more nuclei/ dec cytoplasm; 30% regress and 60% persist
- Correlates w/ CIN III
Biopsy = architecture
- CIN I - low grade dysplasia, disorganization in lower 1/3 of epithelium and koil changes on surface
- CIN II - moderate dysplasia, disorganization of lower 2/3 of epithelium and koil changes on surface sometimes; mitotic activity
- CIN III - severe dysplasia of full thickness; pleomorphic nuclei w/ hyperchromasia, no polarity and mitoses; inc nucleus:cyto
HPV (low v. high risk)
-Dbl stranded DNA virus; 15/40 genital subtypes are oncogenic
- Low risk (warts not pre-cancerous) - 6, 11
- Condyloma acuminatum (flat, spiked and inverted warts)
- High risk - 16, 18
- Over-express E6 and E7
- E6 binds/degrades p53
- E7 binds/degrades RB so no cell cycle suppression
- Over-express E6 and E7
-Can cause both squamous cell and adenocarcinoma
Clear Cell Adenocarcinoma of Cervix
- associated w/ moms that used DES during pregnancy to prevent abortion/miscarriage
