Cervical pathology Flashcards
Which cells of the ectocervix are scraped off in a smear sample?
exfoliating cells
Which cells in the ectocervix proliferate, divide and grow?
basal cells (site above basement membrane)
What is the transformation zone?
the squamo-columnar junction between ectocervical and endocervical epithelia moves position from pre-menarche in response to menarche, pregnancy and menopause.
ectocervix = squamous endocervix = columnar
the region between the initial and new squamo-columnar junctions = TZ
Describe the process of cervical erosion.
Exposure of delicate endocervical epithelium to acid environment of vagina leads to physiological squamous metaplasia.
What are nabothian follicles?
dilated endocervical glands that form polypoid structures.
Why is cervicitis a risk for infertility?
it can be asymptomatic but simultaneously cause silent fallopian tube damage -> infertility
What are some causes of cervicitis?
chlamydia trachomatis and herpes simplex viral infection
Cervical polyps are premalignant.
T/F?
FALSE
not premalignant; localised inflammatory outgrowth
What is cervical intraepithelial neoplasia?
Pre-invasive stage of cervical cancer occurring at TZ.
Dysplasia of squamous cells
What is a koilocyte?
squamous cell that has undergone a number of structural changes due to HPV
Describe the appearance of a koilocyte.
nuclear enlargement
irregular cell membrane
hyperchromasia
perinuclear halo/vacuolisation
What are some risk factors for CIN/cervical cancer?
persistence of high-risk HPV (16 & 18)
vulnerability of SC junction in early reproductive life (age at first intercourse, long term use of OCP, non-use of barrier contraception)
smoking (3x risk)
immunosuppression
What is condyloma acuminatum and what causes it?
Genital warts - thickened “papillomatous” squamous epithelium with cytoplasmic vacuolation (koilocytosis)
due to low risk HPV (6, 11 etc)
Describe the histological features of CIN.
Delay in maturation - basal cells occupy more of epithelium
Nuclear abnormalities - hyperchromasia, increased neocytoplasmic ratio, pleomorphism.
excess mitotic activity - situated above basal layers, abnormal mitotic forms
Describe CIN 1.
Basal 1/3 of epithelium occupied by abnormal cells. Raised no. of mitotic figures in lower 1/3; surface cells quite mature, but nuclei slightly abnormal
Describe CIN II.
Abnormal cells extend to middle 1/3.
Mitoses in middle 1/3; abnormal mitotic figures.
Describe CIN III.
Abnormal cells occupy full thickness of epithelium.
Mitoses often abnormal in upper 1/3
Describe what you might see on a smear test for CIN.
high nucleus: cytoplasm ratio
bigger cytoplasm with raisin-like nucleus
lots of cytoplasm = mild dyskariosis (less cytoplasm = severe)
Pathogenesis of invasive squamous carcinoma of cervix.
develops from pre-exisiting CIN - HPV virus integrated into host DNA.
Most cases should be preventable by screening.
List some symptoms of invasive cervical cancer.
abnormal bleeding - post-coital, post-menopausal, brownish or blood stained vaginal discharge, contact bleeding (friable epithelium)
pelvic pain
haematuria/UTI
ureteric obstruction/renal failure
Where might a carcinoma of the cervix spread locally?
uterine body, vagina, bladder, ureters, rectum
What is the timescale for a HPV infection progressing to high-grade CIN?
6 months-3 years
What is the timescale for high grade CIN progressing to invasive cancer?
5-20 years.
What is cervical glandular intraepithelial neoplasia (CGIN)?
pre-invasive phase of endocervical adenocarcinoma
more difficult to diagnose on smear vs. squamous since it could be growing in a gland
