Cervical Pathology I Flashcards
transformation zone
of cervix - susceptible to HPV infection, dysplasias, cancer
puberty and pregnancy - eversion** - exposure of endocervical canal
adult - squamous metaplasia** of exposed endocervical canal - creates the transformation zone
post-menopause - inversion** - transformation zone into the endocervical canal again
eversion
puberty and pregnancy
squamous metaplasia
adult - forms transformation zone
inversion
post-menopause
lugals
iodine
-turns healthy tissue brown
cervix exam
colored lights
to examine cervix
acetic acid
to examine cervix
white HPV infection
acetyl white lesion
transition zone
cervix-endocervix
SCJ - squamocolumnar junction
chronic cervicitis
changing microbiome
at puberty with flora
estrogen > formation of glycogen > lactobacilli > lactic acid and peroxide
loss of acidosis - loss of flora and overgrowth of bacteria - cervicitis
all infections
may cause changes in squamous mucosa of cervix which may result in atypia on pap smear
ASCUS
atypical squamous cells of uncertain significance
problem for path and clinician
asymptomatic women, PID, ectopic
chlamydia
newborn chlamydia
conjunctivitis
pneumonia
blindness
NAAT
nucleic acid amplification test
dx of chlamydia
chlamydia over time
more chronic
-may scar fallopian tube
site of ectopic pregnancy**
chronic follicular cervicitis
chlamydia trachomatis infection
herpes on cervix
blisters/ulcers
multinucleated cells with intranuclear ground glass viral inclusions
herpes
gonococcus
neisseria gonorrhoeae
gram negative diplococci
thayer martin
lesion
any abnormal finding
shorthand - something of interest
polyp
any mass causing elevation on epithelial surface
sessile
broad based polyp
pednuculated
polyp with stalk
polyp >5cm
may be called tumor
thayer martin
chocolate agar with antibiotics
grows neisseria gonorrhoeae
tx of endocervical polyp
polypectomy
can extrude from endocervical canal
endocervical gland full of mucus
nabothian cyst
very common - often cause no problems
leading cause of cancer death in third world
cervical neoplasms
high risk HPV
16 - 60% of cervical cancers
18 - 10%
risk for HPV
young first intercourse multiple partners immunosuppression BCPs smoking
HBV
causes hepatocellular carcinoma by inserting into hepatic DNA
HPV life cycle
can only infect immature squamous cells
can only replicate in maturing squamous cells
proteins of HPV
E6
E7
E6
HPV product
binds to p53 and inactivates it
E7
HPV product
binds to Rb protein
- prevents binding to E2F
- free E2F binds promoter genes - like c-myc
episome
cytoplasmic form of HPV
high grade HPV and cancer
inserts into DNA - leading to presence of E6 and E7
other locations of HPV squamous cancer
oropharynx, anus, penis, vulva, vagina
p53
involved in causing G1 arrest for DNA repair
-G1 to S transition
guardian of genome
LOF p53 - DNA unrepaired
hyperP Rb
no inhibition of E2F - cancer
hypoP Rb
inhibition of E2F - no transcription
CIN
cervical intraepithelial neoplasm
CIN I
mild dysplasia
low grade squamous intraepithelial lesion (LSIL)
95% go away
minimal nuclear enlargement above lower third
CIN II
moderate dysplasia
high grade SIL
half way nuclear enlargement
CIN III
severe dysplasia
high grade SIL
full thickness nuclear enlargement
HSIL
need excised
for CIN II and CIN III
koilocytic atypia
hallmark of HPV
low grade and high grade
but if this only - low grade
Ki 67
marker of cell proliferation
should only be on basal layer of cell
if extends higher - expansion of proliferation zone
p16
cell cycle regulator
-cyclin kinase inhibitor
high levels - but cell still proliferates - bc p16 target (Rb) is inactivated by E7
HSIL to cancer
10 years - so takes a long time
Tx of cervical dysplasia
abnormal pap - follow up coloscopy and cervical biopsy
also removal of dysplastic tissue
cervical cancer screening recommendations
age 21 to 65
cone bx
area of tissue around cervix is removed and examined
majority of cervical cancers
SCC - 80%
15% - adenocarcinoma
5% - adenosquamous carcinoma and small cell
peak age of invasive cervical cancer
age 45
bleeding after sex
with cervical cancer
T2
extends beyond cervix
death in cervical cancer
invasion of local structures
-obstruction of ureters - renal failure**
tx of cervical cancer
radical hysterectomy
keratin pearl
SCC of cervix
stage 1
confined to cervix
pap smear
10% false negative rate
average lab - misses one every 2 years
combined with HPV DNA test - 99.5% sensitive
no HPV DNA testing in women <30 - high rate of infection
tx with abnormal pap
follow up colposcopic exam
- removal of tissue if high grade
- watchful expectantly low grade
HPV vaccine
new vaccine covers 6, 11, 16, 18, 31, 33, 45, 52, 58
-called 9v
now vaccinating males
