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Repro > Cervical, Vaginal And Vulval Pathologies > Flashcards

Cervical, Vaginal And Vulval Pathologies Flashcards

1
Q

DD of itch

A

candidiasis (albicans/non-albicans), trichomoniasis, public lice, scabies, vulval intra-epithelial neoplasia, atrophic vulvovaginitis, dermatitis (atopic ..)

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2
Q

What type of cells are captured on normal ectocervix epithelium by cervical smear?

A

Exfoliating cells

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3
Q

The ectocervix becomes endocervix at what point?

A

Transition zone - squamo-columnar junction

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4
Q

What is a physiological change in endocervical tissue that is associated with hormonal changes in puberty?

A

Squamous metaplasia over endocervical glands, pre puberty it is glandular epithelium however after puberty it changes to metaplastic squamous epithelium

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5
Q

List 2 types of inflammatory cervical pathologies

A

Cervicitis and cervical polyp

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6
Q

When can cervical polyps cause bleeding?

A

If ulcerated

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7
Q

How can cervicitis lead to infertility?

A

Is often asymptomatic so there can be simultaneous silent fallopian tube damage

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8
Q

List 4 causes of cervicitis

A

Follicular cervicitis,
Chlamydia trachomatis,
Herpes simplex viral infection,
Non-specific acute/chronic inflammation

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9
Q

What is follicular cervicitis?

A

Sub epithelial reactive lymphoid follicles present in cervix

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10
Q

List 5 risk factors for CIN/cervical cancer

A 
Age of first intercourse, 
Long term use of oral contraceptives, 
Not using barrier contraceptives, 
Smoking increases risk x3,
Immunosuppressed people
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11
Q

Human Papillomavirus infections can cause genital warts. What tissue is infected and what does it do to the tissue?

A

Infects squamous epithelium, causes tissue to form condyloma acuminatum

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12
Q

What are condyloma acuminatum?

A

Genital warts - thickened papillomatous squamous epithelium with koilocytosis

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13
Q

What is koilocytosis?

A

Cytoplasmic vacuolation - clear area around nucleus

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14
Q

What types of HPV cause genital warts?

A

Low risk HPV which are 6 and 11

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15
Q

HPV infection can cause Cervical intraepithelial neoplasia. What types of HPV cause CIN?

A

High risk HPV - types 16 and 18

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16
Q

How does CIN affect cervical tissue?

A

Infected epithelium remains flat but shows koilocytosis

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17
Q

Koilocytosis caused by HPV 16/18 can not be detected in cervical smears. True/false?

A

False - it can be detected

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18
Q

HPV infections can cause cervical cancer, what kind of cancer do they most commonly cause and how?

A

Invasive squamous carcinoma - virus is integrated into host DNA

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19
Q

What is found in biopsy of cervix with invasive squamous carcinoma?

A

Keratin band on surface and keratin bundles beneath

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20
Q

What is the timeline for HPV infection to develop into high grade CIN?

A

6 months to 3 years

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21
Q

What is the timeline for high grade CIN to develop into invasive carcinoma?

A

5 to 20 years

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22
Q

There is an 80% cumulative prevalence in a lifetime however most develop immunity. What increases risk of disease?

A

Persistence

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23
Q

CIN 3 is synonymous to what

A

Carcinoma in situ

24
Q

CIN is dysplasia of squamous cells in transformation zone. What stage is it in terms of cervical cancer?

A

Pre-invasive stage

25
Q

Outline the 3 histological changes seen in CIN

A

Delay in maturation of basal cells so immature basal cells occupy more of epithelium,
Nuclear abnormalities e.g. hyperchromasia, increased nucleocytoplasmic ratio and pleomorphism,
Excess mitotic activity e.g. situation above basal layers and abnormal mitotic forms,

26
Q

Outline CIN I grading

A

Basal 1/3 of epithelium occupied by abnormal cells

E.g. raised numbers of mitotic figures in lower 1/3, surface cells quite mature but nuclei slightly abnormal

27
Q

Outline CIN II grading

A

Abnormal cells extend to middle 1/3

E.g. mitoses in middle 1/3 and abnormal mitotic figures

28
Q

Outline CIN III grading

A

Abnormal cells occupy full thickness of epithelium

E.g. mitoses, often abnormal, in upper 1/3

29
Q

At which CIN stage does it start involving glands?

30
Q

Invasive squamous carcinoma causes 75-95% of malignant cervical tumours. It is the ___ commonest female cancer worldwide?

A

2nd commonest

31
Q

What staging is used for cervical cancer and what is it based off?

A

Figo staging - based off stromal invasion and then subdivided by size

32
Q

List 7 symptoms of invasive carcinoma

A

Abnormal bleeding: post coital, post menopausal, brownish/blood stained vaginal discharge, contact bleeding,
Pelvic pain,
Haematuria/urinary infections,
Ureteric obstruction/renal failure

33
Q

Outline the pattern of local spread of squamous carcinoma?

A

Uterine body -> vagina -> bladder -> ureters -> rectum

34
Q

Outline the pattern of lymphatic spread of squamous carcinoma and when it occurs

A

Occurs early,

pelvic -> para-aortic nodes

35
Q

Outline the pattern of haematogenous spread of squamous carcinoma and when it occurs

A

Occurs late,

Spreads to liver, lungs and bone

36
Q

How are squamous carcinomas graded?

A

Well differentiated,
Moderately differentiated,
Poorly differentiated,
Undifferentiated/anaplastic

37
Q

Where does cervical glandular intraepithelial neoplasia originate from?

A

From endocervical endothelium

38
Q

CGIN is more difficult to diagnose on cervical smear than squamous so screening is less effective. It is also only sometimes associated with CIN. True/false?

39
Q

CGIN is preinvase phase of what type of endocervical cancer?

A

Endocervical adenocarcinoma

40
Q

How are adenocarcinomas graded?

A

Well/moderate/poorly differentiated

41
Q

Endocervical adenocarcinoma accounts for 5-25% of cervical cancer. List 4 risk factors

A

Higher social economic class,
Later onset of sexual activity,
Smoking,
HPV

42
Q

Which HPV type is particularly associated with endocervical adenocarcinoma?

43
Q

Vulval intraepithelial neoplasia is the precursor for what kind of cancer?

A

HPV driven SCC

44
Q

Differentiated vulval intraepithelial neoplasia is precursor of what cancer?

A

HPV independent vulval SCC

45
Q

Which type of vulval neoplasia (VIN or dVIN) has higher risk of invasive malignancy and often has a background of inflammatory dermatoses such as lichen sclerosus?

46
Q

VIN is bimodal in its epidemiology. Explain this

A

Occurs in young women and older women

47
Q

Vulvar invasive squamous carcinoma usually arises in what 3 cases?

A

In elderly women,
Ulcer,
Exophytic mass

48
Q

What is most important prognostic factor for vulvar invasive squamous carcinoma?

A

Spread to inguinal lymph nodes

49
Q

Vulvar invasive squamous carcinoma has 90% 5 year survival rate if ______ negative and <60% 5 year survival if ______ positive.

A

90% if node negative,

<60% if node positive

50
Q

What is surgical treatment for vulvar invasive squamous carcinoma?

A

Radical vulvectomy and inguinal lymphadenectomy

51
Q

What is vulvar Paget’s disease?

A

Rare vulvar lesion - intraepithelial vulvar adenocarcinoma

52
Q

How does vulvar Paget’s disease present?

A

Crusting rash, often sharp demarcation and is pruritic or painful

53
Q

Vulvar Paget’s disease can be primary or secondary. Primary arise from intraepidermal glandular cells or pluripotent cells of folliculoebaceous or eccrine units. Where do secondary tumours arise from?

A

Colorectal or urothelial neoplasms

54
Q

List 3 types of vulval infections

A

Candida,
Vulvar warts (HPV 6 & 11)
Bartholin’s gland abscess

55
Q

List 3 types of skin diseases you can get in vulva, which is most common?

A

Lichen sclerosis most common, less so lichen planus and psoriasis

56
Q

Vaginal squamous carcinoma is less common than cervical and vulval squamous carcinoma and is a disease of the elderly. Primary tumours are most common type. True/false?

A

False - everything true except primary tumours are rare!

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