Cervical Vulval Pathology Flashcards
Label this histology slide or the cervix
State which part of the cervix it is
and is it normal
a) exfoliating cells
b) superficial cells
c) intermediate cells
d) parabasal cells
e) basal cells
f) basement membrane
Normal ectocervix
What type of epithelium is this?
Where is it found in the cervix?
Is it normal?
Columnar epithelium
Normal endocervix
What is the transformation zone?
Transformation zone is the squamo-columnar junction between ectocervical (squamous) and endocervical (columnar) epithelia
Is the transformation zone found in the same part of an individual’s cervix throughout her life?
No. The position of the transformation zone alters during life as physiological response to:
- menarche
- pregnancy
- menopause
When does the transformation zone move?
Physiological response to:
- menarche
- pregnancy
- menopause
With regards to pathology; what’s important about the transformation zone?
Transformation zone is where 90% of cervical intraepithelial neoplasias are found
It is liable to infection and pre-malignant changes
What is clinically important to remember about the transformation zone?
TZ is where cervix is most liable to infection and pre-malignant changes and :. this is where we want smear test to come from
What can be seen on this histology slide?
The transformation zone!
It’s a squamo-columnar junction- hence the big “drop-off”
- squamous epithelium is a couple of layers thick but columnar is just the one layer thick
What does cervical erosion describe?
physiological metaplasia of cervix!
“Exposure of delicate endocervical epithelium to acid environment of vagina leads to physiological squamous metaplasia.”
Why/when does the vagina become more acidic?
What happens as a result?
Hormonal changes at the time of menarche make the vagina more acidic
The result is cervical erosion:
- protective mechanism where columnar epithelium undergoes physiologial metaplasia to become squamous
- like when a lung columnar epithelium of a smoker undergoes metaplasia to squamous as a protective mechanism except that would be lung cancer and not physiological
What are the types of pathology seen in the cervix?
(very broadly speaking)
Inflammatory and
Neoplastic
What are the two inflammatory conditions you need to know?
Cervicitis
Cervical polyp
For cervicitis discuss:
- symptoms
- acute/chronic inflammation?
- aetiology
- complications
- often asymptomatic
- non-specific acute/chronic inflammation
- follicular cervicitis- sub epithelial reactive lymphoid follicles present in cervix
- chlamydia trachomatis- sexually transmitted
- herpes simplex viral infection
- can lead to infertility due to simultaenous silent fallopian tube damage
for cervical polyp discuss:
- symptoms
- what is it
- premalignant/non-premalignant?
- if ulcerated can cause bleeding
- localised inflammatory outgrowth
- not premalignant
What types of neoplasia can occur in the cervix?
- Cervical Intraepithelial Neoplasia
- Cervical Cancer
- squamous carcinoma
- adenocarcinoma
Which types of HPV are most associated with cervical cancer?
HPV 16 and HPV 18
What percentage of cervical cancer is associated with HPV?
75%
What is CIN and what is the difference between CIN and Cervical Cancer?
CIN stands for Cervical Intraepithelial Neoplasia
Because CIN is intraepithelial it is not cancer. Cancer is malignant by definition and therefore has to invade the basement membrane.
What are some of the risk factors for CIN/Cervical Cancer?
- persistance of high risk HPV
- many sexual partners increases risk
- vulnerability of SC Junction in early reproductive life
- age at first intercourse
- long term use of oral contraceptives
- non-use of barrier contraceptive
- smoking 3x risk
- immunosuppression
What strains of HPV are most associated with genital warts?
6 and 11
Describe the histological changes seen in genital warts
- Condyloma acuminatum:
- thickened “papillomatous” squamous epithelium with cytoplasmic vacuolation (“koiocytosis”)
What does this histology slide show?
Cervical Intraepithelial Neoplasia caused by HPV 16 & 18
Circle the infected cells
- high nuclear to cytoplasmic ratio
- “raisiny-looking” nuclei
What does this histology slide show?
Cervical cancer
Invasive squamous carcinoma: Virus integrated into host DNA
What is the time range between contracting HPV and developing a high grade CIN?
HPV Infection –> High Grade CIN
- 6 months to 3 years
What is the time range between developing a high grade CIN and developing an invasive cancer?
High Grade CIN –> Invasive Cancer
5 to 20 years
Circle the normal squamous cells in this slide and the abnormal ones
Describe the abnormalities
Mild dyskaryosis with Viral Features (HPV)
- Normal (circled in green) squamous cells have lots of cytoplasm
- Abnormal cells (circled in red):
- much darker
- can see folds in nuclear membrane
- higher nuclear:cytoplasmic ratio
- nucleus looks a raisin
What is CIN?
CIN is the pre-invasive stage of cervical cancer
Where does CIN most commonly occur?
Do CINs have a large surface area?
Occurs at the transformational zone
Can involve large area