cervix Flashcards
what is necessary to cause cervical cancer and dysplasia
HPV
high risk types of HPV in cervical cancer
16 and 18
HPV is transmitted
skin to skin contact
Vast majority of HPV infections are transient
YEP
Asymptomatic Resolve spontaneously 60-70% clear within 1 yr 70-90% clear within 2 yrs Maintain immunity from re-infection with the same HPV type
HPV infection and progression to invasive cancer
there is persistenc infection but at each step, more regress than progress
Takes 10-25 years from initial infection to develop invasive cancer
no screening for cervical caner
< 21 yr
abnormal pap test… do this
colposcopy
Magnification and illumination to aid inspection of the cervix, vagina, and anogenital area
Solutions can be applied to help highlight areas of concern
To help the clinician identify and biopsy areas of greatest concern
colposcopy “diagnostic test”
treatment of CIN 2/3
loop electrosurgical excision procedure (LEEP) and ablation but with the ablation there might some miss of the tissue
- Bleeding or brown discharge, often post-coital
- Also post-menopausal or intermenstrual bleeding
- Back pain, weight loss are late manifestations
- History of inadequate screening
- Diagnosis established by biopsy
invasive cervical cancer
once invasive cervical cancer spreads it does not regress
yep, it spreads by direct extension/growth
invasive cervical cancer spread looks like
it is usually exophytic, a cauliflower-like population
invasive cervical cancer treatment
- early stage:
a. radical hysterectomy
b. chemo - advanced- chemo
invasive cervical cancer prognosis
is caught early there is a high survival rate but if it is late then there is low
HPV prevention
vaccination that contains no E6 or E7 oncogene and it is also protective to HPV 6 and 11
Carcinoma of the cervix usually begins at the junction of the
(A) ectocervix and endocervix
(B) endocervix and endometrium
(C) deep and superficial endocervical glands
(D) vagina and cervix
A) ectocervix and endocervix
The zone between the original SCJ and new SCJ =
TRANSFORMATION ZONE
is a remnant of columnar epithelium forming a cyst under the new squamous epithelium- insignificant
Nabothian cyst
transformation zone
are where cervical dysplasia occurs and where sampling should include squamous and columnar epithelium to ensure that the transformation zone is represented
CIN 1
low grade squamous intraepithelial lesion -
mild dysplasia
CIN 2
low grade squamous intraepithelial lesion -
moderate dysplasia
CIN 3
high grade squamous intraepithelial lesion -
severe dysplasia and carcinoma in situ
1. Statement of adequacy: Satisfactory or unsatisfactory cellularity of the specimen endocervical cells General Statement:
- Malignant cells are or are not identified
- Descriptive statement
the bethesda system
HPV cytopathic effect
- Nuclear enlargement
- Nuclear hyperchromatism
- Nuclear membrane wrinkling
- Multinucleation
- Peri-nuclear cytoplasmic vacuolation (“halo”)
HPV E4 disrupts
keratin matrix
What is the difference between carcinoma in situ (HSIL) and invasive carcinoma?
Carcinoma in situ is confined to the epithelium, while invasive carcinoma infiltrates the underlying stroma.
Only 1-5% of LSIL progress to invasive cancer.
6-72% of HSIL progress to invasive cancer.
yep
invasion of the squamous cell carcinom
microinvasive no more 3mm in depth and 7mm horizontal
lymph nodes involvement of microinvasive carcinoma
3-5 mm have 13.2% risk of LN+
___________ accounts for 5-15% of cervical carcinoma
Adenocarcinoma
vulvula neoplasia: condyloma acuminatum
HPV 6 and 11
koilocytes seen in
HPV
There are two main groups of risk factors for invasive squamous cell carcinoma of vulva:
a. HPV is associated with 30% of vulvar carcinomas (the mean age is 55 years).
b. In an older group (mean 77 years), there is no HPV association. These women may, however, have immunosuppression, and other vulvar dermatoses.
Neoplasia of the vagina is rare
yep
Associated with DES (diethylstilboestrol) exposure of the patient’s mother during pregnancy
Tumors in young (avg. 19 year old) patients
Similar tumors occur in elderly patients, unassociated with DES.
clear cell adenocarcinoma- vaginal neoplasia
Occurs in children, typically <5 years old
- Small round blue cell tumor with rhabdomyoblasts
Embryonal rhabdomyosarcoma: sarcoma botryoides
