Cervix and Uterus Path Flashcards
What is the “cervical os?”
The center hole in the cervix that basically connects the cervix to the uterus (it will be wider in a woman who gave birth vaginally).
What kind of epithelium is found in the exocervix/ectocervix? What about the endocervix? What happens in between the exo and endo?
Exo is squamous, Endo is columnar. In between there is “Squamous metaplasia.”
What is the “transformation zone” and what kind of cells are found here and what’s important about this?
The zone where the endocervix becomes the exocervix, and it is composed of squamous metaplasia, this is the area where we look for dysplasias.
What is a “Nabothian Cyst?”
Completely benign, these are caused when the squamous epithelium overgrows and sheds, they cover the columnar pappilae and obstruct the crypts, thus the mucus gets obstructed and collects in the deeper crypts of the columnar cells –> formation of a Nabothian Cyst.
What is the major bacterial endogenous flora in a woman’s vagina and what does it do?
Lactobacilli, it secretes hydrogen peroxide and lowers the vaginal pH, killing off the overgrowth of other bacteria.
Squamous metaplasia occurs naturally and via trauma and infections, how?
Naturally, when a woman reaches menarchy, cervical sq mucosa uptakes glycogen (due to estrogen spikes) which allows for the growth of bacteria, and their waste product acidifies the environment. The vagina responds with a sq metaplasia. Trauma and infections will also cause this metaplasia as a protective mech.
What do we expect to see in an acute cervicitis?
Neutrophils (acute inflammatory cells), erosions, reactive/repairative epithelial changes.
What do we expect to see in chronic cervicitis?
Mononuclear inflammatory cells such as macrophages, lymphocytes, plasma cells. Necrosis and granulation tissues may be involved.
What do we see in a cervix in response to Herpes infection causing cervicitis?
Intranuclear inclusions, epithelial ulcerations, lymphocytic infiltration.
How do “Trichomonas Vaginalis” look? (They cause cervicitis)
Anarobic, flagellated protozoa that is “pear shaped.”
What does “Chlamydia Trachomatis” look like? (They cause cervicitis).
Small gram neg obligate intracellular organisms, associated with lymphoid germinal centers and prominent plasmacytic infiltrate.
What do we see in Candida Albicans? (They cause cervicitis).
They are fungus/yeast, we see pseudohyphae.
What are “Endocervical Polyps?”
Benign, inflammatory polyp found in the endocervical canal that can cause irregular “spotty” bleeding.
How are endocervical polyp tx-ed?
Surgical excision or curettage.
How do endocervical polyps look?
Soft, mucoid, dilated, showing inflammation and sq metaplasia.
What is “Microglandular Hyperplasia?”
Found in the endocervix, associated with Oral contraceptives (OC’s), Looks like a polyp or erosion, can be mistaken for an adenocarcinoma.
What is Koilocytic Atypia?
A nuclear atypia with a perinuclear halo in the sq epithelium of the cervix, as seen in a HPV infection.
Which strains of HPV is associated with condylomata (Genital warts)?
6,11,42, 44, 53, 54, 62. 6 and 11 especially.
Which HPV strains are associated with cancer?
16 and 18 specially, 31 33 35 39 45 58 and 68 as well.
What class of a virus is HPV and what is its target?
It is a DNA virus and its target is Lower Genital tract, especially the cervix in the transformation zone.
What needs to occur with respect to HPV infection to result in CIN?
Persistant infection, HPV is cleared relatively well by our immune system so there needs to be a persistant infection for progression to CIN.
What is it about the HPV that makes the virus such a high risk for cervical cancer, yet other subtypes arent as high risk?
They produce 2 proteins, E6 and E7. E6 destroys p53, whereas E7 destroys retinoblastoma, and both of these are tumor suppressor proteins.
What is the job of p53?
It’s job is to regulate the progression of the cell from G1 to S phase, to check to see if the DNA produced is damaged. If there’s no damage the cell proceeds to S phase, however if there is damage the p53 will stop the cell and signal to repair enzymes in an attempt to fix the damage, and if damage is too intense apoptosis is induced instead.
Assuming the cell is damaged, what steps does p53 take to fix this? What does it do if damage is too severe?
It calls in repair enzymes to try to fix the damage, however if the damage is too severe p53 will call BAX. BAX will destroy bcl 2, whose job is to maintain the stability of the mitochondria. Once bcl 2 is out, cytochrome c leaks out of the cell and induces apoptosis.
What is the job of Rb (Retinoblastoma)?
It holds the molecule “E2F,” and this is needed for the progression of the cell to go from G1 to S. However for this molecule to be released Rb’s need to be phosphorylated, and if Rb’s are destroyed the E2F are floating around freely and not regulated, all cells can take it up.
What is CIN?
Cervical Intraepithelial Neoplasia, characterized by koilocytic change, nuclear atypia, and increased mitotic activity. This is divided into different grades based on how immature and dysplastic the cells are.
What are the 4 different staging of CIN?
CIN grade I is dysplasia in the first 1/3 of cervical epithelium, II is 2/3, III is most of the thickness of the epithelium, and if the entire thickness of the epithelium is involved its called Carcinoma in situ.
What’s the difference between dysplasia from carcinoma? How does that relate to CIN grading?
Dysplasia can reverse, carcinoma cannot. CIN I, II, and rarely even III can reverse because they are dysplasias at that point. CIS (Carcinoma in situ) is irreversible.
What is the general progression of CIN?
1 to 2 to 3 to CIS to invasive carcinoma. However, 1 has a 66% chance to go back to normal, 2 has a 33% chance to turn back into 1, and 3 rarely ever goes back to 2 but it is possible. Once you go to CIS, it wont reverse.
What distinguishes CIS from invasive carcinoma?
CIS is the entire thickness of the epithelium of the cervix, invasive carcinoma will invade the basement membrane in addition.
