Cervix, Cervix Path Flashcards
HPV is necessary or sufficient to cause cervical cancer and dysplasia?
necessary
HPV subtypes accounting for cancer
16, 18
in addition to cervical cancers, high-risk HPV causes
- oropharyngeal cancer
- anal cancer
- vulvar and vaginal cancer
HPV transmission
skin-skin contact
HPV risk fx
STI risk fx
immunosuppression
smoking
young age
HPV natural history
- vast majority of HPV infections are transient
- asymptomatic
- resolve spontaneously
HPV persistent infection
- by same HPV type after 2 years
- leads to invasive cervical cancer through a stepwise sequence of progressive neoplasia
It takes __ years form initial infection to develop invasive cancer
10-25
cervical cancer screening guidelines
<21 y: none
21-29: pap q3yr
30-65: pap+HPV q 5 yr
>65 y or s/p hyst: no screening (no h/o CIN 2 or >20 in past 20 yr)
colposcopy
-magnification and illumination to aid in cervix/vagina/anogenital area
cervical cancer classification
CIN 1/2/3
CIN 1 recommendation
co-test in 1 year
CIN 2 recommendation
ev 6 mo colpo + pap, or treat
CIN 3 recommendation
treat
tx of CIN 2/3
excisional
- cold-knife cone biopsy
- LEEP
cold-knife cone biopsy
large area of tissue around cervix is excised for examinatino
LEEP
uses electrical current to excise the distal cervix including the transformation zone
Invasive cervical cancer
- bleeding or brown discharge, often post-coital
- back pain, weight loss are late manifestations
- hx of inadequate screening
- dx established by biopsy
Invasive cervical cancer natural hx
- once invasive, no regression
- spreads by direct extension/growth
- exophytic, cauliflower-like
- stage on physical exam
Invasive cervical cancer - early stage disease
tx
radical hysterectomy
chemoradiation therapy
Invasive cervical cancer - advanced stage disease
chemoradiation therapy
5-yr survival of stage Ia cervical cancer
95%
HPV vaccine
L1 capsid HPV viral protein
reduces risk up to 97% for 7 types of high-risk HPV including HPV 16/18 and 6/11 (genital warts)
carcinoma of the cervix usually begins at the junction of the
ectocervix and endocervix
transition zone
between the original squamocolunar junction and the new sqamocolumnar junction
where cervical dysplasia occurs
at puberty, cervix enlarges and ______ extends beyond the external os
endocervix
HPV cytopathic effect
nuclear enlargement, hypERchromatism, membrane wrinkling
multinucleation
peri-nuclear cytoplasmic vacuolation (“halo”) –> KOLIOCYTES
koliocytes
seen in HPV due to E4 disrupting keratin matrix –> peri-nuclear cytoplasmic vacuolation
invasive adenocarcinoma histo
malignant glands invading stroma
pools of mucin from adenocarcinoma
Bethesda system
describes pap findings
LSIL (Low grade squamous intraepithelial lesion)
or
HSIL (High grade squamous intraepithelial lesion
vulval neoplasia
condyloma acuminatum
-due to HPV 6 and 11
vulval carcinoma histo
keratin pearl
invasive nests of squamous cell carcinoma
clear cell adenocarcinoma
-assoc w/ DES (diethylstilbestrol) exposure of the patient’s mother during pregnancy
tumors in young (avg 19)
clear cell adenocarcinoma histo
malignant clear cells with glycogen
embryonal rhabdomyosarcoma
sarcoma botryoides
a vaginal neoplasm
children, <5 years
small round blue cell tumor with rhabdomyoblasts
grape-like tumor
embryonal rhabdomyosarcoma
