Cervix path I Flashcards
what can cause abnormal bleeding that originates from cervix
DUB endometritis benign growths (polyps, adenomyoma) hyperplasia neoplasias
what are the premalignant neoplasms of the cervix
cervical intraepithelial neoplasms
adenocarcinoma in situ
what are the cancers of the cervix
invasive SCC
adenocarcinoma
when is there eversion of the cervical os and what is this
puberty and pregnancy
when the endocervical epithelium is on external os (exposed to vagina)
what will the squamocolumnar junction look like in a post adolescent
squamous metaplasia of the endocervix epithelium creates transition zone
when is there inversion of the cervical os and what is it
inversion= transformation zone moves into the endocervical canal and not seen on exam
post menopausal
what happens if you add acetic acid to biopsy from cervix and it turns white
HPV infected
darker cells on H&E stain means what
more turnover, mitoses, mitochondria etc
what is role of lactobacilli in cervix and uterus
produce vaginal pH <4.5
what can cause loss of acidocis in cervix
bleeding, intercourse, douching, antibiotics
loss of acidosis in cervix can lead to what
loss of normal flora and overgrowth of other bacteria- cervicitis
what specific infections can cause cervicitis
gonorrhea
chlamydia
mycoplasma
HSV
what can cervicitis cause
abnormal pap because of squamous mucosa changes which result in atypia
what is problem with atypia from cervicitis
hard to differentiate atypical squamous cells of uncertain significance from reactive atypical cells that could be dysplasia
what will chlamydia cause in men
white discharge with or without pain, swollen painful testicle, epididymis, prostatitis, reactive arthritis, reiters syndrome
what will chlamydia cause in women
usually asymptomatic, PID or ectopic pregnancy
what can happen to pregnant mother with chlamydia infection
spontaneous abortions, premature birth
what can chlamydia cause in neonate birthed from mom who was infected
conjuntivitis, pneumonia, blindess
presents 1 wk post delivery
what will cervix looks like if had chlamydia for a while
reddened transformation zone
micro of swap from cervix shows inflammatory debris, multinucleated cells with intra-nuclear “Ground glass” viral inclusions
herpes
thayer martin
gonorrhea
what is a sessile polyp
broad based polyp
what is a pedunculated polyp
polyp on a stalk
what Sx can an endocervical polyp cause
spotting of blood
what is a nabothian cyst
endocervical gland filling with mucus
what are host factors for HPV infetion
young at first age intercourse multiple sexual partners male partner with multiple partners immunosuppression use of BCPs smoking
HPV can only infect what cells
immature squamous cells
only can replicate in maturing squamous cells
what tumorogenic proteins does HPV code for
viral E6 and viral E7
What does E6 do
binds tumor suppressor p53 protein and inactivates it
what does E7 do
binds Rb protein preventing it from binding up E2F. free E2F binds promoters like c-myc stimulating cells to enter the cell cycle
how can HPV lead to cancer
inserts into DNA
E6 E7 oncoproteins
HPV squamous cancer is also seen where in the body
waldeyers ring of oropharynx, anus, penis, vulva and vagina
what is synonymous to low grade squamous intraepithelial lesion LSIL
CIN I, mild dysplasia
what Cervical Intraepithelial neoplasms are considered high grade squamous intraepithelial lesion HSIL
CIN II III and CINIII/CIS
course of action for CIN II or III
biopsy
cone
1/3 squamous epithelium has enlarged nuclei, what stage is this
CIN I
ki-67 is a marker for what
cell proliferation
p16 is what and how does HPV escape it
cell cycle regulator (cyclin kinase inhibitor)
despite high levels, HPV infected cells proliferate because target of p16 (RB) is inactivated by E7
90% cervical dysplasia will do what over 2 years
regress
abnormal pap requires what follow up
colposcopy and cervical biopsy
what are methods to remove dysplastic tissue
cryotherapy
electrocautery
topical 5-fluoruracil
conization
what age is recommended to ahve pap
21 or sooner if sexually active
at what age are pap smears usually discontinued
65
what is a cold cone biopsy
large area is excised for examination
why is cone biopsy the best way to definitively check for cancer
glandular cells become neoplastic
if there is invasion of the endocervix of cancer what is best step
hysterectomy
80% cervical cancer is what type
SCC
second most common cervical cancer type
adeno
peak incidence of invasive cervical CA
45 y.o
