Cervix to vulva pathology Flashcards
Cervix
protect uterus becasue it is sterile
goes from stratified squamous to columnar epithelium
Endocervical polyps aka benign lesion
benign mass, protruding through cervix, may bleed (ulceration or inflammation), glandular or metaplastic squamous lining, dilated glands with mucous, no malignant potential
Basal cells have paps cells glandular and simp squamous
Cervical pre neoplasia and neoplasia
Causative agent: mainly human papilloma virus (oncogenic strains of HPV 16 and 18)- tropism for immature squamous epithelium of transformation zone (basal zone is availible and prone to infection), most HPV infections are transient, persistent infection may cause Squamous intraepithelial lesion (SIL)
Risk factors directly related to HPV exposure, early age at 1st intercourse, multiple sexual partners, male partner with multiple previous sexual partners, persistent infection by high risk strains of Papillomavirus
younger women has more basal cells
Epidemiology of HPV infection
75-80 of sexually active adults will acquire genital tract infection before 50, 45 of US women ages 20-24 test positive, most cervical cancers are associated with high risk HPV
HPV oncogenic potential
The viral DNA integrates into the host genome, over expression of E6 and E7 oncoproteins- inactivate RB and p53, activate cyclin CDK complexes, and combat cellular senescence
The net effect of HPV E6 and E7 proteins is to immortalize cells and remove the restraints on cell proliferation
Screening for cervical precancerous lesions
Pap smear remains the most successful cancer- screening test
HPV DNA testing: highly sensitive but lower specificity, recommended for women aged 30 or older (to detect persistent disease)
Adenocarcinoma in situ of the cervix
Equivalent in malignant potential to CIN3
Most lesions are caused by HPV - 90% of lesions related to HPV 18 (40%), 16 (40%) and 45 (10%)
Removal or destruction of the lesion prevents progression
More difficult to detet colposcopically
Give HPV Vaccines!
vulva
inflammatory disorders- vulvitis (bacterial, fungal, viral infections, HSV, HPv, gonococcus syphillis, contact dermatitis, molluscum contagiosum)
Non- neoplastic epithelial lesions- lichen sclerosus (increased risk of SCC), lichen simplex chronucus
Neoplastic lesions- squamous dysplasia (condyloma, VIN, (LSIL and HSIL) Carcinoma of the vulva (SCC, AC, BCC, melanoma), paget disease of the vulva, mesenchymal lesion
Lichen SClerosis
premenarchal or postmenopausal, painful, pruritic (itchy), Thin epidermis (shinny), fibrotic dermis, loss of appendages, chronic inflammatory cell infiltrate, 1-5% develop squamous cell carcinoma
vulvar dysplasia
Precursor lesion, vulvar intraepithelial neoplasia, high grade (VIN2 and Vin 3), HPV associated, subtypes 18 and 16, Full thickness dysplasia (nuclear atypia, high nuclear/ C ratio, abundant mitosis), progression to invasive squamous cell carcinoma, Most are HPV related some are not
carcinoma of vulva
3% of female genital tract malignancies, mostly>60yrs, 90% SCC, Adenocarcinoma, basal cell carcinoma, malignant melanoma, 2 distinct forms (high risk HPV associated) preceded by VIN, multifocal, poorly differntiated, higher incidence in smokers and immunodeficient, In older age group- preceded by reactive changes , mainly lichen sclerosis, well differentiated, keratinizing
Extramammary pagets disease
red scaly plaques, intraepidermal proliferation of malignant cells, most commonly de novo from epidermal progenitor cells)
Occasionally associated with subepidermal tumor, or from skin adenexal structures, large pale cells in the epidermis (glandular), positive with mucin stain or low molecular cytokeratin (CK7) differential diagnosis- malignant melanoma, SCC
Vaginal malignant neoplasms
Squamous cell carcinoma- hpv associated
Clear cell carcinoma- DES exposurepp> vaginal adenosis
Sarcoma botryoides- infants and young children <5 yo
