Cervix, Vagina, Vulva Flashcards
Sarcomas arise from which type of tissue?
Mesenchymal
Carcinomas arise from which tissue type?
Epithelial
What cell types differentiates the cervical transformation zone?
The cervical transformation zone is where the stratified squamous cells of the exocervix abruptly becomes the columnar epithelium of the endocervix.
In the transformation zone, two types of epithelia exist: squamous epithelium with glands behind it
What is the clinical relevance of the cervical transformation zone?
It is the site of cervical squamous carcinoma
Is HPV a DNA or RNA virus?
DNA
What are the 4 high risk subtypes of HPV?
16, 18, 31, 33
What are the two common low risk subtypes of HPV?
6, 11
People infected with HPV 6 or 11 are at risk for developing which pathology?
Chondyloma (wart)
People infected with a high risk HPV (16, 18, 31, 33) are at risk for developing which pathology?
CIN —> invasive cancer
cervical intraepithelial neoplasia
List the two HPV oncoproteins and what they bind to (what makes High risk HPV high risk?)
E6 –> p53
E7 –> Rb (holds E2F)
Binding to the tumor suppressor neutralizes their function and they are now pro-tumorigenic
HPV promotes a clonal outgrowth of which type of cell in the cervical transition zone?
Squamous cells (75%) Glands beneath (adenocarcinomas) - (15%)
Which is the characteristic cell of the chondyloma?
Koilocyte
Raisen look with perinuclear halo
Differentiate a squamous intraepithelial lesion vs CIN
SIL is simply a scraping of squamous cells from the top layer
CIN staging requires a biopsy to determine how deep atypical cells are found
If the top layer is terrible looking, we can say it is a high grade SIL because in order for the top cells to be atypical, the entire thickness of the epithelium must be atypical
What is the outlook for a low SIL/CIN I lesion?
60% regression
30% persist
10% progression to high SIL
What is the outlook for a high SIL (CN II /CN III) lesion?
30% regression
60% persist
10% progression to carcinoma, usually within 10 years
What are the recommendations for getting Pap smears?
21-65: every 3 years
Or- every 5 years if done along with HPV testing
20% of cervical cancers have a somatically acquired mutation of which tumor suppressor gene?
LKB1
Other than HPV infections, what are other risk factors for invasive cervical cancer?
smoking, immunodeficiency (AIDS defining illness)
WHat is the treatment for cervical cancer?
Hysterectomy, lymph node dissection
Other than high risk HPV, name two risk factors for cancer of the vulva
Lichen sclerosis
Non-HPV related
WHat is the vulvar presentation of squamous cell carcinoma?
Leukoplakia (white plaque)
What is the vaginal presentation of squamous cell carcinoma?
Vaginal bleeding, discharge
Which age group is affected by lichen scleorsis?
Post-menopausal
Thinning of the epidermis and fibrosis of the dermis describes the histology of which vulvar pathology?
Lichen scleorsis
Lichen simplex chronicus is associated with what epidemiology?
Chronic irritation/scratching
Hyperplasia of the vulvar epithelium is associated with which vulvar pathology?
Lichen simplex chronicus
What is seen on physical exam on someone with lichen simplex chronicus?
Leukoplakia
Thick, leathery skin
What is the increased risk of malignancy associated with lichen simplex chronicus?
None
What is the risk of progression to squamous cell carcinoma of the vulva in lichen sclerosis?
Small risk of progression to cancer- especially in the elderly
What is the hallmark histology of paget’s disease?
Intraepidermal proliferation of malignant cells
Arises from intraepidermal progenitor cells
What are the physical findings associated with paget disease of the vulva
Red, scaly, crusted plaque
How do you differentiate melanoma from Paget disease?
PAS stain, Keratin stain
PAS+ only for paget disease (mucin staining)
Keratin + (only for paget disease)
Which drug is associated with increased rates of clear cell adenocarcinoma?
DES- given to mothers to prevent abortions –> increased risk in their female offspring
DES –> adenosis (persistence of columnar epithelium in the upper 2/3rds of the vagina —> increased risk for clear cell adenocarcinoma)
What is the precursor lesion to adenocarcinoma of the vagina?
vaginal adenosis – persistence of columnar epithelium in the upper 1/3 of the vagina
(Upper 2/3rds derived from mullerian duct, bottom 1/3 derived from urogenital sinus)
Rhabdomyosarcomas are cancer of what precursor cell?
Skeletal muscle
What is another name for embryonal rhabdomyosarcoma of the vagina?
Sarcoma botryoides (grape-like mass)
What age group presents with embryonal rhabdomyosarcoma?
Children, usually less than 5 years old
What is the clinical presentation of an embryonal rhabdomyosarcoma
Bleeding, soft, grape-like masses protruding through the vagina (or penis of males)
Name two IHC stains for identification of embryonal rhabdomyosarcomas
Desmin (muscle cell intermediate filament),
myogenin (TF of immature skeletal muscle)
Both are found in rhabdomyoblasts- tumor cell of origin. They also display cytoplasmic cross-striations
Cancer from lower 1/3 of vagina spreads to which lymph nodes?
Inguinal
Cancer from the upper 2/3rd of the vagina drain to which lymph nodes?
Regional iliac nodes
`Can CIN reverse? Does carcinoma in situ reverse?
CIN- can reverse
Carcinoma in situ- does not reverse
Pap smears are great a detecting what type of cancer?
Squamous cell carcinoma of the cervix
- NOT adenocarcinoma of the cervix
The quadrivalent HPV vaccine covers which 4 serotypes?
6, 11, 16, 18
