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2nd Repro > Cervix/vagina/vulva pathology > Flashcards

Cervix/vagina/vulva pathology Flashcards

1
Q

The external surface of the cervix that is open to the vagina is called the

A

ectocervix.

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2
Q

The muscularis layer of_____ contains abundant fibrous tissue and less smooth muscle than the myometrium of the uterus.

A

cervix

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3
Q

The area between the simple columnar and stratified squamous epithelium of the cervix is knows as the

A

squamocolumnar junction

or transition zone

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4
Q

The squamocolumnar junction is more external during the reproductive years and the exposed columnar epithelium undergoes metaplasia converting it to _______. This area is called the transformation zone.

A

stratified squamous epithelium

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5
Q

The mucosa of the cervical canal is covered by ______ that is highly folded and appears like glands on cross section. This mucosa secretes cervical mucus.

A

simple columnar epithelium

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6
Q

o Mostly caused by sexually transmitted infections

A

Cervicitis

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7
Q

Neoplasia

– Most epithelial lesions of cervix are caused by oncogenic strains of :

• Squamous lesions • Glandular lesions

A

Human Papilloma Virus (HPV)

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8
Q

What is normally present in a pap smear?

A

squamos cells, glandular cells and small amount of inflammatory cell

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9
Q

see this multinucleated cells with nuclear inclusions

A

Herpes

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10
Q

Common finding: Benign mass, protruding through cervix

Glandular or metaplastic with squamous lining

Dilated glands with mucus

May bleed (ulceration or inflammation)

**No malignant potential **

A

Endocervical polyps

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11
Q

Risk factors for cervical neoplasia

A

– Early age at first intercourse

– Multiple sexual partners

– Male partner with multiple previous sexual partners

– Persistent infection by high-risk strains of papillomavirus

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12
Q

 Precancerous lesions of cervix, is preceded by HPV infection. Most people clear the HPV, but some persist, causing neoplasia of the cervix

A

Cervical intraepithelial neoplasia (CIN)

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13
Q

 Progression to carcinoma is dependent on degree of dysplasia

 Dysplasia is characterized by nuclear atypia, increased N:C ratio, and abundant mitoses

 Subdivided into CIN 1 (low grade), CIN 2 and CIN 3 (high grade)

depending on degree of dysplastic cells:

 CIN 1:

 CIN 2:

 CIN 3:

A

 CIN 1: basal 1/3rd of epithelium with dysplastic cells

 CIN 2: 2/3rd of epithelium with dysplasia

 CIN 3: Full thickness dysplasia

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14
Q

Natrual hx of Squamos intraepitheilial lesions or SILs:

Lows SILS

High SIL

A

Low will regress 60% of the time, 30% persist, 10% to HSIL

High will regress 30% adn persisit 60% and 10% carcinoma

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15
Q

Distinctive feature of cervical cancer on histology

A
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16
Q

Low grade SIL vs high grade

A

look at picture

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17
Q

is the next test following a positive pap smear to evaluate for CIN

A

Colposcopy

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18
Q

understand grading of CIN

A

Staging increase involvemtent

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19
Q

How does CIN, SIL and dysplasia compare?

A
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20
Q

Whats going on in this pap smear?

A

HSIL (CIN II)

see higher dysplasia, higher N:C ration and more nucleus present withjust a rim of cytoplasm

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21
Q

Characteristic of LSIL pap smear

A

see bi-nucleate

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22
Q

What markers may be seen in high risk HPV that we can stain with

A

Ki-67 or p16INK4

23
Q

Cervical Adenocarinoma in-situ AIS stains with:

A

glands have p16+

24
Q

Can have a mix of high grade and low grade and that is the only staging done for this type of cancer

A

Cervical Adenocarcinoma In-situ

HSIL is when you have p+16 devo on the outside!

25
Q

Squamous cell carcinoma 75%

Adenocarcinoma and mixed 20%

Small cell carcinoma 5%

All caused by HPV

A

Invasive Carcinoma of the Cervix

26
Q

Invasive carcinoma of cervix develops in ____

– Microscopic to deeply invasive

A

transformation zone

27
Q

What cervical cancer would get ot colon and bladder?

28
Q

REcommendation for cervical cancer screen

A

• Cytology (“Pap Smear”) +/- High Risk HPV testing – Begin age 21
– Co-testing after age 30
– Guidelines change frequently

• Colposcopy for screen-positive women

29
Q

Guardasil works for:

A

6,11,16,18 : Prevention of ≥CIN2 in HPV- naïve women

30
Q

Pap smear screening increases early detection of cervical squamous dysplasia which can then be treated before ______

Pap smears may not detect glandular abnormalities (cervical crypts)

A

it progress to carcinoma

31
Q

The quadrivalent HPV vaccine is a mixture of four HPV type-specific VLPs prepared from the L1 proteins of HPV 6, 11, 16, and 18 combined with an aluminum adjuvant.

32
Q

 Comprises 20% of all cervical cancers
 Carcinoma arising in the endocervical glands.
 More difficult to sample for by pap smear due to the crypts/folds in the

cervical canal

A

Adenocarcinoma of the cervix

33
Q

Vulvitis

– Bacterial, fungal, viral infections

– HSV, HPV, gonococcus, Syphilis

Contact dermatitis

Molluscum contagiosum

A

Inflammatory disorders

34
Q

Premenarchal or postmenopausal Painful, pruritic (itchy) vag lips,

Thin epidermis (shinny)

A

Lichen Sclerosus : benign

35
Q

pathogenesis of lichen sclerosus

A

Fibrotic dermis, loss of appendages, chronic inflammatory cell infiltrate

Sclerotic hypocellular dermis

36
Q

• Secondary to chronic irritation: Underlying inflammatory

dermatosis and can appear as leukoplakia see: Epithelial thickening

A

Lichen Simplex Chronicus

37
Q

Hyperkeratosis, Dermal chronic inflammation

No known predilection for malignancy

38
Q

o Precancerous lesion of the vulva
o Associated with high risk types of HPV.

 Subdivided into VIN 1 (low grade), VIN 2 and VIN 3 (high grade) depending on degree of dysplastic cells – same as cervix

A

Vulvar intraepithelial neoplasia (VIN)

39
Q

You see leukoplakia on pt vagian, whats your next step?

A

Biopsy required to rule out: Inflammatory dermatosis, lichen sclerosis, vulvar dysplasia and carcinoma

40
Q

Low grade squamous intraepithelial lesion and condylomas (VIN-1)

High grade squamous intraepithelial lesion (VIN 2-3)

Invasive Squamous cell carcinoma

Adenocarcinoma
– (skin appendages and Bartholin glands)

Paget’s disease (extramammary).

Basal cell carcinoma

Malignant Melanoma

A

all examples of precancerous or malignant lesions

41
Q

Papillary, raised or flat on anogenital surfaces, single or multiple, small or very large

Koilocytosis (perinuclear cytoplasmic vacuolization and wrinkled nuclear

contours)

A

Condyloma Accuminata: VIN-1 (warty lesion)

42
Q

HPV associated with condyloma accuminata

A

HPV associated, subtypes: 6 and 11

43
Q

Vulvar Intraepithelial Neoplasia, High grade (VIN-2 &VIN-3) and

HPV associated, subtypes 18 &16 are all:

A

Precursor lesions in vulva

44
Q

What do we see in full thickness vulvar dysplasia

A

Full thickness dysplasia

– Nuclear atypia

– High Nuclear/Cytoplasmic raio

– Abundant mitosis

45
Q

o 90% of vulvar malignancies are invasive squamous cell cancer
o Occurs in the menopausal age group
o 2 distinct subtypes: that which is preceded by vulvar dysplasia (VIN) and that preceded by reactive changes (ie lichen sclerosus)

A

Invasive squamous cell carcinoma

46
Q

Invasive squamous cell carcinoma : 90% of vulvar malignancies are

A

invasive squamous cell cancer

47
Q

o Seen as red scaly plaques on the labia

o Characterized by large pale glandular cells in the epidermis

A

Paget’s disease (extramammary)

48
Q

Carcinoma of vulva:

Preceded by VIN; multifocal, poorly differentiated

Higher incidence in smokers, immunodeficiency

A

High risk HPV associated

49
Q

Carcinoma of vulva
• Preceded by reactive changes, mainly Lichen sclerosis • Well differentiated, keratinizin

A

seen in older people, not HPV releated

50
Q

Stain to differntiate Pagets of vulva

A

Positive with mucin stain or low molecular cytokeratin (CK7)

51
Q

o Related to maternal DES exposure while in-utero

o Vaginal Adenosis is seen with DES exposure and can lead to clear cell carcinoma

A

 Clear cell carcinoma of vagina

52
Q

o Seen in infants and young children
o Seen as soft polypoid masses in the vagina
o Can also be seen in the urinary Bladder and bile ducts o Characterized by primitive cells.

A

Sarcoma botryoides (embryonal rhabdomyosarcoma)

53
Q

Differnce btwn low grade and high grade Vaginal Intraepithelial Neoplasia

A

– Low grade squamous Intraepithelial Lesion

• VAIN-1:Mild dysplasia

– High Grade Squamous Intraepithelial Lesion

  • VAIN-2: Moderate dysplasia
  • VAIN-2: Severe dysplasia

2nd Repro (16 decks)

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