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Reproduction & Sexual Health > Cervix, Vulva & Vagina Pathology > Flashcards

Cervix, Vulva & Vagina Pathology Flashcards

1
Q

Describe the histology of a normal ectocervix

A

Basement membrane underpinned in stroma, basal cells on top then paranasal cells. Nuclei get smaller and become exfoliating cells

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2
Q

What does the ectocervix look like on a smear?

A

Squamous velds, small well defined nucleus with large surrounding cytoplasm

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3
Q

Describe the histology of a normal endocervix

A

Single layer of glandular epithelium, lined by single cell layer of columnar epithelium

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4
Q

What does the endocervix look like on a smear?

A

Cytoplasm, nuclei and cilia can be seen

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5
Q

Describe the transformation zone

A

Squamo-columnar junction

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6
Q

What is inflammation of the cervix called?

A

Cervicitis

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7
Q

What can cause inflammation of the cervix?

A

Chlamydia
Herpes
Follicular cervicitis

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8
Q

Name the neoplasm that can present in the cervix

A

Cervical intraepithelial neoplasia
Cervical intraepithelial glandular neoplasia
Squamous carcinoma
Adenocarcinoma

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9
Q

State the risk factors for cervical pathology

A 
High risk HPV 
Many sexual partners 
Vulnerable SC Junction 
- age of first intercourse 
- long term oral contraceptives
- non-use barrier contraception 
Smoking 
Immunosuppression (HIV/Chemotherapy)
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10
Q

Describe low risk HPV

A

Type 6 and 11

Infection of squamous epithelium causes enlarged nuclei, thickened and papillomatous with cytoplasmic vacuolation

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11
Q

Describe high risk HPV

A

Type 16 and 18
Cervical intraepithelial neoplasia
Pale cells with odd shaped nuclei

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12
Q

What is special about squamous cells?

A

They can produce keratin

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13
Q

What is CIN?

A

Pre-invasive, dysplasia of squamous cells at the transformation zone

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14
Q

What nuclear abnormalities can be seen in CIN?

A

Hyperchromasia
Increased nucleocytoplasmic ratio
Pleomorphism

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15
Q

What happens to the basal cells in CIN?

A

Usually the nuclei get smaller (mature) towards the surface but in CIN there is excess mitotic activity above basal layers and abnormal mitotic figures can be seen

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16
Q

What is seen in CIN I?

A

Basal 1/3 of epithelium occupied by abnormal cells, surface cells mature but nuclei slightly abnormal

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17
Q

What is seen in CIN II?

A

Abnormal cells extend into the middle 1/3 with mitoses and abnormal mitotic figures

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18
Q

Describe CIN III

A

Abnormal cells occupy full thickness of epithelium with mitoses and abnormal cells
Squamous cell carcinoma in situ

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19
Q

How is a squamous carcinoma staged?

A 
IA - 3-7mm
IB - confined to cervix, >5mm
II - spread to adjacent organs 
III - involvement of pelvic floor 
IV - distant mets
20
Q

How is a squamous carcinoma graded?

A

Well
Moderately
Poor
Undifferentiated/anaplastic

21
Q

What are the symptoms of squamous carcinoma?

A

Abnormal Bleeding
Pelvic Pain
Haematuria/urinary infections
Ureteric obstruction/renal failure

22
Q

How is CIN treated?

A

I - conservative

II and III - cold coagulation or large loop excision

23
Q

How will squamous carcinoma spread?

A

Local - uterine body, vagina, bladder, ureter, rectum
Lymphatic - early (para-aortic)
Haematogenous - late (liver, lungs, bone)

24
Q

How is stage IA squamous carcinoma treated?

A

Local excision

Simple hysterectomy and pelvic lymphadenectomy

25
Q

What is the treatment for IB-IIA squamous carcinoma?

A

Radical hysterectomy and pelvic lymphadenectomy

Oophrectomy

26
Q

If a patient is unsuitable for surgery what is the alternative?

A

Radical radiotherapy and cisplatin chemotherapy

27
Q

If the cancer has spread past the cervix how is it treated?

A

Radical radiotherapy and cisplatin chemotherapy

28
Q

Describe the precursor to adenocarcinoma

A

Cervical glandular intraepithelial neoplasia

Endocervical origin - irregular gland shape lined by atypical cells with dark nuclei and mitotic figures

29
Q

What does cervical adenocarcinoma look like?

A

Glands budding to form more, atypical cellular architecture

30
Q

What are the specific risk factors for adenocarcinoma?

A

Higher SE class, later onset sexual activity, smoking, HPV 18

31
Q

Name some vulvar pathologies

A 
Vulval intraepithelial neoplasia 
Vulvar invasive squamous carcinoma 
Vulvar Paget's disease 
Infections - candida, warts
Lichen sclerosis 
Lichen Planes
32
Q

What are the two types of vulvar intraepithelial neoplasia?

A

Usual Type

Differentiated

33
Q

Describe VIN of usual type

A

HPV driven, graded I,II,III looks viral and similar to cervical lesions

34
Q

Describe differentiated VIN

A

High grade, not viral driven and risk of malignancy is high

35
Q

What disease can often be in the background to differentiated VIN?

A

Lichen sclerosis

36
Q

What does VIN usually cause in young women?

A

Multifocal, recurrent or persistent disease that can cause treatment problems

37
Q

What does VIN usually cause in older women?

A

Greater risk of progression to invasive squamous carcinoma

38
Q

How does vulvar squamous carcinoma present?

A

Elderly women with ulcer or exophytic mass

39
Q

Where does vulvar squamous carcinoma spread to?

A

Inguinal lymph nodes

40
Q

How is vulvar squamous carcinoma treated?

A

Radical vulvectomy

Inguinal lymphadenectomy

41
Q

What does vulvar squamous carcinoma look like on histology?

A

Irregular invasive nests of tumour with whirls of keratin

42
Q

How does vulvar paget’s disease present?

A

Crusting rash often sharply demarcated that causes itching or pain

43
Q

How is vulvar paget’s treated?

A

Excision

44
Q

What cells are present in primary paget’s?

A

Intraepithelial glandular cells - pluripotent of folliculosebaceous/eccrine unit

45
Q

Name four vaginal pathologies

A

Polyps/cysts
VaIN
Squamous carcinoma
Melanoma

Reproduction & Sexual Health (36 decks)

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