Cervix, Vulva & Vagina Pathology Flashcards
Describe the histology of a normal ectocervix
Basement membrane underpinned in stroma, basal cells on top then paranasal cells. Nuclei get smaller and become exfoliating cells
What does the ectocervix look like on a smear?
Squamous velds, small well defined nucleus with large surrounding cytoplasm
Describe the histology of a normal endocervix
Single layer of glandular epithelium, lined by single cell layer of columnar epithelium
What does the endocervix look like on a smear?
Cytoplasm, nuclei and cilia can be seen
Describe the transformation zone
Squamo-columnar junction
What is inflammation of the cervix called?
Cervicitis
What can cause inflammation of the cervix?
Chlamydia
Herpes
Follicular cervicitis
Name the neoplasm that can present in the cervix
Cervical intraepithelial neoplasia
Cervical intraepithelial glandular neoplasia
Squamous carcinoma
Adenocarcinoma
State the risk factors for cervical pathology
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)
Describe low risk HPV
Type 6 and 11
Infection of squamous epithelium causes enlarged nuclei, thickened and papillomatous with cytoplasmic vacuolation
Describe high risk HPV
Type 16 and 18
Cervical intraepithelial neoplasia
Pale cells with odd shaped nuclei
What is special about squamous cells?
They can produce keratin
What is CIN?
Pre-invasive, dysplasia of squamous cells at the transformation zone
What nuclear abnormalities can be seen in CIN?
Hyperchromasia
Increased nucleocytoplasmic ratio
Pleomorphism
What happens to the basal cells in CIN?
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
What is seen in CIN I?
Basal 1/3 of epithelium occupied by abnormal cells, surface cells mature but nuclei slightly abnormal
What is seen in CIN II?
Abnormal cells extend into the middle 1/3 with mitoses and abnormal mitotic figures
Describe CIN III
Abnormal cells occupy full thickness of epithelium with mitoses and abnormal cells
Squamous cell carcinoma in situ
How is a squamous carcinoma staged?
IA - 3-7mm IB - confined to cervix, >5mm II - spread to adjacent organs III - involvement of pelvic floor IV - distant mets
How is a squamous carcinoma graded?
Well
Moderately
Poor
Undifferentiated/anaplastic
What are the symptoms of squamous carcinoma?
Abnormal Bleeding
Pelvic Pain
Haematuria/urinary infections
Ureteric obstruction/renal failure
How is CIN treated?
I - conservative
II and III - cold coagulation or large loop excision
How will squamous carcinoma spread?
Local - uterine body, vagina, bladder, ureter, rectum
Lymphatic - early (para-aortic)
Haematogenous - late (liver, lungs, bone)
How is stage IA squamous carcinoma treated?
Local excision
Simple hysterectomy and pelvic lymphadenectomy
What is the treatment for IB-IIA squamous carcinoma?
Radical hysterectomy and pelvic lymphadenectomy
Oophrectomy
If a patient is unsuitable for surgery what is the alternative?
Radical radiotherapy and cisplatin chemotherapy
If the cancer has spread past the cervix how is it treated?
Radical radiotherapy and cisplatin chemotherapy
Describe the precursor to adenocarcinoma
Cervical glandular intraepithelial neoplasia
Endocervical origin - irregular gland shape lined by atypical cells with dark nuclei and mitotic figures
What does cervical adenocarcinoma look like?
Glands budding to form more, atypical cellular architecture
What are the specific risk factors for adenocarcinoma?
Higher SE class, later onset sexual activity, smoking, HPV 18
Name some vulvar pathologies
Vulval intraepithelial neoplasia Vulvar invasive squamous carcinoma Vulvar Paget's disease Infections - candida, warts Lichen sclerosis Lichen Planes
What are the two types of vulvar intraepithelial neoplasia?
Usual Type
Differentiated
Describe VIN of usual type
HPV driven, graded I,II,III looks viral and similar to cervical lesions
Describe differentiated VIN
High grade, not viral driven and risk of malignancy is high
What disease can often be in the background to differentiated VIN?
Lichen sclerosis
What does VIN usually cause in young women?
Multifocal, recurrent or persistent disease that can cause treatment problems
What does VIN usually cause in older women?
Greater risk of progression to invasive squamous carcinoma
How does vulvar squamous carcinoma present?
Elderly women with ulcer or exophytic mass
Where does vulvar squamous carcinoma spread to?
Inguinal lymph nodes
How is vulvar squamous carcinoma treated?
Radical vulvectomy
Inguinal lymphadenectomy
What does vulvar squamous carcinoma look like on histology?
Irregular invasive nests of tumour with whirls of keratin
How does vulvar paget’s disease present?
Crusting rash often sharply demarcated that causes itching or pain
How is vulvar paget’s treated?
Excision
What cells are present in primary paget’s?
Intraepithelial glandular cells - pluripotent of folliculosebaceous/eccrine unit
Name four vaginal pathologies
Polyps/cysts
VaIN
Squamous carcinoma
Melanoma
