CH 48 Premalignant & Malignant Disorders of the Uterine Cervix

Question 1

Cervical intraepithelial neoplasia (CIN) general considerations

Answer 1

formerly called dysplasia, means disordered growth and development of the epithelial lining of the cervix. high grade lesions can turn into cancer if left untreated. All patients with CIN 2 and CIN 3 should be treated when diagnosed

Question 2

mild dysplasia/CIN 1

Answer 2

disordered growth of the lower third of the epithelial lining

Question 3

moderate dysplasia/CIN 2``

Answer 3

abnormal maturation of lower two thirds of the lining

Question 4

severe dysplasia/CIN 3

Answer 4

encompasses more than two thirds of the epithelial thickness with carcinoma in situ representing full thickness dysmaturity

Question 5

ASC-US

Answer 5

histology shows atypical squamous cells of undetermined significance

Question 6

ASC-H

Answer 6

histology shows atypical squamous cells in which high grade lesion cannot be excluded.

Question 7

LSIL

Answer 7

low grade squamous intraepithelial lesion denotes cytologic changes consistent koilocytic atypia or CIN1

Question 8

HSIL

Answer 8

high grade squamous intraepithelial lesion denotes the cytologic findings corresponding with CIN 2 and CIN 3

Question 9

CIN patho

Answer 9

most comonly detected in women in their 20s. low risk HPV (6, 11, 42, 43, and 44) associated with condylomata and low grade lesions (CIN 1); high risk HPV types (16, 18, 31, 33,35,45,51,52,56,58,59,68) are associated with invasive cancer and high risk lesions (CIN 1 and CIN 2). Over 90% of infected women will have spontaneous resolution over 2 year period.

Question 10

CIN risk factors

Answer 10

multiple partners, early onset of sexual activity, high risk sexual partner, hx of STIs, smoker, HIV infection, AIDS, long term oral contraception use, multiparity, and other immunisuppression forms

Question 11

Quadrivalent HPV vaccination

Answer 11

Guardasil, covers HPV 16, 18, 6, and 11

Question 12

Bivalent HPV vaccination

Answer 12

Cervarix, covers HPV 16, 18

Question 13

HPV vaccination

Answer 13

prevents CIN 2 or worse, recommend offering to all girls age 11-26, and as young as 9 if indicated (in males too). Prophylactic and not therapeutic. Still give even if woman has hx of HPV infection since usually its not the harmful

Question 14

cervical cytology screening

Answer 14

shouldn’t begin before age 21. test every 3 years (don’t test for HPV) for ages 21-29. Then women age 30 and older should have cytology and HPV cotesting every 5 years or cytology alone every 3 years. Discontinue at age 65 if tests have been negative 10 years prior. Discontinue if total hysterectomy has been done.

Question 15

HPV testing, when to test

Answer 15

21 years or older with ASC-US with reflex HPV testing; LSIL in postmenopausal women; follow up after CIN1 or negative colposcopy in women with ASC-US, ASC-H, LSIL, or atypical glandular cells; adjunct to cytology for primary screening in women older than 30 and still have uterus and are not immunosuppressed

Question 16

visual screening for HPV

Answer 16

used in low resource settings. done with direct visual inspection or by performing cervicoscopy using acetic acid, toluidine blue, or lugol’s iodine

Question 17

CIN symptoms and signs

Answer 17

usually no signs or symptoms, diagnosis based on biopsy findings following abnormal routine cervical cytology smear.

Question 18

CIN pathology

Answer 18

dysplastic cell is characterized by anaplasia, increased nuclear to cytoplasmic ratio (large nucleus), hyperchromatism with changes in the nuclear chromatin, multinucleation, and abnormalities in differentiation.

Question 19

ACIS

Answer 19

adenocarcinoma in situ, defined as the presence of endocervical glands lined by atypical columnar epithelium that cytologically resembles the cells of stromal invasion