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Book - Molavi > Chapter 16 - Cervix & Vagina > Flashcards

Chapter 16 - Cervix & Vagina Flashcards

1
Q

Name two types of cervical biopsies.

For what indication are they performed?

A

ECC (smallest) and LEEP/cone (ink!)

Usually done to evaluate for squamous or glandular dysplasia.

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2
Q

Describe the normal histology of the ectocervix. How does it vary with age?

A

Nonkeratinized squamous epithelium continuous with surrounding vaginal wall. While plump and full of glycogen in younger women, in postmenopausal women it may be thin and atrophic.

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3
Q

Describe the normal histology of the transitional zone.

What is the signifiance of squamous metaplasia here?

A

Abrupt transition from squamous to mucous-secreting columnar epithelium.

Squamous metaplasia results from irritation/inflammation, and can only be called above the transition zone and in the presence of normal endocervical component

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4
Q

Describe the normal histology of the endocervical glands.

A

Branching and complex glands that are pale with a dark outline of crescent-shaped nuclei. Squamous metaplasia can occur here and replace the glands.

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5
Q

Describe the appearance of the cervical stroma.

A

It is very fibrotic, and may feature numerous normal cysts and glandular proliferations.

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6
Q

What are the morphologic features of LSIL?

A

Viral cytopathic effect involving primarily the upper cell layers of the epithelium.

Koilocytes, with wrinkled hyperchromatic nuclei and perinuclear halo. Binucleation is common.

Maintenance of basal layer. Mitoses in lower 1/3 only.

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7
Q

What are the morphologic features of HSIL?

A

Dysplastic changes with higher N/C ratio.

Atypia in all cell layers, with boulder nuclei and many mitoses (CIN2 in middle third, CIN3 full-thickness).

HSIL can grow into endocervical glands (report this!)

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8
Q

What benign entity can be mistaken for HSIL? What are its morphologic features?

A

Immature squamous metaplasia, featuring:

Well-defined cell borders & low N/C ratio, pinker than HSIL, birds-egg nuclei, surface mucin.

“Boiling mud” look?

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9
Q

What immunostaining can differentiate HSIL from immature squamous metaplasia?

A

Ki67 (proliferation; positive only in basal layer in metaplasia)

p16 (HPV; negative or at most focal in metaplasia)

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10
Q

Describe the morphologic features of reactive cervical epithelium.

A

Regularly spaced nuclei with prominent nucleoli and smooth contours

Maturing uper layers without atypia

Spongiotic edema

Neutrophils

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11
Q

What are the features of squamous invasion in the cervix?

A

Same as in other sites:

Deep keratinization & desmoplastic stromal response
Large nucleoli
Blurred/sawtooth interface between epithelium and stroma, loss of palisading basal layer

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12
Q

How is squamous microinvasion defined, and what is its significance?

A

Invasion to a depth of less than 3 mm, which has a better prognosis.

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13
Q

What is the differential diagnosis for squamous invasion?

A

Pseudoepitheliomatous hyperplasia

Glandular involvement by HSIL

Placental site nodules

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14
Q

How can invasive squamous carcinoma be distinguished from glandular involvement by HSIL?

A

Look for remnants of columnar epithelium, a smooth rounded contour to the gland, and lack of individual cells in the stroma. All suggest glandular involvement.

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15
Q

What is a placental site nodule?

Describe their morphology.

A

A remote remnant of pregnancy.

Look for aggregates of trophoblastic cells that look bizarrely atypical, found in hyaline nodules.

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16
Q

What is an endocervical polyp?

A

A polyp with fibrotic stroma and normal glands or epithelium. May have cysts, inflammation, or tubal metaplasia.

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17
Q

What is a nabothian cyst?

What are tunnel clusters?

A

Nabothian cyst is a large dilated mucous-filled gland lined with columnar epithelium.

Tunnel clusters are lobular groups of complex branching glands also with columnar epithelium.

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18
Q

What is the significance and morphology of microglandular hyperplasia?

A

It is associated with OCP use.

Looks like a proliferation of small back-to-back glands with cuboidal/columnar cells with mucin vacuoles. It is cribriformed but pink.

19
Q

Describe the morphologic features of endometriosis.

A

Dense blue palisaded columnar glands without mucus (endometrium!), with edematous stroma. Look for red blood cells or hemosiderin.

20
Q

Name 3 glandular lesions in the cervix.

A

Reactive atypia

Adenocarcinoma in situ (AIS)

Invasive adenocarcinoma

21
Q

Describe the morphologic features of cervical adenocarcinoma in situ.

A

Close clusters of dark glands

Tall, pseudostratified & hyperchromatic nuclei with nucleoli.

Papillary or cribriform architecture (beware stromal invasion)

Mucin

Ki67++, P16 diffusely positive

22
Q

Describe the morphologic features of invasive cervical adenocarcinoma.

A

Cell clusters diving into the stroma with desmoplastic response.

Glands that are significantly deeper and back-to-back.

23
Q

How can endocervical adenocarcinoma be distinguished from endometrial adenocarcinoma?

A

Immunohistochemistry; endocervical should be p16+, while the endometrial should be ER+/PR+.

24
Q

Describe the role of HPV in vaginal and vulvar disease.

A

HPV causes squamous lesions which follow the same progression as in the cervix. VIN1-3.

25
Q

What is bowenoid papulosis?

A

A clinical term to refer to VIN3, or vaginal/vulvar carcinoma in situ.

26
Q

Describe the morphologic features of condyloma acuminatum.

A

An exophytic, verrucous lesion with subtle LSIL-changes. Epithelium predominates over stroma, otherwise consider a skin tag.

27
Q

Describe the gross and histologic morphologic features of lichen sclerosus.

A

Gross: Flat, white, shiny patch.

Histo: Pale swath of collagen beneath a thin epidermis.

28
Q

Describe the morphologic features of lichen simplex chronicus.

What should be considered before making this diagnosis?

A

Epidermal thickening and hyperkeratosis over a chronically inflamed dermis.

Diagnosis of exclusion; first rule-out fungal infection and squamous dysplasia!

29
Q

Describe the morphology and clinical significance of Paget’s disease, extramammary type.

A

Large atypical carcinomatous cells percolating through a benign epidermis.

Unlike in the breast, its presence does not reflect an underlying cancer. Melanoma must be considered in a differential, however.

30
Q
A

Squamous metaplasia at the transition zone (arrow)

31
Q
A

Endocervical glands

Arrow: Apical mucin glands and basal nuclei

32
Q
A

LSIL

Arrows: Koilocytes

33
Q
A

HSIL

34
Q
A

Immature squamous metaplasia

35
Q
A

Left: Squamous dysplasia
Arrow: Nested irregular cells
Arrowhead: Prominent nucleoli

Right: Reactive changes
Arrow: Small, dense nucleoli

36
Q
A

Invasive squamous cell carcinoma

Arrow: Huge & pleomorphic cells

Arrowhead: Ragged border & infiltrating cells

37
Q
A

Placental site nodule

Arrow: Decidualized periphery

Arrowhead: Mostly small and oval nuclei with smudgy chromatin

38
Q
A

Microglandular hyperplasia

Arrow: Mucinous cells

Arrowhead: Squamous metaplasia

39
Q
A

Endometriosis

Arrow: Endometrial epithelium

Arrowhead: Bloody endometrial stroma

40
Q
A

Endocervical adenocarcinoma in situ

Arrow: Intestinal-type goblet cells

Arrowhead: Residual normal gland

Circle: Mitoses

41
Q
A

VIN3.

Arrow: Large atypical cells

Arrowhead: Hyperkeratosis and parakeratosis

42
Q
A

Condyloma.

Arrow: Hyperkeratotic squamous epithelium

Arrowhead: Prominent fibrovascular cores

43
Q
A

Lichen sclerosus

Arrow: Dense, pale, homogenous collagen band

44
Q
A

Paget’s disease, extramammary type

Arrowhead: Nonsquamous paget cells

Book - Molavi (29 decks)

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