Chapter 19: Vulva, Vagina and Cervix Flashcards
What is the most common uterine tumor? a) Leiomyoma b) Leiomyosarcoma c) Endometrial carcinoma d) Endometriosis
a) leimyoma (originates from myometrium)
Just know where to point out vulva, vagina, cervix, uterus, tuba falopii and ovaria.
Okay
What three structures can be found in the uterus?
Endometrium (lining of uterus), myometrium and serosa/peritoneum.
This picture is uterus tissue. Can you point out the glandular structures (epithelium) and stroma? And also point out the myometirum.
Glandular structures * Stroma ** Myometrium ***
What tumors originate from the myometrium?
Mesenchymal tumors -> leimyomas or leiosarcomyomas
What are (morphological) characterisations of Lichen Sclerosis? (and where can the disease exist)
Marked thinning of the epidermis, fibrosis of the superficial dermis and chronic inflammatory cells (T cells)in the deeper dermis. (the disease occurs in the vulva)
What are (morphological) characterisations of Lichen Simplex Chronicus? (and where can the disease exist)
Thickened epidermis and hyperkeratosis. (the disease occurs in the vulva)
What are condylomas and what two types exist?
Warty lesions of the vulva. Condylomata lata (flat, minimally elevated lesions) and condylomata acuminata (papillary and distincly elevated)
What are histological features of condylomas?
Koilocytosis, where perinuclear cytoplasmic vacuolization and a wrinkled nuclear contour occurs.
Just know that the most common type of carcinoma in the vulva is squamous cell carcinoma. Of this type, there are two distinct forms. One is high-risk HPV related and occurs in middleaged women. The other occurs in older women, sometimes following a long history of reactive epithelial changes.
Okay
How do vulvar carcinomas commonly manifest?
As areas of leukoplakia
What is Extramammary Paget Disease?
Paget disease is an intraepidermal proliferation of epithelial cells that can occur in the skin of the vulva or nipple of the breast. In the picture you can see large tumor cells with pale-pink cytoplasm that infiltrate the epidermis. Also chronic inflammatory cells are present in the underlying dermis.
Is squamous cell carcinoma of the vagina common?
No, it is extremely uncommon.
What was found in 1970 (for illustration)?
In 1970, clear cell adenocarcinoma, a very rare tumor, was identified in a cluster of young women whose mothers took diethylstilbestrol during pregnancy to prevent threatened abortion. Follow-up studies determined that the incidence of this tumor in persons exposed to diethylstilbestrol in utero is low.
Fill in: Most tumors of the cervix are of … (1) origin and are caused by oncogenic strains of … (2).
(1) = epithelial (2) = HPV
HPV has a tropism for …
the immature squamous cells of the transformation zone.
What is meant by the transformation zone of the cervic?
Colomnar mucus-secreting epithelium of the endocervix is joined to the squamous epithelial covering of the exocervix at the cervical os. During puberty eversion occurs, where the columnar epithelial cells become exposed. These cells undergo squamous metaplasia, forming a region called the transformation zone (typically place for tumors to arise).
What are precursors from which most invasive cervical carcinomas develop?
Squamous intraepithelial lesions (SILs)
Like most other DNA viruses, HPV uses host cell DNA polymerases to replicate its genome and produce virions. Virions must be shed from the surface of the squamous mucosa, yet under normal circumstances squamous cell maturation is accompanied by a cessation of DNA replication, which would prevent virus production. HPV “solves” this problem through the action of two viral oncoproteins, E6 and E7. What is the function of these proteins?
They inhibit p53 and RB
What is displayed in this picture?
Cervical transformation zone showing the transition from mature glycogenated squamous epithelium, to immature metaplastic squamous cells, to columnar endocervical glandular epithelium
What two factors of viral integration contribute to transformation of non-invasive cervical cancer to invasive cervical cancer?
Integration always disrupt an HPV gene that negatively regulates E6 and 7, which leads to their increased expression. Sometimes HPV integrates near a host cell oncogene, such as MYC, leading to its overexpression as well.
HPV-related carcinogenesis begins with the precancerous epithelial change termed SIL, which usually precedes the development of an overt cancer by many years, sometimes decades. What two types of SIL are there?
SIL is divided into low-grade squamous intraepithelial lesion (LSIL) and a high-grade intraepithelial neoplasia (HSIL).
What are characteristics of LSIL?
LSIL is associated with producitve HPV infection, but no invasion (they usually even regress).
What are characteristics of HSIL?
HSIL demonstrates increased proliferation, arrested epithelial maturation and lower levels of viral replication. HSIL is considered at high risk for progression to carcinoma.
