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Clinical Pathology > Diseases of the female genital system 1 > Flashcards

Diseases of the female genital system 1 Flashcards

1
Q

What is dysplasia?

A
  • Earliest morphological manifestation of multistage process of neoplasia
  • In-situ disease; non-invasive
  • Shows cytological features of malignancy, but no invasion
  • No invasion = no metastasis = curable
  • If left, significant chance of developing invasive malignancy
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2
Q

How might smoking be a relevant risk factor in cervical cancer?

A

Smoking is known to decrease to numbers of antigen presenting cells in cervical epithelium and may effectively cause local Immunosuppression.

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3
Q

What are the features of HPV?

A
  • Double stranded DNA viruses
  • 7.9kb circular genome, 7 ‘early genes’, 2 ‘late’ genes
  • > 100 subtypes, based on DNA sequence
  • Different types affect different tissues
  • Lifecycle linked to epithelial differentiation
  • Genital HPVs grouped into low and high oncogenic risk
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4
Q

What are the high risk sub-types associated with high-grade pre-invasive and invasive disease?

A

16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68

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5
Q

What percentage of cervical cancers contain HPV?

A

99.7%

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6
Q

What percentage of cervical cancers are caused by 16 and 18?

A

70%

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7
Q

What kind of lesions are caused by ‘low risk’ HPV 6, 11 etc…

A
  • Lower genital tract warts (condylomas = benign squamous neoplasms), low grade ‘IN’s
  • Very rarely in malignant lesions
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8
Q

What kind of lesions are produced by ‘high risk’ 16 and 18?

A

High grade ‘IN’s and invasive carcinomas

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9
Q

What is the function of E6 HPV protein?

A
  • Binds to and inactivates p53.

- p53 mediates apoptosis in response to DNA damage

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10
Q

What is the function of E7

A
  • Binds to and inactivates RB1 gene product.
  • RB1 is tumour suppressor gene
    Controls G1/S checkpoint in cell cycle
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11
Q

What are the two pathways to vulval intraepithelial neoplasia?

A
  • Classical/warty/baseloid

- Differentiated VIN

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12
Q

What are the relevant features of the classical/warty/baseloid pathway?

A
  • Graded VIN 1-3
  • Related to HPV infection
  • Younger people
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13
Q

What are the features of the differentiated VIN pathway?

A
  • Not graded
  • Not HPV related
  • Occurs in chronic dermatosesesp. lichen sclerosus
  • Older people
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14
Q

What is the recurrence rate for VIN?

A
  • 35-50%
  • Positive margins predict recurrence
  • Progression to invasive Ca in 4-7% treated women and up to 87% of those untreated.
  • Invasion more likely to occur in postmenopausal and immunocompromised
  • Spontaneous regression may occur particularly in young, postpartum women
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15
Q

What is the most common vulval cancer?

A

squamous cell carcinoma

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16
Q

What are the aetiologies of squamous cell carcinoma?

A
  • VIN - associated with HPV

- Associated with inflammatory dermatoses

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17
Q

What is the pattern of spread from a vulval squamous cell carcinoma?

A
  • Locally to involve vagina and distal urethra
  • To ipsilateral inguinal LNs
  • To contralateral inguinal LNs, deep iliofemoral LNs (25% if inguinal nodes +ve)
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18
Q

What percentage of vulval cancers are melanoma?

A

5%

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19
Q

What is the pattern of spread from malignant melanoma of the vulva?

A
  • Local recurrence in 1/3, spread to urethra frequent
  • Lymph node/haematogenous spread common
  • Depth of invasion correlates with LN involvement
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20
Q

What percentage of vulval cancers are Extramammary Paget’s disease?

A

5%

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21
Q

What is extra-mammary Paget’s disease of the vulva?

A

In-situ adenocarcinoma of squamous mucosa
Tend to recur following excision
Can develop invasive adenocarcinoma

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22
Q

What is the macroscopic appearance of Paget’s disease of the vulva?

A

Pruritic/burning/eczematous patch

23
Q

What name is given to the microscopic appearance of Paget’s disease of the vulva?

A

Buck shot

24
Q

In what percentage of women is Paget’s disease related to regional malignant disease?

A

5%

25
Q

What is the transformation zone of the cervix?

A

The squamocolumnar junction

26
Q

What is the epithelial type of the ectocervix?

A

Stratified squamous

27
Q

What is the epithilial type of the endocervix?

A

Columnar

28
Q

Where does CIN occur?

A

At the transformation zone?

29
Q

Where does the transformation zone lie prior to menarche?

A

Slightly inside the cervical canal, proximal to the external os.

30
Q

What happens to the transformation zone during menarche?

A

The cervix everts and the transformation zone is exposed. It now lies outside of the cervical canal, distal to the external os.

31
Q

What happens to the transformation zone during mesopause?

A

It retracts and lies within the cervical canal again.

32
Q

What is the regression, persistence, progression to CIN III and progression to invasion of CIN I?

A
  • Regression 60%
  • Persistence 30 %
  • Progression to CIN III 10%
  • Progression to invasion 1%
33
Q

What is the regression, persistence, progression to CIN III and progression to invasion of CIN II?

A
  • Regression 40%
  • Persistence 40 %
  • Progression to CIN III 20%
  • Progression to invasion 5%
34
Q

What is the regression, persistence, and progression to invasion of CIN III?

A
  • Regression 33%
  • Persistence ~56%
  • Progression to invasion 20% - 70%
35
Q

What are the positive features of the cervical screening programme?

A
  • Available test has high sensitivity and specificity
  • Test is not harmful
  • Defined pre-invasive stage
  • Long enough to allow intervention
  • Simple, successful treatment
36
Q

Why is there no screening below 25?

A
  • Evidence does not support its use
  • High HPV carriage rate, incl high risk types – 70-80% will be eliminated
  • Reactive changes produce confusing cytology
  • Unnecessary LLETZ procedures can have obstetric consequences
37
Q

What is used in the treatment of CIN?

A

Colposcopy - large loop excision of the transformation zone (LLETZ)

38
Q

What is the most important causative factor in cervical squamous cell carcinoma?

A

The contraction of high risk HPV

39
Q

What are the risk factors for cervical squamous cell carcinoma?

A
  • Multiple sexual partners
  • Male partner with multiple partners
  • Young age at first intercourse
  • High parity
  • Low socioeconomic group
  • Smoking
  • Immunosuppression
40
Q

What is are the clinical features of cervical squamous cell carcinoma?

A

Early

  • Bleeding (non-menstrual)
  • Discharge

Late

  • signs and symptoms due to local spread
  • bladder - urinary symptoms
  • ureters - hydronephrosis
41
Q

What are the clinical features/presentation of cervical adenocarcinoma?

A

Same as SCC

42
Q

Is cervical adenocarcinoma related to high risk adenocarcinoma?

A

Yes

43
Q

What is the precursor to cervical adenocarcinoma?

A

Cervical glandular intraepithelial neoplasia (CGIN)

44
Q

Why does cervical adenocarcinoma have a worse prognosis, stage for stage, than SCC?

A

Possibly due to radioresistance

45
Q

What is the FIGO staging for cervical cancer?

A

I Confined to cervix

II Invades beyond uterus, not to pelvic side wall

III Extends to pelvic wall, lower 1/3 vagina, hydronephrosis

IV Invades bladder or rectum or outside pelvis

46
Q

Where does cervical cancer metastasize to?

A
  • Predictably to pelvic and para-aortic lymph nodes

- Via blood to lungs, bone etc

47
Q

At what cervical cancer stage would you consider radical Rx with surgery or chemoradiotherapy?

A

II

48
Q

At what cervical cancer stage would you consider palliative Rx?

A

III

49
Q

What is dyskaryosis?

A

Abnormal cytologic changes of squamous epithelial cells characterized by hyperchromatic nuclei and/or irregular nuclear chromatin. May progress to neoplastic disease.

50
Q

What happens if the result of a cervical screen shows no dyskaryosis?

A

HPV test performed - if HPV -ve normal recall, if HPV +ve refer to colposcopy.

51
Q

What happens if the result of a cervical screen shows mild dyskaryosis?

A

HPV test performed - if HPV -ve normal recall, if HPV +ve refer to colposcopy.

52
Q

What happens if the result of a cervical screen shows moderate dyskaryosis?

A

Refer for colposcopy + Rx

53
Q

What happens if the result of a cervical screen shows severe dyskaryosis?

A

Refer for colposcopy + Rx

Clinical Pathology (65 decks)

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