Diseases of the female genital system part 1

Question 1

what is Dysplasia?

Answer 1

Earliest morphological manifestation of multistage process of neoplasia. It is in situ with no invasion so curable.

Question 2

Human Papilloma Virus is an ———- stranded DNA virus?

Answer 2

HPV is a double stranded. DNA virus.

Question 3

HPV risk groups

Answer 3

Genital HPV is grouped into low risk and high oncogenic risk. Low risk HPV (6,11) linked to genital warts. High risk linked to invasive cancer. Types 16 and 18 are associated with 70% of cervical cancer.

Question 4

What are the 2 HPV Vaccinations?

Answer 4

• Gardasil

- Cervarix

Question 5

How does high risk HPV cause cancer?

Answer 5

• High risk HPV is integrated into host chromosomes.
• Up-regulates E6 and E7 expression.
• E6 binds to and inactivates P53 gene. (P53 mediates apoptosis in response to DNA damage - so no apoptosis)
• E7 binds to RB1 gene product. (RB1 is the tumour suppressor gene, controls G1/S checkpoint in cell cycle)

Results in accumulation of DNA damage and dysregulation of cell proliferation.

Question 6

What is the classic presentation of Vulval Intraepithelial neoplasia (VIN)?

Answer 6

Warty.

• related to young people.
• HPV infection
• It is graded from 1-3. The higher the grade the more likely it is to become invasive.

Question 7

What are the characteristics of differetiated vulval intraepithelial neoplasia (VIN)?

Answer 7

• not graded
• not HPV related
• in older people.
• occurs in chronic dermatoses esp. lichen sclerosus.
• lichen sclerosus is a chronic inflammatory disease that affects the vulva.
• differentiated VIN can develop into cancer.

Question 8

Squamous cell carcinoma (vulval) oncogenic pathways

Answer 8

• Associated with Vulval intraepithelial neoplasia and HPV.
• Also associated with inflammatory dermatoses e.g. Lichen Sclerosus.
• Spreads locally to vagina and urethra. Then to lymph nodes.

Question 9

Malignant Melanoma (vulval tumour)

Answer 9

• 5% of vulval cancer

- aggressive, spreads via lymph nodes and blood.

Question 10

Paget’s Disease (vulval tumour)

Answer 10

• eczematous
• in situ adenocarcinoma of squamous mucosa.
• can develop into invasive adenocarcinoma!!
• usually no underlying tumour

Question 11

Cervical Pathology - describe the anatomy of the cervix from pre-puberty to menopause.

Answer 11

The external os of the cervix is lined by squamous epithelium. The endocervical cancal is lined by columnar epithelium. They meet at the squamo-columnar junction (transformational zone)

Before puberty this squamo-columnar junction lies within the endocervial.
During menarche and pregnancy the squamo-columnar junction comes to lie on the vaginal aspect of the external os.
After menopause the junction retreats back into the canal.

Question 12

What are the risk factors od Cervical Squamous cell carcinoma?

Answer 12

• HPV
• multiple sexual partners
• young age at first intercourse
• smoking
• immunosupression

Question 13

Cervical adenocarinoma

Answer 13

adenocarcinoma is malignant tumour formed from glandular structures in epithelial tissue.

The precursor of cervical adenocarcinoma is Cervical Glandular Intraepithelial Neoplasia.