Female Genital Tract 1 Flashcards
What are the layers of a normal ectocervix?
- nonkeratinized stratified squamous epithelium (cell with a lot of glycogen-low ph, lactobacillus produce)
- stroma=dense connective tissue; small amount of smooth muscle
What cells make up the endocervix?
simple columnar epithelium
What happens in the cervical transformation zone from birth to young adult to adult?
- Young adult: the columnar epithelium everts
- acidity of vagina is one factor that encourages squamous metaplastic change
- band of squamous metaplasia lying between the original and new SCJ(squamocolumnar junction=transformation zone
- exocervix with restored squamous columnar junction
What are the three steps of the squamous metaplasia of transformation zone?
- Early stage: reserve cells begin to proliferate
- Later stage: proliferating reserve cells displace the glandular epithelium
- Final step: cells mature into glycogen-rich squamous cells
Why does the transformation zone matter?
site of cervical squamous carcinoma
What are the high and low risk types of HPV, a oncogenic DNA virus?
High risk: 16, 18, 31, 33
Low risk: 6, 11
What happens with low risk HPV 6, 11 episomal infection? what is the characteristic cell?
condyloma characteristic cell=koilocyte -nuclear enlargement -irregular nuclear membrane contour -hyperchromasia -perinuclear halo
exophytic condyloma “condyloma acuminatum”
What happens with high risk HPV 16,18 viral integration?
1. CIN persistent infection 2. Higher grade CIN 3. invasive cancer 4. Metastasis
How is HPV oncogenic?
- HPV oncoproteins E6, E7 bind to Rb and p53 and neutralize their function
- monoclonal outgrowth of squamous cells
What is the difference between CIN1 and CIN2/CIN3?
CIN 1= low grade SIL
- koilocytes prominent
- basalmost layer is orderly
CIN2/CIN3=high grade SIL
-abnormal mitotic figures
-basalmost layer is jumbled
(CIN3 full thickness)
How do you manage CIN/SIL?
Biopsy
- via colposcopy
- contour, color, and vascular pattern distinguish LSIL, HSIL
LSIL-observation
HSIL-surgical excision, long term follow up
What do the bivalent vaccines protect against, what about the quadrivalent?
bivalent: 16, 18
quadrivalent: 16, 18, 6, 11
Some invasive carcinoma of the cervix are from somatically acquired mutations in what tumor suppressor gene?
LKB1
WHat is the peak incidence, symptoms and key risk factor for invasive carcinoma of the cervix?
45 yrs old
symptoms: vaginal bleeding, leukorrhea, dyspareunia, dysuria
key risk factor: high risk HPV infection
other risk factors: smoking, immunodeficiency (AIDs defining illness)
-keratin peras in well differentiated tumors
What is the treatment for cervical carcinoma?
hysterectomy, lymph node dissection
-mortality strongly correlated to tumor stage
advanced disease=local invasion, obstruction of ureters and urinary bladder
What are the different stages of cervical cancer?
0: carcinoma in situ
1: confined to cervix
2: extends beyond cervix but not to pelvic wall, involves vagina but not lower 1/3
3: extends to pelvic wall, involves vagina lower 1/3
4: extends beyond true pelvis or involves bladder or rectum
How common is vulva squamous cell carcinoma? who, risk factors, precursor, presentation, metastases
- 3% of all femal genital cancers
- > 60 yrs old
- risk factors
- high risk hpv 16, 18
- non hpv related: lichen sclerosus - precursor: vulvar intraepithelial neoplasia
- presentation: leukoplakia
- metastases: regional lymph nodes
How common is vaginal squamous cell carcinoma? who, risk factors, precursor, presentation, metastases
- extremely uncommon
- > 60 yrs old
- risk factors
- high risk hpv 16, 18 - precursor: vaginal intraepithelial neoplasia
- presentation: vaginal bleeding, discharge
- metastases: regional lymph nodes
lichen sclerosus
postmenopausal women
-uncertain etiology, but suspect autoimmune
Symptoms: none, pruritus, soreness, irritation
Histology: Thinning of epidermis, fibrosis of dermis
Physical exam: leukoplakia-thin white plaques on vulva
small risk of progression to cancer
Vulva condyloma
war
condyloma acuminata
HPV 6, 11
low risk of progression to cancer
condyloma lata
treponema pallidum
stage 2 syphilis-teeming with spirochetes
lichen simplex chonicus
associated with chronic irritation, scratching
Histology: hyperplasia of vulvar epithelium
Exam: leukoplakia; thick leathery skin
No increased risk of malignancy
paget disease of the vulva (extramammary paget disease)
- intraepidermal proliferation of malignant cells
- can also occur in breast nipple - no underlying tumor
- arise from intra-epidermal progenitor cells
- presents as RED, scaly, crusted plaque
Histology: single cells with pale vacuolated cytoplasm with abundant glycosaminoglycans
PAS +
cytokeratin +
not S100 positive vs melanoma
clear cell adenocarcinoma of vagina
- rare malignancy associated with diethylstilbestrol exposure in utero
- malignancy proliferation of glands with clear cytoplasm
- precursor lesion= vaginal adenosis-persistence of columnar epithelium in upper 1/3 vagina
- clinical examination: red, granular areas adjacent to normal pale pink vaginal mucosa
embryonal rhabdomyosarcoma of vagina
- aka sarcoma botryoides
- rare primary vaginal cancer
- children
