Female Genitalia

Question 1

Describe HPV

Answer 1

• double stranded DNA virus
• lifecycle linked to epithelial differentiation
• genital HPV grouped into low/high oncogenic risk

Question 2

What are low risk HPV groups

Answer 2

• Genital warts (condylomas- benign squamous neoplasms)
• Low grade cytological abnormalities
• Subtypes 6 & 11 most common & linked to genital warts

Question 3

What cancers are classed as high grade HPVs?

Answer 3

• High grade INs
• Penile intraepithelial neoplasia & (invasive) squamous cell carcinoma
• Oral squamous cell carcinoma
• Type 16 & 18 subtypes most risk

Question 4

What is the mode of action for HPV

Answer 4

• early genes expressed at inset of infection
• control viral replication
• oncogenic viruses involved in cell transformation
• late genes codes caspid proteins
• high risk HPV integrated into host chromosome
• upregulate E6, E7 expression
• E6 binds to & inactivates p53 (mediates apoptosis, respond to DNA damage)
• E7 binds to RB1 gene product (RB1= TSG controls G1/S checkpoint in cell cycle)

Question 5

What are the 2 main types of vulval intraepithelial neoplasia? Describe them

Answer 5

• Classical/warty/baseloid=graded VIN 1-3, young people, related to HPV
• Differentiated= not graded, not HPV related, occurs in chromic dermatoses (lichen sclerosus), older people

Question 6

Describe the behaviour of VIN

Answer 6

• 35-50% recur
• positive margins= recurrence
• progression to invasive carcinoma
• invasive more likely to occur in postmen/immunocompromised

Question 7

What is the most common vulvar carcinoma?

Answer 7

Squamous cell carcinoma

Question 8

Describe squamous cell Carcinoma

Answer 8

• associated VIN (70 lichen sclerosus)
• eroded plaque/ulcer
• spreads locally to vagina/distal urethra/inguinal lymph nodes

Question 9

Name some vulvar tumours and describe them

Answer 9

• malignant melanoma= 50% of cancers, 1/3 local recurrence, urethral/haem/lymph node spread
• Squamous cell carcinoma
• Paget’s disease= 5%, adenocarcinoma of squamous mucosa, can become invasive, pruritic/burning/eczematous patch

Question 10

Describe Paget’s disease

Answer 10

• pruritic/burning/eczematous patch
• adenocarcinoma of squamous mucosa
• tend to reoccur
• can develop invasive adenocarcinoma
• bladder, cervix, perianal component

Question 11

What area is vulnerable to HpV oncogenic effects?

Answer 11

Transformation zone

Question 12

What are risk factors for cervical squamous cell carcinoma?

Answer 12

• HPV
• smoking
• high parity
• low socioeconomic group
• immunosuppression
• young age of first intercourse
• multiple sexual partners

Question 13

Name some intraepithelial neoplasia

Answer 13

• Vulval intraepithelial neoplasia (VIN)
• Cervical intraepithelial neoplasia (CIN)
• Cervical glandular intraepithelial neoplasia (CGIN)
• Anal intraepithelial neoplasia (AIN)
• Vaginal intraepithelial neoplasia (VaIN)

Question 14

What is the transformation zone?

Answer 14

Physiological area of squamous metaplasia, area used for smearing

Question 15

What is cervical intraepithelial neoplasia?

Answer 15

• Pre-invasive stage of cervical squamous cell carcinoma
• Detection in cervical screening (high sensitivity & specificity)
• Graded CIN1,2,3

Question 16

Describe cervical adenocarcinomas

Answer 16

• Presentation/spread same as squamous cell
• Related to high risk HPV
• CGIN precursor
• Stage for stage worse prognosis than squamous cell as radioresistant