Female Pathology: Cervix

Question 1

what is the cervix

Answer 1

neck of uterus

Question 2

what is the cervix divided into

Answer 2

exocervix and endocervix

Question 3

epithelium of exocervix

Answer 3

nonkeratinizing squamous epithelium

Question 4

epithelium of endocervix

Answer 4

single layer of columnar cells

Question 5

what is the junction between exocervix and endocervix called

Answer 5

transformation zone

Question 6

What is HPV, what’s its most popular target

Answer 6

sexually transmitted DNA virus

- cervix in the transformation zone

Question 7

how is HPV eradicated

Answer 7

acute inflammation

Question 8

persistent infection of HPV leads to increase risk of what

Answer 8

cervical dysplasia ( cervical intraepithelial neoplasia ) CIN

Question 9

What are high risk HPV types

Answer 9

16, 18, 31, 33

Question 10

What are low risk HPV types

Answer 10

6, 11

Question 11

high risk HPV produces what proteins which destroy what

Answer 11

E6 - destroys p 53

E7 - destroys Rb

Question 12

histo for cervical intraepithelial neoplasia

Answer 12

koilocytic change
disordered cellular maturation
nuclear atypia
increased mitotic activity within endothelial

Question 13

What are the different grades of cervical intraepithelial neoplasia, CIN

Answer 13

CIN I: less than 1/3 thickness of epithelium
CIN II: less than 2/3 thickness of epithelium
CIN III: slightly less than entire thickness
Carcinoma in situ: entire thickness

Question 14

how does CIN progress

Answer 14

stepwise function to eventually become invasive squamous cell carcinoma

Question 15

what is cervical carcinoma

Answer 15

invasive carcinoma arises from cervical epithelium

Question 16

who usually gets cervical carcinoma

Answer 16

middle-aged women

Question 17

clinical presentation for cervical carcinoma

Answer 17

vaginal bleeding: especially postcoital bleeding

cervical discharge

Question 18

what is a key risk factor for cervical carcinoma

Answer 18

high-risk HPV infection

Question 19

what are secondary risk factors

Answer 19

smoking

immunodeficiency

Question 20

what are the most common subtypes of cervical carcinoma

Answer 20

squamous cell carcinoma

adenocarcinoma

Question 21

how can cervical carcinoma impact other organs

Answer 21

• invade through anterior uterine wall into bladder
• block ureters
• hydronephrosis with postrenal failure

Question 22

what is a common cause of death for cervical carcinoma

Answer 22

postrenal failure

Question 23

what is gold standard for screening

Answer 23

pap smear

Question 24

what is the goal of screening

Answer 24

catch dysplasia (CIN) before it develops into carcinoma

Question 25

when does pap smear screening begin

Answer 25

21 years

performed every 3 years

Question 26

process of pap smear

Answer 26

• cells are scraped from transformation zone using brush and analyzed under microscope

Question 27

under microscope what is high-grade dysplasia characterized as

Answer 27

cells with hyperchromatic (dark) nuclei

high nuclear to cytoplasmic ratios

Question 28

What happens when a patient comes back with an abnormal pap smear, what do you do next

Answer 28

confirmatory colposcopy and biopsy

Question 29

what are limitations of pap smear

Answer 29

• inadequate sampling of transformation zone ( false negative)
• limited efficacy in screening for adenocarcinoma

Question 30

HPV vaccines cover what strains

Answer 30

6,11,16,18

Question 31

antibodies generated by HPV vaccine protect against what depending on the strain

Answer 31

6,11: condylomas

16,18: CIN and carcinoma