Gynaecological Pathology

Question 1

describe the normal anatomy of the cervix

Answer 1

ectocervix; outer part, lined by squamous epithelium which is not keratinised
endocervix; inner part, lined by mucin-secreting glandular epithelium
transformation zone; where the ectocervix and endocervix join together, where premalignant and malignant lesions arise

Question 2

describe the histology of the ectocervix

Answer 2

normal cervical squamous epithelium
looks like that lining f the skin
no keratin layer
non underlying skin appendage structures
nuclei close at the base and apart at the surface
nuclei small and all look the same

Question 3

describe the histology of the endocervix

Answer 3

lined by a single layer of mucin-secreting glandular epithelium
dips down into the stroma of the cervix

Question 4

describe an unsuitable cervical smear

Answer 4

not enough cells on the slide
lots of inflammatory cells
lots of flood
repeat in 3 months

Question 5

describe a borderline cervical smear

Answer 5

mild abnormalities within the nuclei of the cells within the cervix
may be viral, due to inflammation, or abnormal
repeat in 6 months

Question 6

describe an abnormal cervical smear

Answer 6

premalignant
mild dyskaryosis; CIN 1, repeat in 6 months
moderate dyskaryosis; CIN 2, refer to colposcopy
severe dyskaryosis; CIN 3, refer to colposcopy

Question 7

describe the cytopathology of koilocytosis

Answer 7

manifestation of HPV infection within the cervix
nuclei slightly enlarged, slightly normal
indicates a borderline smear

Question 8

describe the cytopathology of CIN 1 on a cervical smear

Answer 8

nuclei are larger
nuclear chromatin is abnormal
speckled pattern to the nuclear chromatin; mildly dyskaryotic smear

Question 9

describe the cytopathology of CIN 2 on a cervical smear

Answer 9

moderately dyskaryotic nucleus
nucleus occupies approximately 2/3s of the cell
abnormal
speckled chromatin

Question 10

describe the cytopathology of CIN 3 on a cervical smear

Answer 10

a group of severely dyskaryotic cells
nucleus is really big compared to the cell
alternate dark and light areas within the nucleus

Question 11

describe the histopathology of koilocytosis

Answer 11

nuclei slightly enlarged in the basal layers
larger nuclei towards the surface
very irregular

Question 12

describe the types of pre-invasive histopathology

Answer 12

CIN; cervical intraepithelial neoplasia, changes of the squamous epithelium
CGIN; cervical glandular intraepithelial neoplasia, much rarer, changes of the glandular epithelium

Question 13

describe the histopathology of CIN 1

Answer 13

koilocytes up towards the surface

cells in the lower 1/3 of the epithelium are very enlarged and abnormal

Question 14

describe the histopathology of CIN 2

Answer 14

abnormal cells confined to the lower 2/3 of the epithelium

Question 15

describe the histopathology of CIN 3

Answer 15

abnormal cells occupying the full epithelial thickness
mitotic figures throughout
no maturation
nuclei much more crowded towards the base than at the surface
severe dysplasia

Question 16

describe the histopathology of high grade CGIN

Answer 16

lots of mucin
pale mucin within the cells
nuclei are heaping up one on the other
apoptotic bodies; individual cell death
mitotic figures

Question 17

what is the significance of CIN diagnosis?

Answer 17

CIN 1; mostly regress and go back to normal
CIN 3; some cases, if untreated, will progress
all of the lesions have to be treated when they are picked up

Question 18

what is the treatment of pre-invasive cervical lesions?

Answer 18

low grade; ablation
high grade; usually excised
loop or cone biopsy, refer to histology, confirmation of no invasive cancer, patient requires follow up
cervical smear after 6 months, then once a year for 10 years

Question 19

describe the low risk types of HPV

Answer 19

6 and 11

may be associated with koilocytosis and CIN 1

Question 20

describe the high risk types of HPV

Answer 20

16 and 18

may just get a low grade lesion with the potential to develop the high grade lesions and the invasive cancers

Question 21

what are the risk factors for development pre invasive and invasive lesions in the cervix?

Answer 21

AIDs at first intercourse
early AIDS
multiple sexual partners
smoking
OCP?

these are all risk factors for HPV infection