HPV & genital neoplasia

Question 1

Cytological features of HPV

Answer 1

• Koilocytosis
• Cells present in clusters or single
• nucleus: large, hyperchromic, multinucleation & binucleation
• parakeratosis: nuclei in keratinised cell
• Dyskeratosis: abnormal premature keratinisation in cells

Question 2

Pitfalls to cytological features of HPV (ie. may be confused by…)

Answer 2

• Perinuclear clearing as a result of cell. changes from inflammation
• heavily glycogenated intermediate cells @ late secretory phase
• changes in glandular cells

Question 3

features to know that you’re looking at a koilocyte

Answer 3

• larger nuclei
• wide clearing in cell
• thick & well-defined rim
• biphasic stain (blue & pink stain on cell)

Question 4

why would might we look into anogenital cytology? What is AIN?

Answer 4

bc cause & pathogenesis is same to squamous neoplasia in cervix. i.e CIN = AIN
- anal intraepithelial neoplasia: arise in transformation zone - squamo-columnar junction w/ rectal columnar mucosa

Question 5

What is CIN?

Answer 5

Cervical intraepithelial neoplasm: the abnormal growth of precancerous cells in the cervix

Question 6

How is HPV graded when refering to the progression of HPV in the transformation zone? (ANS: cytology = histology: features)

Answer 6

1. LSIL = CIN 1 (/ mild dysplasia): 33.33% layer undiff.
2. HSIL = CIN 2 (/ moderate): 50% layer undiff.
   = CIN 3 (/ severe): 75% layer undiff.
   = CIN 3 (/ carcinoma in situ): 100% undiff.
3. invasive carcinoma

Question 7

nuclei feature of normal & CIN nuclei

Answer 7

• normal: heterochromatin (dark) finely granular & eveny distributed
• CIN: intense heterochromatic (darker) & coarse grunules, unevenly distributed?

Question 8

Why CST screening age has changed to 25 yo? & what are the exceptions

Answer 8

• bc found that <25 yo associated w/ LR HPV (genital warts)

- Except if they are showing symptoms

Question 9

Pitfalls when diagnosing CIN

Answer 9

• reactive/inflamm. changes
• squamous metaplastic cells
• Endocervical cells
• lymphocytes infiltrate (follicular cervititis)
• radiation changes

Question 10

what is the P16 stain & when is it used w/ diagnosis?

Answer 10

a) P16 protein > decelerates cell cycle. Seen in all cervical cancer & preneoplastic lesions
b) For HR & IR of HPV (16,18, 33, 52, 58)