L42- Female GUT Pathology II (cervix) Flashcards
Ectocervix is lined by (1) cells with (2) features.
Endocervix is lined by (3) cells.
(4) is the point where (1) and (3) meet.
1- non-keratinized stratified squamous epithelium (covers external os)
2- (post-puberty) stores glycogen to support normal flora
3- simple columnar epithelium, mucus-secreting
4- squamocolumnar junction (T-junction / transformation zone)
_____ is the clinical importance of the T-zone
junction may have immature squamous cells –> susceptible to HPV infection
Acute Cervicitis:
- (1) definition
- (2) causes
- (3) risk factors
1- inflammation of columnar epithelial cells of Endocervix (not erosion)
2- gonococcal, chlamydia, candida, trichomonas, herpes
3- post-partum, post-D&C
Acute Cervicitis:
- (1) morphology / appearance
- (2) Sxs
1- infiltration of endocervical tissue w/ large amounts of polymorphonuclear leukocytes
2- purulent vaginal discharge
Chronic Cervicitis:
- (1) Sxs / presentation
- (2) morphological changes
1- non-specific symptoms or incidental finding
2, Cervix:
- lymphocyte and plasma cell infiltration
- granularity and thickening
- Retention / Nabothian cysts in some cases
Cervical Squamous Metaplasia;
- (1) definition
- (2) causes
- (high/low) malignant potential
1- replacement of glandular epithelium by squamous epithelium
2- non-specific response to irritation
3- NO malignant potential
Endocervical Polyp:
- (1) definition
- (2) time of occurrence (age)
- (3) composition
1- benign exophytic growth w/in endocervical canal
2- pre-menopausal (vaginal spotting)
3- fibromyxomatous stroma covered by dilated endocervical glands, inc vascularity, edema, inflammation
Endocervical Polyp:
- (high/low) malignant potential
- (2) Tx
1- NO malignant potential
2- curettage or surgical excision
Condyloma Acuminatum:
- (1) are the causes, commonly in (2) age group
- (3) changes in pregnancy
1- HPV 6, 11
2- 20-40 y/o
3- enlargement
Condyloma Acuminatum:
- (1) morphology
- (2) Tx
1- soft, tan, cauliflower-like papillomatous mass + koilocytosis
2- excisional biopsy, diathermy, laser vaporization
list the risk factors for Cervical Intraepithelial Neoplasia (note- split HPV high and low risk)
HPV, high-risk: *16, 18, 33, 35, 45
HPV, low-risk: 6, 11, 40, 54
-high viral load
- young sexually activity, multiple partners
- parity, >7
- immunosuppression
- certain HLA Ags
- chlamydia
- smoking
describe the following features of normal cervical epithelium development:
- nuclei and cytoplasm
- basal cells
- mitoses
Basal Cells: small, cuboidal/columnar, high nuclear:cytoplasm ratio
Mitoses are rare, limited to basal layer (BM)
- Nuclei shrink
- Cytoplasm increases –> cells flatten + glycogen accumulation
what are the changes in cervical epithelium in cervical intraepithelial neoplasia
Nuclei (basal cells) remain large (epithelium)
Cells remain cuboidal (no flattening)
no glycogen storage
mitoses above BM
describe Koilocytic Atypia of cervix
- nuclear changes in epithelium
- cytoplasmic ‘halos’ consisting of perinuclear vaculoes via HPV: E5 to ER membrane (partial involvement)
describe progression of CIN and SIN
CIN = cervical intraepithelial neoplasia SIN = squamous intraepithelial neoplasia
Dysplasia:
- Mild = CIN I // low grade SIL (LSIL)
- Moderate = CIN II // HSIL
- Severe = CIN III // HSIL
- Carcinoma in situ = CIN III // HSIL
CIN I:
- positive for (1), marker of proliferation
- HPV, high-risk, will upregulate (2)
1- Ki67 (abnormal proliferation above basal layer)
2- p16
list testing for CIN status or screening
- *PAP, if abnormal –>
- colposcope
- colposcopy- vascular pattern, thickenint
- Schiller test (lather cervix w/ iodine –> look for pale patched)
- 5% acetic acid applied to cervix for before/after observation
-If smear abnormal —> biopsy
PAP smears:
- begin at (1) y/o
- (2) exam frequency
- (3) need if HPV vaccinated
1- 21 y/o
2- every 3 yrs (OR if 30-65 y/o: co-testing PAP + HPV every 5 yrs) –> only continue in high-risk after 65 y/o
3- regular cervical screening (every 3 yrs)
CIN I = ______ + distinguishing features
CIN I = mild dysplasia, LSIL
- koilocytic atypia
- enlarged hyperchromatic irregular nuclei
- perinuclear halo
CIN II/III = ______ + distinguishing features
CIN II/III = moderate-severe dysplasia, HSIL
- inc nuclear:cytoplasmic ratio
- pleomorphic, hyperchromatic nuclei
LSIL lesions:
- (1)% regress
- (2)% persist
- (3)% progress to HSIL
1- 60%
2- 30%
3- 10%
HSIL lesions:
- (1)% regress
- (2)% persist
- (3)% progress to CA
1- 30%
2- 60%
3- 10%
CIN / SIL Tx
- cryosurgery
- electrocoagulation
- laser
- LEEP (loop electrical excision procedure)
- cone biopsy
Cervical carcinoma distribution of types
80% SCC
15% adenocarcinoma
<5% adenosquamous, neuroendocrine CA
list major HPV serotypes for cervical cancer
(high risk) HPV 16, 18, 31, 33
Cervical carcinoma:
- (1) main age group
- (2) main Sxs
- (3) Dx
- (4) Tx
1- 30-50 y/o
2- irregular vaginal bleeding, postcoital bleeding, vaginal discharge, pyometra (via obstruction)
3- colposcopic biopsy
4- surgery, radiation
Cervical Cancer morphology (mostly gross)
- exophytic –> necrotic fungating mass
- ulcerative
-rarely infiltrative
describe the possible outcomes of untreated Cervical carcinoma
main cause of death: pyelonephritis, uremia, ureteral obstruction
-distant metastasis: liver, lung, bone marrow
Micro-invasive Cervical carcinoma, stage IA:
- (1) size / dimensions
- (BV/LN) invasion
- (3) Dx
- (4) Tx
1- <3mm from BM w/in epithelium and width <7mm
2- none
3/4- (excision) cone biopsies or hysterectomy specimens via simple hysterectomy –> keratin pearls
Adenocarcinoma:
- (1) most affected age group
- (2)% of cervical cancers
- (3) are precursors
- (4) associated infections
1- 30s
2- 15%
3- adenocarcinoma in situ
4- HPV 16, 18
Adenocarcinoma:
- (1) characterization
- (2) Tx
1:
- proliferation of glandular epithelium
- composed of malignant endocervical cells
- large hyperchromatic nuclei
- relative mucin-depleted cytoplasm
2- hysterectomy
