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DERS (reproductive) > L42- Female GUT Pathology II (cervix) > Flashcards

L42- Female GUT Pathology II (cervix) Flashcards

1
Q

Ectocervix is lined by (1) cells with (2) features.

Endocervix is lined by (3) cells.

(4) is the point where (1) and (3) meet.

A

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)

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2
Q

_____ is the clinical importance of the T-zone

A

junction may have immature squamous cells –> susceptible to HPV infection

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3
Q

Acute Cervicitis:

  • (1) definition
  • (2) causes
  • (3) risk factors
A

1- inflammation of columnar epithelial cells of Endocervix (not erosion)

2- gonococcal, chlamydia, candida, trichomonas, herpes

3- post-partum, post-D&C

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4
Q

Acute Cervicitis:

  • (1) morphology / appearance
  • (2) Sxs
A

1- infiltration of endocervical tissue w/ large amounts of polymorphonuclear leukocytes

2- purulent vaginal discharge

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5
Q

Chronic Cervicitis:

  • (1) Sxs / presentation
  • (2) morphological changes
A

1- non-specific symptoms or incidental finding

2, Cervix:

  • lymphocyte and plasma cell infiltration
  • granularity and thickening
  • Retention / Nabothian cysts in some cases
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6
Q

Cervical Squamous Metaplasia;

  • (1) definition
  • (2) causes
  • (high/low) malignant potential
A

1- replacement of glandular epithelium by squamous epithelium

2- non-specific response to irritation

3- NO malignant potential

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7
Q

Endocervical Polyp:

  • (1) definition
  • (2) time of occurrence (age)
  • (3) composition
A

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

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8
Q

Endocervical Polyp:

  • (high/low) malignant potential
  • (2) Tx
A

1- NO malignant potential

2- curettage or surgical excision

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9
Q

Condyloma Acuminatum:

  • (1) are the causes, commonly in (2) age group
  • (3) changes in pregnancy
A

1- HPV 6, 11
2- 20-40 y/o
3- enlargement

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10
Q

Condyloma Acuminatum:

  • (1) morphology
  • (2) Tx
A

1- soft, tan, cauliflower-like papillomatous mass + koilocytosis

2- excisional biopsy, diathermy, laser vaporization

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11
Q

list the risk factors for Cervical Intraepithelial Neoplasia (note- split HPV high and low risk)

A

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
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12
Q

describe the following features of normal cervical epithelium development:

  • nuclei and cytoplasm
  • basal cells
  • mitoses
A

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
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13
Q

what are the changes in cervical epithelium in cervical intraepithelial neoplasia

A

Nuclei (basal cells) remain large (epithelium)
Cells remain cuboidal (no flattening)

no glycogen storage

mitoses above BM

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14
Q

describe Koilocytic Atypia of cervix

A
  • nuclear changes in epithelium

- cytoplasmic ‘halos’ consisting of perinuclear vaculoes via HPV: E5 to ER membrane (partial involvement)

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15
Q

describe progression of CIN and SIN

A 
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
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16
Q

CIN I:

  • positive for (1), marker of proliferation
  • HPV, high-risk, will upregulate (2)
A

1- Ki67 (abnormal proliferation above basal layer)

2- p16

17
Q

list testing for CIN status or screening

A
  • *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

18
Q

PAP smears:

  • begin at (1) y/o
  • (2) exam frequency
  • (3) need if HPV vaccinated
A

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)

19
Q

CIN I = ______ + distinguishing features

A

CIN I = mild dysplasia, LSIL

  • koilocytic atypia
  • enlarged hyperchromatic irregular nuclei
  • perinuclear halo
20
Q

CIN II/III = ______ + distinguishing features

A

CIN II/III = moderate-severe dysplasia, HSIL

  • inc nuclear:cytoplasmic ratio
  • pleomorphic, hyperchromatic nuclei
21
Q

LSIL lesions:

  • (1)% regress
  • (2)% persist
  • (3)% progress to HSIL
A

1- 60%
2- 30%
3- 10%

22
Q

HSIL lesions:

  • (1)% regress
  • (2)% persist
  • (3)% progress to CA
A

1- 30%
2- 60%
3- 10%

23
Q

CIN / SIL Tx

A
  • cryosurgery
  • electrocoagulation
  • laser
  • LEEP (loop electrical excision procedure)
  • cone biopsy
24
Q

Cervical carcinoma distribution of types

A

80% SCC
15% adenocarcinoma
<5% adenosquamous, neuroendocrine CA

25
Q

list major HPV serotypes for cervical cancer

A

(high risk) HPV 16, 18, 31, 33

26
Q

Cervical carcinoma:

  • (1) main age group
  • (2) main Sxs
  • (3) Dx
  • (4) Tx
A

1- 30-50 y/o

2- irregular vaginal bleeding, postcoital bleeding, vaginal discharge, pyometra (via obstruction)

3- colposcopic biopsy

4- surgery, radiation

27
Q

Cervical Cancer morphology (mostly gross)

A
  • exophytic –> necrotic fungating mass
  • ulcerative

-rarely infiltrative

28
Q

describe the possible outcomes of untreated Cervical carcinoma

A

main cause of death: pyelonephritis, uremia, ureteral obstruction

-distant metastasis: liver, lung, bone marrow

29
Q

Micro-invasive Cervical carcinoma, stage IA:

  • (1) size / dimensions
  • (BV/LN) invasion
  • (3) Dx
  • (4) Tx
A

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

30
Q

Adenocarcinoma:

  • (1) most affected age group
  • (2)% of cervical cancers
  • (3) are precursors
  • (4) associated infections
A

1- 30s
2- 15%
3- adenocarcinoma in situ
4- HPV 16, 18

31
Q

Adenocarcinoma:

  • (1) characterization
  • (2) Tx
A

1:

  • proliferation of glandular epithelium
  • composed of malignant endocervical cells
  • large hyperchromatic nuclei
  • relative mucin-depleted cytoplasm

2- hysterectomy

DERS (reproductive) (14 decks)

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