L6 – Gynaecopathology: Infection-Related Tumours of the Cervix

Question 1

What is the primary aetiological agent in cervical epithelial pathology?

Answer 1

Human papilloma virus (HPV) is the dominant infectious agent causing cervical neoplastic changes.

Question 2

How many HPV genotypes are known and which are considered high risk?

Answer 2

There are over 300 genotypes; high-risk types (e.g. HPV 16 and 18) account for around 75% of cervical cancers.

Question 3

Where is HPV most commonly detected in the cervix?

Answer 3

HPV typically affects the squamo–columnar junction of the cervix.

Question 4

How does HPV persist in infected cells?

Answer 4

The virus can exist as a circular episome; in cervical cancer, integration into the host DNA disrupts regulatory regions.

Question 5

What is koilocytosis and what does it indicate?

Answer 5

Koilocytosis is perinuclear clearing seen in HPV-infected cells, indicating productive infection.

Question 6

How does the integration of HPV DNA affect cell regulation?

Answer 6

Integration leads to disruption of the E2 gene and overexpression of oncogenes E6 and E7, which inactivate tumour suppressors such as p53.

Question 7

What does CIN stand for and how is it graded?

Answer 7

CIN stands for cervical intraepithelial neoplasia, graded from 1 (mild dysplasia) to 3 (severe dysplasia).

Question 8

What is the difference between HPV-related and HPV-independent cervical carcinomas?

Answer 8

While most cervical cancers are HPV-driven, a significant proportion—especially adenocarcinomas—may be HPV-independent and carry a worse prognosis.

Question 9

What imaging or cytological features are used to stage cervical carcinoma?

Answer 9

Staging involves assessing the extent of invasion, lymph node involvement, and, in some cases, the use of cervical screening programmes.

Question 10

How does the cervical screening programme contribute to cervical cancer prevention?

Answer 10

Regular screening detects pre-neoplastic lesions early, allowing for prompt treatment and reduction in cancer incidence.

Question 11

What is the clinical importance of distinguishing between CIN and invasive carcinoma?

Answer 11

CIN lesions can often be managed conservatively, whereas invasive carcinoma requires more aggressive treatment.

Question 12

How does early detection via screening influence prognosis?

Answer 12

Early detection significantly improves survival rates by allowing treatment before invasion and metastasis occur.

Question 13

What are common treatments for CIN and cervical carcinoma?

Answer 13

Treatments include local excision, cryotherapy for CIN, and for invasive carcinoma, radical hysterectomy with or without radiotherapy.

Question 14

How is the role of HPV vaccination integrated into cervical cancer prevention?

Answer 14

HPV vaccination, along with screening and treatment, forms a triad in global strategies to eliminate cervical cancer.

Question 15

What is the impact of treatment on the prognosis of cervical carcinoma?

Answer 15

Effective treatment can dramatically reduce mortality, particularly when cancers are detected at an early stage.

Question 16

Why is ongoing research important in HPV-related cervical pathology?

Answer 16

It continues to refine screening, diagnostic, and treatment modalities, especially for lesions that are HPV-independent.

Question 17

What cytological differences are noted between low-grade and high-grade CIN?

Answer 17

Low-grade CIN shows mild atypia and koilocytic changes, whereas high-grade CIN displays marked atypia and loss of cellular polarity.

Question 18

How does disruption of the E2 gene lead to cervical carcinogenesis?

Answer 18

Loss of E2 results in uncontrolled expression of E6 and E7, which inactivate tumour suppressor proteins p53 and Rb.

Question 19

What are the benefits and limitations of HPV DNA testing in cervical screening?

Answer 19

It improves sensitivity but may detect transient infections that do not progress to neoplasia.

Question 20

How does colposcopy enhance the diagnostic accuracy of cervical lesions?

Answer 20

It provides magnified visualisation of the cervical epithelium and allows for targeted biopsies.

Question 21

How do morphological features of cervical adenocarcinoma affect treatment?

Answer 21

Adenocarcinoma may be HPV-independent and often requires more extensive surgical management due to its aggressive behaviour.

Question 22

What impact does the integration status of HPV DNA have on lesion progression?

Answer 22

Integrated HPV DNA is more frequently associated with high-grade lesions and a higher risk of progression to invasive carcinoma.

Question 23

How does quality control in cervical screening programmes affect patient outcomes?

Answer 23

Regular, high-quality screening reduces cervical cancer incidence by ensuring early detection and treatment.

Question 24

What is the significance of persistent HPV infection in cervical pathology?

Answer 24

Persistence is a key factor in progression from low-grade lesions to high-grade CIN and invasive carcinoma.

Question 25

What is the primary function of cervical cancer screening programs?

Answer 25

Cervical cancer screening programs aim to detect precancerous and early-stage cancerous changes, reducing incidence and mortality.

Question 26

How does HPV contribute to cervical cancer development?

Answer 26

HPV infection leads to cellular dysregulation, promoting cervical intraepithelial neoplasia (CIN) and invasive carcinoma.

Question 27

What are the two major epithelial types of the cervix?

Answer 27

The cervix consists of endocervical (glandular) and ectocervical (squamous) epithelium.

Question 28

Where is the transformation zone located, and why is it significant?

Answer 28

The transformation zone is the area where squamous and glandular epithelium meet, a common site for HPV-related changes.

Question 29

How do low-grade and high-grade cervical intraepithelial neoplasia (CIN) differ?

Answer 29

Low-grade CIN lesions often regress spontaneously, whereas high-grade CIN has a higher risk of progressing to cancer.

Question 30

What are the primary histological types of cervical cancer?

Answer 30

The two major types are squamous cell carcinoma and adenocarcinoma.

Question 31

Why is squamous metaplasia important in HPV-related pathology?

Answer 31

Squamous metaplasia is the normal replacement of glandular epithelium with squamous cells but can become dysplastic in HPV infections.

Question 32

What embryological structures contribute to the formation of the female reproductive tract?

Answer 32

The Müllerian ducts give rise to the female reproductive tract, including the uterus, fallopian tubes, and cervix.

Question 33

How can Müllerian duct abnormalities affect reproductive health?

Answer 33

Improper fusion of Müllerian ducts can cause anatomical abnormalities, affecting fertility and increasing pathology risks.

Question 34

What are the clinical signs of cervical cancer?

Answer 34

Common clinical signs of cervical cancer include abnormal vaginal bleeding, pelvic pain, and postcoital spotting.

Question 35

How does adenocarcinoma of the cervix differ from squamous cell carcinoma?

Answer 35

Adenocarcinoma originates from glandular epithelium and may not always be HPV-related, whereas squamous cell carcinoma is strongly linked to HPV.

Question 36

What is the role of HPV vaccination in preventing cervical cancer?

Answer 36

HPV vaccination prevents infection with high-risk strains, reducing the incidence of cervical cancer.

Question 37

Why is postmenopausal bleeding a significant clinical symptom?

Answer 37

Postmenopausal bleeding is a red flag for malignancy and should prompt immediate investigation.

Question 38

How does endometrial carcinoma classification affect prognosis?

Answer 38

Type 1 endometrioid carcinomas are generally slow-growing, while Type 2 serous carcinomas are more aggressive with poorer prognosis.

Question 39

What are the histological features of endometrioid carcinoma versus serous carcinoma?

Answer 39

Endometrioid carcinoma features gland formation similar to normal endometrium, whereas serous carcinoma exhibits highly atypical, aggressive cells.

Question 40

Why is the detection of adenocarcinoma in cervical screening important?

Answer 40

Cervical screening must detect both squamous and glandular lesions to ensure early diagnosis and treatment.

Question 41

How does the implementation of screening and vaccination programs impact cervical cancer rates?

Answer 41

Countries with well-implemented HPV vaccination and screening programs have seen a significant decline in cervical cancer rates.

Question 42

What is the significance of hormonal dysregulation in gynecopathology?

Answer 42

Hormonal imbalances can contribute to gynecological disorders, including endometrial hyperplasia and cancer.

Question 43

How do genetic abnormalities contribute to gynecological cancers?

Answer 43

Genetic mutations, such as those affecting tumor suppressors, can drive the development of gynecological malignancies.

Question 44

Why is understanding cervical histology important in diagnosing cervical neoplasia?

Answer 44

Understanding cervical histology helps differentiate between normal, dysplastic, and malignant changes, guiding diagnosis and treatment.

Question 45

What embryological structure gives rise to the uterus, fallopian tubes, and cervix?

Answer 45

The Müllerian ducts (paramesonephric ducts).

Question 46

What is the significance of mesonephric remnants in female reproductive anatomy?

Answer 46

They are benign remnants but can be mistaken for malignancies if not recognized.

Question 47

Why is fusion of the Müllerian ducts important in uterine development?

Answer 47

Proper fusion is essential for normal uterine anatomy; failure can cause uterine malformations like bicornuate or septate uterus.

Question 48

What anatomical feature increases vulnerability to HPV infection in the cervix?

Answer 48

Areas of squamous metaplasia at the transformation zone are more susceptible to HPV infection.

Question 49

What is squamous metaplasia, and where does it occur in the cervix?

Answer 49

The replacement of glandular epithelium by squamous epithelium, occurring at the cervical transformation zone.

Question 50

Why is the transformation zone of the cervix important in cervical screening?

Answer 50

It is the site where squamous and glandular epithelia meet and where HPV-related lesions often arise.

Question 51

What cytological feature indicates productive HPV infection?

Answer 51

Koilocytosis, seen as a perinuclear clearing around the nucleus.

Question 52

What is the main difference in viral DNA behavior between low-risk and high-risk HPV infections?

Answer 52

Low-risk HPV maintains episomal DNA, while high-risk HPV integrates its DNA into the host genome.

Question 53

Which viral proteins are involved in disrupting host tumor suppressor pathways during high-risk HPV infection?

Answer 53

E6 and E7 viral proteins.

Question 54

How does HPV-mediated disruption of p53 affect cellular behavior?

Answer 54

It inhibits key tumor suppressor pathways, leading to increased cellular proliferation and genomic instability.

Question 55

Why can most low-grade HPV infections regress spontaneously?

Answer 55

Because the immune system can often clear HPV infections before neoplastic progression occurs.

Question 56

What risk factor, besides HPV, increases the likelihood of cervical cancer progression?

Answer 56

Smoking.

Question 57

What cytological changes are seen in low-grade cervical intraepithelial neoplasia (CIN 1)?

Answer 57

Expansion of the basal epithelial layer with koilocytosis in upper layers.

Question 58

How does high-grade CIN differ microscopically from low-grade CIN?

Answer 58

High-grade CIN shows full-thickness atypia and loss of cellular maturation.

Question 59

What histological feature indicates invasion in cervical carcinoma?

Answer 59

Invasion into the cervical stroma and destruction of normal architecture.

Question 60

What is the typical route of lymphatic spread for cervical cancer?

Answer 60

Through pelvic lymph nodes.

Question 61

Why is fertility-preserving surgery sometimes possible for early cervical cancer?

Answer 61

Procedures like LLETZ (large loop excision of the transformation zone) can remove pre-cancerous lesions while preserving the uterus.

Question 62

Why has the HPV vaccination programme been extended to boys in some countries?

Answer 62

To reduce the spread of HPV and prevent HPV-related cancers in males, such as oropharyngeal cancer.

Question 63

What other cancers, besides cervical cancer, are associated with HPV infection?

Answer 63

Penile, anal, vaginal, vulvar, and oropharyngeal cancers.

Question 64

Why is postmenopausal cervical cancer a growing concern despite vaccination programmes?

Answer 64

Older, postmenopausal women were not vaccinated and often have less regular screening.

Question 65

How does the colposcopy procedure assist in diagnosing cervical pre-cancerous changes?

Answer 65

It enables direct visualization of abnormal cervical epithelium for biopsy.

Question 66

What is the advantage of modern liquid-based cytology over traditional PAP smears?

Answer 66

Liquid-based cytology removes debris and blood, making interpretation clearer and more reliable.

Question 67

Why are adenocarcinomas harder to detect with current cervical screening methods?

Answer 67

They may not be HPV-driven and thus evade virus-based screening tests.

Question 68

What is the clinical consequence of HPV-negative cervical adenocarcinomas?

Answer 68

They often present at later stages and carry a worse prognosis due to delayed detection.

Question 69

What anatomical factors make the cervix prone to local tumor spread?

Answer 69

The cervix's close proximity to the bladder, rectum, and pelvic walls facilitates local spread.

Question 70

What are potential complications if cervical tumors invade surrounding structures?

Answer 70

Invasion into bladder or rectum can cause fistulae and complicate surgical management.