L68 Flashcards
Which strain of HPV is linked specifically to GYN adenocarcinomas?
HPV 18
@ exocervix
Which strain of HPV is linked specifically to GYN squamous cell carcinomas?
HPV 16
@ endocervix
What is the mechanism by which HPV is oncogenic?
E6 protein - inactivates p53
E7 protein - inactivates Rb
No regulation in moving from G1 -> s
When you do an HPV DNA screening test, what strains are you looking for?
High risk (16, 18) only - finding low risk strains doesn’t change management
HPV strains in the quadrivalent vaccine
6, 11, 16, 18
When do you start HPV vaccine?
11/12
Give up until 26 - after this, likely already exposed
3 main risk factors for developing cervical carcinoma
- Exposure to HPV
- Immune suppression - can’t resolved HPV infection on your own
- Smoking - “I didn’t smoke it down there doc!”
Describe the dysplastic pre-cursor lesions for cervical carcinoma
CIN 1 = 1/3 thickness
CIN 2 = 2/3
CIN 3 = slightly less than full thickness
CIN 1-3 are dysplastic b/c potential to reverse
CIS = carcinoma in situ = entire thickness
Explain the LSIL vs HSIL histo grading of lesions
LSIL = CIN 1 = see hollowed out cells at upper layers of productive virus HSIL = CIN 2 or 3 = integrated HPV
What is a genital wart caused by HPV called? What do you see on histo?
Condyloma acuminatum
HPV 6/11
1. Papillae looking
2. Koilocytosis
Which gene can you find activated in HSIL caused by HPV?
p16 - normally downreg by Rb but you’ve lost that via E7
What type of cervical cancer (squamous vs adeno) progresses linearly down the CIN -> carcinoma pathway?
Squamous cell = 100% SCC cervical is due to HPV CIN 1 (LSIL) -> 2 -> 3 (HSIL) -> CIS -> carcinoma This is why so well captured by pap screening
Management of LSIL
F/u pap smears
Many regress on own
Management of HSIL
Colposcopy + biopsy
Remove @ transformation zone
TESTQ what are the 5 categories of squamous lesions?
ASC-US // LSIL
ASC-H // HSIL
SCC
F/u for an ASC-US lesion
DNA test for high risk HPV
If positive, colposcopy + biopsy
TESTQ: f/u for ASC-H lesion
Colposcopy + biopsy
Why type of cervical cancer is not best detected by pap smear?
Adenocarcinoma (glandular changes)
Precursor = adenocarcinoma in situ, usually incidental finding after biopsy for HSIL (aka something that did show up on pap)
Who gets pap smears? How often?
> 21, every 3 yrs (every 5 if do HPV testing at same time)
Stop > 65
What histo characteristic defines SCC at cervix?
Invade through basement membrane
What is an endocervical polyp?
BENIGN cervical polyp
What are the 2 benign lesions in the vagina?
Gartner duct cyst
Fibroepithelial polyp
What vaginal cancer would you expect in girls under 5yo?
Embryonal rhabdomyosarcoma = malig immature skeletal muscle “grape-like” mass
Protrudes from vagina
What is the name of a leukoplakia lesion on the vulva that is paper thin? Describe patho process
Lichen sclerosis - post-meno (older) women
Thin epi
Sclerosis dermis
Lichen sclerosis: benign or malignant?
Benign
Some risk for SCC vulvar carcinoma
What is the name of a leukoplakia lesion on the vulva that is thick, leathery? Describe patho process
Lichen simplex chronicus
Irritation/scratch -> hyperplasia of epi
100% benign
What cyst will present unilat, painful at the lower vestibule next to vaginal canal
Bartholin cyst
What is the precursor lesion for vulvar SCC that is HPV related? Morphology?
HSIL -> HPV vulvar SCC
Warty lesion
What is the precursor lesion for vulvar SCC that is NOT HPV related? Morphology?
Differentiated VIN -> vulvar SCC
H/o lichen sclerosis
Keratin, well diff lesion
What is paget disease of the vulva? Presentation
Malignant epi cell in epidermis of vulva = carcinoma in situ w/o underlying carcinoma elsewhere (vs nipple)
Red, itchy, ulcer lesion on outer vagina
What must you rule out vs Paget
Melanoma (-keratin, +S100)
Rectal or urothelial carcinoma
