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P&T Block 5 Renal > L68 > Flashcards

L68 Flashcards

1
Q

Which strain of HPV is linked specifically to GYN adenocarcinomas?

A

HPV 18

@ exocervix

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2
Q

Which strain of HPV is linked specifically to GYN squamous cell carcinomas?

A

HPV 16

@ endocervix

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3
Q

What is the mechanism by which HPV is oncogenic?

A

E6 protein - inactivates p53
E7 protein - inactivates Rb
No regulation in moving from G1 -> s

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4
Q

When you do an HPV DNA screening test, what strains are you looking for?

A

High risk (16, 18) only - finding low risk strains doesn’t change management

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5
Q

HPV strains in the quadrivalent vaccine

A

6, 11, 16, 18

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6
Q

When do you start HPV vaccine?

A

11/12

Give up until 26 - after this, likely already exposed

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7
Q

3 main risk factors for developing cervical carcinoma

A
  1. Exposure to HPV
  2. Immune suppression - can’t resolved HPV infection on your own
  3. Smoking - “I didn’t smoke it down there doc!”
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8
Q

Describe the dysplastic pre-cursor lesions for cervical carcinoma

A

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

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9
Q

Explain the LSIL vs HSIL histo grading of lesions

A 
LSIL = CIN 1 = see hollowed out cells at upper layers of productive virus
HSIL = CIN 2 or 3 = integrated HPV
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10
Q

What is a genital wart caused by HPV called? What do you see on histo?

A

Condyloma acuminatum
HPV 6/11
1. Papillae looking
2. Koilocytosis

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11
Q

Which gene can you find activated in HSIL caused by HPV?

A

p16 - normally downreg by Rb but you’ve lost that via E7

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12
Q

What type of cervical cancer (squamous vs adeno) progresses linearly down the CIN -> carcinoma pathway?

A 
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
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13
Q

Management of LSIL

A

F/u pap smears

Many regress on own

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14
Q

Management of HSIL

A

Colposcopy + biopsy

Remove @ transformation zone

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15
Q

TESTQ what are the 5 categories of squamous lesions?

A

ASC-US // LSIL
ASC-H // HSIL
SCC

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16
Q

F/u for an ASC-US lesion

A

DNA test for high risk HPV

If positive, colposcopy + biopsy

17
Q

TESTQ: f/u for ASC-H lesion

A

Colposcopy + biopsy

18
Q

Why type of cervical cancer is not best detected by pap smear?

A

Adenocarcinoma (glandular changes)
Precursor = adenocarcinoma in situ, usually incidental finding after biopsy for HSIL (aka something that did show up on pap)

19
Q

Who gets pap smears? How often?

A

> 21, every 3 yrs (every 5 if do HPV testing at same time)

Stop > 65

20
Q

What histo characteristic defines SCC at cervix?

A

Invade through basement membrane

21
Q

What is an endocervical polyp?

A

BENIGN cervical polyp

22
Q

What are the 2 benign lesions in the vagina?

A

Gartner duct cyst

Fibroepithelial polyp

23
Q

What vaginal cancer would you expect in girls under 5yo?

A

Embryonal rhabdomyosarcoma = malig immature skeletal muscle “grape-like” mass
Protrudes from vagina

24
Q

What is the name of a leukoplakia lesion on the vulva that is paper thin? Describe patho process

A

Lichen sclerosis - post-meno (older) women
Thin epi
Sclerosis dermis

25
Q

Lichen sclerosis: benign or malignant?

A

Benign

Some risk for SCC vulvar carcinoma

26
Q

What is the name of a leukoplakia lesion on the vulva that is thick, leathery? Describe patho process

A

Lichen simplex chronicus
Irritation/scratch -> hyperplasia of epi
100% benign

27
Q

What cyst will present unilat, painful at the lower vestibule next to vaginal canal

A

Bartholin cyst

28
Q

What is the precursor lesion for vulvar SCC that is HPV related? Morphology?

A

HSIL -> HPV vulvar SCC

Warty lesion

29
Q

What is the precursor lesion for vulvar SCC that is NOT HPV related? Morphology?

A

Differentiated VIN -> vulvar SCC
H/o lichen sclerosis
Keratin, well diff lesion

30
Q

What is paget disease of the vulva? Presentation

A

Malignant epi cell in epidermis of vulva = carcinoma in situ w/o underlying carcinoma elsewhere (vs nipple)
Red, itchy, ulcer lesion on outer vagina

31
Q

What must you rule out vs Paget

A

Melanoma (-keratin, +S100)

Rectal or urothelial carcinoma

P&T Block 5 Renal (30 decks)

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