Lecture 21 Workshop Clinical Pathological Conference of the Uterus

Question 1

Most HPV infections are cleared by the immune system (True/False)

Answer 1

True

Question 2

What is the most common type of the HPV virus

Answer 2

HPV 16/18

Question 3

Where do you see cervical changes in a patient

Answer 3

Transformation zone

Question 4

What is the age group that are included in the cervical screening programme

Answer 4

Ages 25-64

Question 5

How often must you get cervical smears

Answer 5

5 yearly smears

Question 6

If a patient is hrHPV positive what is the next step

Answer 6

Triage with cytology

Done by HPV tests and not cytology staining

Question 7

What technology does HPV test use

Answer 7

PCR and Hybridisation

Question 8

When would cervical cytology take place

Answer 8

If the patient is high risk and HPV +ve

Question 9

What is a sign of CIN in cervical cytology samples

Answer 9

Abnormal cells (Dyskaryosis)

Question 10

What are the nuclear features of abnormal cells in cervical cancer

Answer 10

Increased size
Coarse irregular chromatin
Nucleoli

Question 11

If Dyskaryosis is detected in the cytology sample what is the next step

Answer 11

Colposcopy

Question 12

How is colposcopy carried out

Answer 12

Acetic acid and Iodine is used and a small biopsy is taken to make a diagnosis

Question 13

What does CIN stand for

Answer 13

Cervical Intraepithelial Neoplasia

Question 14

What is the function of E7 protein product

Answer 14

Prevents cell cycle arrest

Question 15

What is the function of E6 protein product

Answer 15

Inhibits cell death

Question 16

What is the function of L1 and L2

Answer 16

Forms into protein coat where early genes are contained

Question 17

Describe the HPV histology

Answer 17

Koilocytosis
Cells with wrinkled nucleus
Perinuclear halo
Multinucleation

Question 18

Name low risk HPV types

Answer 18

6,11,42,44

Genital warts and low grade CIN

Question 19

Name high risk HPV types

Answer 19

16,18,31,45

High grade CIN and (more rarely) cancer

Question 20

How does HPV cause high grade CIN

Answer 20

Viral DNA integrates into host cell genome
Overexpression of viral E6 and E7
Dereguation of host cell cycle

Question 21

What is CIN 1

Answer 21

Low grade dysplasia

Will regress

Question 22

What is CIN 2

Answer 22

Moderate dysplasia

May regress

Question 23

What is CIN 3

Answer 23

Severe dysplasia

Unlikely to regress

Question 24

What is the treatment of CIN2/3

Answer 24

Excise transformation zone of cervix- LLETZ
Ablate TZ (Thermal/laser)

Question 25

What is the follow-up treatment for CIN

Answer 25

Follow up LBC at 6 months for cytology and high risk HPV
Negative- 3 year
Positive- colposcopy