Lecture 21 Workshop Clinical Pathological Conference of the Uterus Flashcards
Most HPV infections are cleared by the immune system (True/False)
True
What is the most common type of the HPV virus
HPV 16/18
Where do you see cervical changes in a patient
Transformation zone
What is the age group that are included in the cervical screening programme
Ages 25-64
How often must you get cervical smears
5 yearly smears
If a patient is hrHPV positive what is the next step
Triage with cytology
Done by HPV tests and not cytology staining
What technology does HPV test use
PCR and Hybridisation
When would cervical cytology take place
If the patient is high risk and HPV +ve
What is a sign of CIN in cervical cytology samples
Abnormal cells (Dyskaryosis)
What are the nuclear features of abnormal cells in cervical cancer
Increased size
Coarse irregular chromatin
Nucleoli
If Dyskaryosis is detected in the cytology sample what is the next step
Colposcopy
How is colposcopy carried out
Acetic acid and Iodine is used and a small biopsy is taken to make a diagnosis
What does CIN stand for
Cervical Intraepithelial Neoplasia
What is the function of E7 protein product
Prevents cell cycle arrest
What is the function of E6 protein product
Inhibits cell death
What is the function of L1 and L2
Forms into protein coat where early genes are contained
Describe the HPV histology
Koilocytosis
Cells with wrinkled nucleus
Perinuclear halo
Multinucleation
Name low risk HPV types
6,11,42,44
Genital warts and low grade CIN
Name high risk HPV types
16,18,31,45
High grade CIN and (more rarely) cancer
How does HPV cause high grade CIN
Viral DNA integrates into host cell genome
Overexpression of viral E6 and E7
Dereguation of host cell cycle
What is CIN 1
Low grade dysplasia
Will regress
What is CIN 2
Moderate dysplasia
May regress
What is CIN 3
Severe dysplasia
Unlikely to regress
What is the treatment of CIN2/3
Excise transformation zone of cervix- LLETZ Ablate TZ (Thermal/laser)
What is the follow-up treatment for CIN
Follow up LBC at 6 months for cytology and high risk HPV
Negative- 3 year
Positive- colposcopy
