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Reproductive Pathology > Lesions of the Cervix > Flashcards

Lesions of the Cervix Flashcards

1
Q

What are the 4 main diseases of the cervix?

A
  1. Lower and upper genital tract infections
  2. Non specific inflammatory conditions
  3. Benign tumours
  4. Malignant tumours
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2
Q

What is the endocervix?

A

the inner part of the cervix that forms a canal that connects the vagina to the uterus
- lined with mucin secreting columnar epithelium

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3
Q

What is the ectocervix?

A

the portion of the cervix that projects into the vagina

- lined by stratified squamous epithelium

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4
Q

What is the junction between the epithelia of the endocervix and the ectocervix?

A

squamocolumnar junction (SCJ)

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5
Q

The squamocolumnar junction is the result of?

A
  1. continuous remodeling process resulting from uterine growth
  2. cervical enlargement
  3. hormonal status
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6
Q

Describe the SCJ at birth?

A

SCJ is exposed to the vagina due to oedema as a result of maternal oestrogen
- subsides after one week and remains in that position until puberty

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7
Q

Describe the SCJ at puberty?

A

due to influence of oestrogens, oedema comes back and the SCJ together with the columnar epithelium move outside to be exposed in the vagina

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8
Q

What happens when the squamocolumnar junction is exposed to the vagina?

A

exposed columnar epithelium is in a harsh environment and adapts by undergoing squamous metaplasia
- new squamocolunmar junction is formed

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9
Q

What is the transformation zone?

A

The area between the initial (true SCJ) and the new (physiological SCJ)

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10
Q

What is the significance of the transformation zone?

A
  • TZ contains actively and fast dividing cells
  • These cells are prone to HPV infection and DNA damage
  • Thus rich soil for precancerous lesions and carcinoma
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11
Q

Describe the epidemiology of squamous cell carcinoma of the cervix?

A
  • Common in the Sub-Saharan Africa
  • Seen in younger patients now
  • AIDS defining illness
  • Big burden in Malawi commonly seen as advanced tumours
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12
Q

What are the risk factors for squamous cell carcinoma?

A
  1. Early age at first sexual intercourse
  2. Multiple sexual partners
  3. Increased parity
  4. Male partner with multiple previous sexual partners
  5. Presence of high risk HPV
  6. Exposure to oral contraceptives and nicotine
  7. Presence of other genital infections e.g. chlamydia
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13
Q

Describe the role of HPV in the pathogenesis of SCC?

A
  1. HPV infects cells and its DNA is integrated into the host genome
  2. Early viral genes E6 and E7 disrupt the cell cycle regulatory proteins
    - E6 disrupts p53
    - E7 disrupts the retinoblastoma gene (RB)
  3. The cell goes into an uncontrolled proliferation
  4. Acquires further DNA damage
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14
Q

What is cervical intraepitelial neoplasia?

A
  • Precancerous stage for SCC
  • CIN represent a continuum of morphologic changes
  • Can progress to cancer or can spontanenously regress
  • Associated with high risk HPV (HPV16 and 18)
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15
Q

Describe the grading of CIN?

A

Graded according to severity of dysplasia

  1. CIN I: Mild dysplasia; <1/3 of epithelial thickness
  2. CIN II: Moderate dysplasia: >1/3 to <2/3
  3. CIN III: Severe dysplasia: >2/3 to full thickness
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16
Q

What is invasive SCC?

A

Disruption and invasion beyond basement membrane denotes invasive cancer
- Potential for lymphovascular invasion and metastases

17
Q

Describe the characteristics of invasive SCC tumours?

A
  1. Fungating (exophytic): common
  2. Ulcerating
  3. Infiltrative
18
Q

What is the importance of cervical SCC screening?

A
  1. the cancer is preventable

2. the cancer can be detected early through screening

19
Q

How is cervical SCC screening done?

A
  1. visual inspection with acetic acid (VIA)

2. exfoliative cytology i.e. PAP smears

20
Q

Describe the demography for screening for cervical SCC and HIV?

A
  1. Recommended in all HIV positive females from 25yrs

2. Non HIV females from 35 years

21
Q

The precancerous lesions on cytology are now graded as?

A
  1. Low grade intraepithelial lesion (LSIL) = CIN I
  2. High grade intraepithelial lesion (HSIL) = CINII and CINIII
    - HSIL requires urgent management with colposcopy and biopsy
    - LSIL: Can wait with repeat PAP in a year or so

Reproductive Pathology (8 decks)

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