Pap

Question 1

what is a pap?

Answer 1

A screening tool for premalignant cervical changes, NOT a diagnostic test

Question 2

cervical cells are removed from where?

Answer 2

from the ectocervix, transforamtion zone, and endocervical areas

Question 3

pt symptoms very important because why?

Answer 3

false positives and false negatives can occur

Question 4

the benefits of screening in decreasing the incidence and mortality of cervical cancer

Answer 4

need to be weighted against the risks of over diagnosis

Question 5

2 main types of cervical cancer

Answer 5

squamous cell carcinoma (more prevalent) adenocarcinoma

Question 6

screening can ??

Answer 6

detect precursors and early- stage disease for both types

Question 7

treatment of precursors and early- stage disease can prevent ?

Answer 7

the development of invasive cervical cancer

Question 8

cervical cancer screening recommended, however

Answer 8

whom to screen/ the optimal testing method (pap, HPV, both) and frequency are debated

Question 9

how are squamous cervical cytologic abnormalities reported (those detected with Pap tests)

Answer 9

using the term cervical squamous intraepithelial lesions (CSIL)

Question 10

cervical squamous intraepithelial lesions (CSIL) is stratified into 2 categories which are ??

Answer 10

low- grade squamous intraepithelial lesion (LSIL) high- grade squamous intraepithelial lesion (HSIL)

Question 11

LSIL (especially in young women) associated with

Answer 11

generally a transient HPV infection

Question 12

HSIL is more likely associated with

Answer 12

persistent HPV infection and a higher risk of progression to cervical cancer

Question 13

cytologic (Pap) findings were described with the following term

Answer 13

squamous intraepithelial lesion (SIL)

Question 14

histologic changes (always talking about a biopsy) described with the following term

Answer 14

cervical intraepithelial neoplasia (CIN)- this term CIN has 3 degrees of severity (grades 1 through 3, the higher the number the more serious the neoplastic changes are)

Question 15

CIN 1 is

Answer 15

a low grade lesion, refers to MILDLY atypical cellular changes in the lower third of the epithelium. HPV cytopathic effect ( koilocytotic atypia) is often present

Question 16

CIN 2 is

Answer 16

considered a high- grade lesion, refers to MODERATELY atypical cellular changes confined to the basal 2/3s of the epithelium (formally called moderate dysplasia) with preservation of epithelial maturation. There is considerable variability in this category

Question 17

CIN 2 is stratified according to p16 immunostaining to identify precancerous lesion but

Answer 17

it has poor reproducibility and is likely a heterogeneous mix that includes lesions that could be called CIN 1 or 3.

Question 18

specimens that are p16- negative are referred to are referred to as

Answer 18

LSIL

Question 19

specimens that are p16- positive are referred to as

Answer 19

HSIL

Question 20

CIN 3 is a ??

Answer 20

high- grade lesion, refers to SEVERELY atypical cellular changes encompassing GREATER than 2/3rds the epithelial thickness and includes full thickness lesions (previous terms were severe dysplasia or carcinoma in situ) referred to as HSIL

Question 21

this is?

Answer 21

mild dysplasia, CIN 1

Question 22

this is?

Answer 22

moderate dysplasia, CIN 2, p16 staining should be performed

Question 23

this is?

Answer 23

severe dysplasia, CIN 3

Question 24

this is?

Answer 24

Carcinoma in situ, CIN 3

Question 25

changes in Bethesda guidelines

Answer 25

LSIL cervical cytologic specimens that contain a few cells that are suspicious but not diagnostic of HSIL are reported as atypical squamous cells and cannot exclude high- grade squamous intraepithelial lesion (previosuly there was no recommendation on how to report these)

Question 26

another change in Bethesda guidelines

Answer 26

benign- appearing endometrial cells are reported only in women 45 years and older. (old threshold was 40 years old)

Question 27

factors that may interfere with Pap

Answer 27

meds that alter results- digitalis and tetracylcine vaginal meds/ contraceptives within 48 hrs of exam use of lub on speculum douching or tub baths within past 24 hrs poor collection or fixation technique

Question 28

contraindication for pap

Answer 28

menstruation

Question 29

related test to pap

Answer 29

colposcopy- main role is to locate abnormal appearing epithelium and to dorect biopsies to areas in which cervical intraepithelial neoplasia (CIN) 2,3 or invasive ca is suspected

Question 30

what is transformation zone

Answer 30

defined colposcopically as the area bordered laterally by the original squamocolumbnar junction and medially by the new sqiamocolumnar junction. Photo is showing: The original or native squamocolumnar junction (SCJ) migrates onto the portio as the result of changes in the hormonal milieu or of vaginal deliveries

Question 31

teaching point- ASC-US

Answer 31

atypical squamous cells with uncertain significance- some cells not normal, but we don't know why they changed or what impact they may have, usually not serious and may be d/t a vaginal infection or HPV, usually want a f/u exam repeat Pap or HPV testing

Question 32

teaching point- ACS-H

Answer 32

atypical squamous cells- high- some cells are not normal and there is a small possibility that they may be pre cancerous, we will perform a colposcopy to better look at cervix

Question 33

teaching point- AGC

Answer 33

atypical glandular cells- glandular cells produce mucus and are located in cervix or utuerus, these results mean some glandular cells are not normal but etiology is unclear. these changes are usually more serious, women with AGC have higher risk of cervical cancer, colposcopy recommended to examine any irregular tissue

Question 34

teaching point- LSIL

Answer 34

low grade squamous intraepithelial lesion- low grade means there are early changes in teh size/ shape of cells. often associated with presence of HPV, which may also cause genital warts. colpocopy, HPV testing recommended, or repeat pap

Question 35

teaching point- HSIL

Answer 35

high- grade squamous intraepithelial lesion- high grade means cells are very different from normal cells, usually precancerous and are more likely to lead to cervical cancer. colposcopy recommended to determine cancer risk

Question 36

teaching point- inflammation

Answer 36

if inflammation is present in the cells on the pap, it means that some WBCs were seen, its very common and usually does not signify a problem. if the inlammation is severe, we want to figure out the cause there may be an infection, we may want a repeat pap to see if the inflamation has improved

Question 37

teaching point- hyperkeratosis

Answer 37

this is a finding of dried skin cells on the pap. this change often occurs from using a cervical cap or diaphragm or from having a cervical infection. this rarely needs any more evaluation than a repeat pap in 6 mos- 1 year. if its still present we may want another pap or a colposcopy