Pathology Flashcards
where is the transformation zone?
what does it consist of?
Transformation zone (TZ) – Squamo-columnar junction between ectocervical (squamous) and endocervical (columnar) epithelia
what’s a nabothian follicle?
They are most often caused when stratified squamous epithelium of the ectocervix (toward the vagina) grows over the simple columnar epithelium of the endocervix (toward the uterus). This tissue growth can block the cervical crypts (subdermal pockets usually 2–10 mm in diameter), trapping cervical mucus inside the crypts.
How long does it typically take from HPV infection to cancer
HPV infection to High grade CIN
6 months - 3 years
High Grade CIN to Invasive Cancer
5 -20 years
What does CIN stand for?
what is it and where does it occur?
Cervical itra-epithelial carcinoma
Pre-invasive stage of cervical cancer
Occurs at the transformation zone.
Can involve large area.
Dysplasia of squamous cells
Not visible by naked eye
Asymptomatic
Detectable by cervical screening
what is a koilocyte
A Koilocyte is a squamous epithelial cell that has undergone a number of structural changes, which occur as a result of infection of the cell by human papillomavirus.
Nuclear enlargement (two to three times normal size)
Irregularity of the nuclear membrane contour
A darker than normal staining pattern in the nucleus, known as Hyperchromasia
A clear area around the nucleus, known as a perinuclear halo.
describe the different grades of cervical interepithelial neoplasia
CIN I - Basal 1/3 of epithelium occupied by abnormal cells.
¨Raised numbers of mitotic figures in lower 1/3.
¨Surface cells quite mature, but nuclei slightly abnormal.
CIN II - Abnormal cells extend to middle 1/3.
¨Mitoses in middle 1/3
¨Abnormal mitotic figures
CIN III - Abnormal cells occupy full thickness of epithelium.
¨Mitoses, often abnormal, in upper 1/3.
describe the staging of invasive squamous carcinoma
Stage 1A1 - depth up to 3mm, width up to 7mm
Stage 1A2 - depth up to 5mm, width up to 7mm
Low risk of lymph node metastases
Stage 1B - confined to the cervix
Stage 2 - spread to adjacent organs (vagina, uterus, etc..)
Stage 3 - involvement of pelvic wall
Stage 4 - distant metastases or involvement of rectum or bladder.
where does squamous cell carcinoma typically spread to
early stage
lymphatics
late organs
Local
uterine body, vagina, bladder, ureters, rectum
Lymphatic
early
pelvic, para-aortic nodes
Haematogenous
late
liver, lungs, bone
Name other HPV driven diseases
Vulvar Intraepithelial Neoplasia, VIN
Vaginal Intraepithelial Neoplasia, VaIN
Anal Intraepithelial Neoplasia, AIN
describe the grading of cervical carcinoma
Well differentiated
Moderately differentiated
Poorly differentiated
Undifferentiated / anaplastic
describe the staging of cervical carcinoma including the organs to which the cancer has spread
