Pathology

Question 1

What types of epithelium are normally found in the cervix?

Answer 1

ectocervix = stratified squamous epithelium (non-keratinised)
endocervix - simple columnar epithelium

Question 2

What is the transformation zone of the cervix?

Answer 2

where the columnar epithelium transitions to stratified squamous epithelium

Question 3

What is cervical erosion?

Answer 3

Physiological squamous metaplasia to protect against trauma, resulting in immature squamous epithelium (benign)

Question 4

What name is given to the benign mucous-filled cysts found on the surface of the cervix, and what commonly causes them?

Answer 4

Nabothian follicles/cysts - commonly caused by cervical erosion

Question 5

What is condyloma acuminatum and what condition is it associated with?

Answer 5

thickened papillomatous squamous epithelium with cytoplasmic vacuolation (koilocytosis) - associated with Genital warts (HPV 6 and 11)

Question 6

What does koilocytosis indicate?

Answer 6

HPV infection

Question 7

Name 3 physiological processes that alter the position of the transition zone.

Answer 7

Menarche
Pregnancy
Menopause

Question 8

What is a complication of cervicitis?

Answer 8

Infertility due to simultaneous silent fallopian tube damage

Question 9

What benign cervical condition can cause IMB and PMB?

Answer 9

cervical polyp

Question 10

What are the risk factors for cervical cancer?

Answer 10

Persistence of high risk HPV infection
- many sexual partners
- long term use of OCP
- non-use of barrier contraception
Smoking
Immunosuppression

Question 11

Where does CIN occur?

Answer 11

Transformation zone

Question 12

What are the stages of CIN and where do they occur?

Answer 12

CIN 1: lower (basal) third of epithelium
CIN 2: lower and middle third of epithelium
CIN 3: all thirds (full thickness) of epithelium

Question 13

Why is CIN pre-malignant, and not malignant?

Answer 13

There is no breach of the basement membrane

Question 14

What is stage 4 invasive cervical carcinoma?

Answer 14

Distant metastasis or involvement of bladder or rectum

Question 15

What is stage 2 invasive cervical carcinoma?

Answer 15

spread to adjacent organs - vagina, uterus

Question 16

What is stage 3 invasive cervical carcinoma?

Answer 16

Involvement of pelvic wall

Question 17

Where does CGIN originate from?

Answer 17

endocervical epithelium

Question 18

What is CGIN?

Answer 18

cervical glandular intraepithelial neiplasia - pre-invasive phase of endocervical adenocarcinoma

Question 19

What is vulvar Paget’s disease?

Answer 19

crusting rash
tumour cells in the epidermis, contain mucin
tumour arises from sweat glands in the skin, usually no underlying cancer

Question 20

What is Meigs syndrome?

Answer 20

Triad of ascites, plural effusion (classically right sided), and benign ovarian tumour (e.g. fibroma, Brenner tumour, granulosa cell tumour)

Question 21

What is the best management for moderate dyskariosis on a smear?

Answer 21

suggestive of CIN II - refer to colposcopy

Question 22

What is the best management of severe dyskariosis on a smear?

Answer 22

suggestive of CIN III - refer to colposcopy

Question 23

When is urgent referral to colposcopy indicated?

Answer 23

suspected invasive cancer

emergency referral is 2 weeks

Question 24

What is the histological definition of a teratoma?

Answer 24

Made from all three germ cell layers - mesoderm (e.g. muscle, connective tissue), endoderm (epithelium e.g. organ epithelium, sebaceous glands), ectoderm (skin and it’s appendages)