Pathology: Cervical, Vulvul and Vagina

Question 1

What is the transformation zone

Answer 1

Squamo-columnar junction between ectocervic(squamous) and endocervix (columnar)

Question 2

What is cervical erosion

Answer 2

Exposure of delicate endocervical epithelium to acid environment of vagina leads to physiological squamous metaplasia

Question 3

What is a nabothian follicle (cyst)

Answer 3

a mucus-filled cyst on the surface of the cervix. 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).

Question 4

What can cause inflammatory pathology of the cervix

Answer 4

Cervicitis

Cervical polyp- can bleed, not premalignant

Question 5

What can cause cervicitis

Answer 5

Follicular cervicitis- sub epithelial reactive lymphoid follicles present
Infection - chlamydia or herpes simplex

Question 6

What neoplasms affect the cervix

Answer 6

CIN

Cancer- squamous carcinoma or adenocarcinoma

Question 7

What is the cause of 70 percent of cervical cancer

Answer 7

HPV 16 and 18

Question 8

What are the factors the increase risk of cervical cancer

Answer 8

Persistant high risk HPV infection - 16, 18, 31, 33, 35
Many sexual partners increases this risk
Vunerability of SC junction in early reproductive life - age at first intercourse, long term use of oral contraceptive, not using barrier contraception
Smoking
Immunosuppresion eg HIV

Question 9

What HPV types are ‘low risk’ and cause genital warts

Answer 9

6 and 11

Question 10

What is the pathological appearances of genital warts (aka condyloma acuminatum)

Answer 10

thickened “papillomatous” squamous epithelium with cytoplasmic vacuolation (“koilocytosis”).

Question 11

What is the pathological appearance of CIN

Answer 11

Infected epithelium remains flat, but may shows koilocytosis, which can be detected in cervical smears

Question 12

At what point does the cell become invasive squamous carcinoma

Answer 12

when virus fully integrated into the host DNA

Question 13

In what time frame does HPV infection become high grade CIN

Answer 13

6 mths to 3 yrs

Question 14

In what time frame does high grade CIN become invasive cancer

Answer 14

5-20 yrs

Question 15

What is the lifetime risk of acquiring HPV infection

Answer 15

80 percent - most people develop immunity and clear their HPV

Persistent HPV increase cancer risk

Question 16

What are the features of CIN

Answer 16

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

Question 17

What histological feature indicated HPVinfection

Answer 17

koilocytosis

Question 18

What cell features may koilocytes have

Answer 18

Koilocytes may have the following cellular changes:

• Nuclear enlargement (two to three times normal size) ie increases nucleocytoplasmic ratio
• 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

Question 19

What are the three histological features of CIN

Answer 19

• Problem with maturation
• Nuclear abnormalities - koilocytes
• Excess mitosis

Question 20

What percentage of CIN 1 progress to invasion

Answer 20

1 percent

Question 21

What percentage of CIN2 progress to cervical cancer

Answer 21

5 percent

Question 22

What percentage of CIN 3 progress to cancer

Answer 22

more than 12 percent

Question 23

What is the most common type of malignant cervical tumours

Answer 23

Squamous cell - 95 percent

Develop from CIN

Question 24

What age group are most likely to get cervical cancer

Answer 24

women in their 30s and forties

Question 25

What is stage 1A1 squamous cell cervical cancer

Answer 25

depth up to 3mm, width up to 7mm

Question 26

Stage 1A2

Answer 26

depth up to 5mm, width up to 7mm

Question 27

Stag 1B

Answer 27

confined to cervic

Question 28

Stage 2

Answer 28

adjacent organ spread ef vagina, uterus

Question 29

Stage 3

Answer 29

Involvement of pelvic wall

Question 30

Stage 4

Answer 30

distant mets or rectum/bladder involvement

Question 31

list the symptoms of cervical cancer

Answer 31

Post coital or post menopausal bleeding
Brown or blood stained vaginal discharge
Content bleeding - friable epithelium
Pelvic pian
Haematuria/utis
Ureteris obstruction/renal failure

Often Asymtomatic

Question 32

Which lymph nodes with cervical cancer first spread to

Answer 32

Pelvic the para aortic

Question 33

What is CGIN

Answer 33

Cervical glandular intraepithelial neoplasi
Origin from endocervix
The preinvasive phase of endocervical ADENOCARCINOMA

Question 34

What is the problem with CGIN

Answer 34

Screening less effective because it is difficult to see on smear

Can be associated with CIN

Question 35

What type of cervical cancer has a worse prognosis

Answer 35

ndocervical adenocarcinoma

Question 36

Name other HPV mediated diseases

Answer 36

VIN
VaIN
AIN
Often synchronous

Question 37

What is the epidemiology of VIN

Answer 37

Bimodal

Young and older women ( more likely to become invasive in older women)

Question 38

Are vulvar invasive squamous carcinomas always HPV related

Answer 38

no, can arise from normal epithelium

Question 39

What is the most important prognostic indicator in vulval cancer

Answer 39

inguinal lymph node invasion

Question 40

What is vulvar pagets disease

Answer 40

rare, slow-growing, usually noninvasive intraepithelial (in the skin) adenocarcinoma outside the mammary gland and includes Paget’s disease of the vulva

Question 41

What are the symptoms of vulvar pagets

Answer 41

Crustin rash
Mucin containing tumour cells
Arises from sweat gland