Pathology: Cervical, Vulvul and Vagina Flashcards
What is the transformation zone
Squamo-columnar junction between ectocervic(squamous) and endocervix (columnar)
What is cervical erosion
Exposure of delicate endocervical epithelium to acid environment of vagina leads to physiological squamous metaplasia
What is a nabothian follicle (cyst)
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).
What can cause inflammatory pathology of the cervix
Cervicitis
Cervical polyp- can bleed, not premalignant
What can cause cervicitis
Follicular cervicitis- sub epithelial reactive lymphoid follicles present
Infection - chlamydia or herpes simplex
What neoplasms affect the cervix
CIN
Cancer- squamous carcinoma or adenocarcinoma
What is the cause of 70 percent of cervical cancer
HPV 16 and 18
What are the factors the increase risk of cervical cancer
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
What HPV types are ‘low risk’ and cause genital warts
6 and 11
What is the pathological appearances of genital warts (aka condyloma acuminatum)
thickened “papillomatous” squamous epithelium with cytoplasmic vacuolation (“koilocytosis”).
What is the pathological appearance of CIN
Infected epithelium remains flat, but may shows koilocytosis, which can be detected in cervical smears
At what point does the cell become invasive squamous carcinoma
when virus fully integrated into the host DNA
In what time frame does HPV infection become high grade CIN
6 mths to 3 yrs
In what time frame does high grade CIN become invasive cancer
5-20 yrs
What is the lifetime risk of acquiring HPV infection
80 percent - most people develop immunity and clear their HPV
Persistent HPV increase cancer risk
What are the features of CIN
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 histological feature indicated HPVinfection
koilocytosis
What cell features may koilocytes have
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
What are the three histological features of CIN
- Problem with maturation
- Nuclear abnormalities - koilocytes
- Excess mitosis
What percentage of CIN 1 progress to invasion
1 percent
What percentage of CIN2 progress to cervical cancer
5 percent
What percentage of CIN 3 progress to cancer
more than 12 percent
What is the most common type of malignant cervical tumours
Squamous cell - 95 percent
Develop from CIN
What age group are most likely to get cervical cancer
women in their 30s and forties
What is stage 1A1 squamous cell cervical cancer
depth up to 3mm, width up to 7mm
Stage 1A2
depth up to 5mm, width up to 7mm
Stag 1B
confined to cervic
Stage 2
adjacent organ spread ef vagina, uterus
Stage 3
Involvement of pelvic wall
Stage 4
distant mets or rectum/bladder involvement
list the symptoms of cervical cancer
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
Which lymph nodes with cervical cancer first spread to
Pelvic the para aortic
What is CGIN
Cervical glandular intraepithelial neoplasi
Origin from endocervix
The preinvasive phase of endocervical ADENOCARCINOMA
What is the problem with CGIN
Screening less effective because it is difficult to see on smear
Can be associated with CIN
What type of cervical cancer has a worse prognosis
ndocervical adenocarcinoma
Name other HPV mediated diseases
VIN
VaIN
AIN
Often synchronous
What is the epidemiology of VIN
Bimodal
Young and older women ( more likely to become invasive in older women)
Are vulvar invasive squamous carcinomas always HPV related
no, can arise from normal epithelium
What is the most important prognostic indicator in vulval cancer
inguinal lymph node invasion
What is vulvar pagets disease
rare, slow-growing, usually noninvasive intraepithelial (in the skin) adenocarcinoma outside the mammary gland and includes Paget’s disease of the vulva
What are the symptoms of vulvar pagets
Crustin rash
Mucin containing tumour cells
Arises from sweat gland
