Pathology of Cervix, Vagina, and Vulva 1 Flashcards

Describe the etiologic role that high risk HPV plays in the development of invasive cervical carcinoma.

1
Q

What is the area of transition of the cervix?

A

The transition from the glandular epithelium of the internal cervix to the squamous epithelium on the ectocervix

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2
Q

What is squamous metaplasia of the cervix?

A

Upon onset of menarche, the glandular epithelium on the external face of the cervix is replaced with squamous epithelium - area known as the transformation zone

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3
Q

What area of the cervix is uniquely sensitive to HPV?

A

transformation zone

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4
Q

What are the most important risk factors for cervical cancer?

A
  • HPV related
    • Multiple sexual partners
    • High parity
    • Early initiation of sexual activity
  • Smoking
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5
Q

What is the main etiologic factor for driving squamous dysplasia and how does it occur?

A
  • High risk HPV infection
    • viral DNA, extremely common
    • Most cases, immune system able to clear infection without dysplaisa
  • Some cases, infection becomes persistent and can result in dysplasia that evolves over the course of years to invasive cervical carcinomas
  • Mechanism
    • dysregulates cell cycle
    • uses two viral proteins
      • E6 - accelerates degradation of p53, impairs DNA repair and apoptosis
      • E7 - disrupts E2F-Rb dimers, which promotes re-entry into the cell cycle
    • P16 is upregulated as E2F-Rb dimers are disrupted, leads to uncontrolled cell replications
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6
Q

What are the low and high risk HPV types?

A
  • Low risk
    • types 6 and 11
    • associated with transient infections and genital warts
    • virtually never result in severe dysplasia or invasive cervical carcinoma
    • does not integrate into host genome - episomes
  • High risk
    • types 16 and 18 are most common (also 31 and 33)
    • much more likely to persist and promote dysplasia
    • also responsible for invasive carcinomas in the vagina, vulva, and head and neck
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