Pathology of Cervix, Vagina, and Vulva 2 Flashcards

Describe the protracted natural history of cervical dysplasia and the low rate of progression to invasive cervical carcinoma.

1
Q

What is dysplasia and how does it relate to cervical cancer? (important!)

A
  • Invasive cervical carcinoma only arises in the background of squamous dysplasia
    • Most cases of mild dysplasia harbor high risk HPV as do almost all cases of moderate/severe dysplasia and invasive carcinoma
    • Squamous dysplasia is 100x more common than invasive carcinoma
  • Definition
    • dysregulated growth and loss of maturation in squamous epithelium without invasion into the underlying stroma
  • Typically progresses from mild to moderate to severe forms before invading through the basement membrane and into the stroma
  • Most cases of squamous dysplasia won’t progress and will spontaneously regress without treatment
    • it takes years for progress from LSIL to HSIL and years to progress to invasive carcinoma
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2
Q

What is the gross appearance of cervical carcinoma?

A

Exophytic, firable mass on the surface of the cervix

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3
Q

What are the microscopic and key findings of a tumor that is squamous cell cervical carcinoma?

A
  • Microscopic appearance
    • individual squamous cells
    • infiltrates throgh a cellular and inflammatory (desmoplastic) stroma
  • Key features
    • intracellular bridges between adjacent tumor cells
      • tight junctions - made of desmosomes
    • keratinization which appears as bright orange/pink material either inside or outside the cytoplasm
  • 90% of cervical cancers
  • HPV infected squamous cells called koilocytes
    • markedly enlarged with irregular nuclei but abundant cytoplasm
    • wrinkled nuclei and perinuclear clearing
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4
Q

What are the important features of adenocarcinoma of the cervix?

A
  • 10% of cervical cancer
  • Key features
    • gland formation by definition
    • intracellular and extracellular mucin production
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5
Q

What are some key findings of dysplasia on histology?

A
  • High nuclear:cytoplasmic ratios
  • Somewhat enlarged crowded nuclei with irregular contours
  • Mitotic figures above the basal layer
  • No invasion of the underlying stroma by definition
  • Grading
    • abnormal cells confined to bottom 1/3 of epithelium = mild
      • Low grade intraepithelial lesion (LSIL) = CIN 1
    • extension to middle 2/3 = moderate
      • CIN 2
    • upper 1/3 = high grade
      • High grade squamous intraepithelial lesion (HSIL) = CIN 2,3
    • full thickness also called carcinoma in situ
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6
Q

What are some other common infecious diseases of the female reproductive tract?

A
  • Syphilis
    • Treponema pallidum
    • Primary, secondary, and tertiary stages
  • Herpes simplex (HS)
    • Type 2 fairly common
    • persists in regional nerve ganglion
    • risk of transmission to fetus
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7
Q

Describe the histology of HPV infected cells in the cervix.

A
  • Koilocytes
    • cells infected with HPV
    • not dysplastic
  • Big cells in the superficial portion of the epithelium
  • Big dark crinkled nuclei (raisin-oid), often binucleated
  • Perinuclear clear halo
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