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
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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
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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
2
Q
What is the gross appearance of cervical carcinoma?
A
Exophytic, firable mass on the surface of the cervix
3
Q
What are the microscopic and key findings of a tumor that is squamous cell cervical carcinoma?
A
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Microscopic appearance
- individual squamous cells
- infiltrates throgh a cellular and inflammatory (desmoplastic) stroma
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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
- intracellular bridges between adjacent tumor cells
- 90% of cervical cancers
- HPV infected squamous cells called koilocytes
- markedly enlarged with irregular nuclei but abundant cytoplasm
- wrinkled nuclei and perinuclear clearing
4
Q
What are the important features of adenocarcinoma of the cervix?
A
- 10% of cervical cancer
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Key features
- gland formation by definition
- intracellular and extracellular mucin production
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
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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
- abnormal cells confined to bottom 1/3 of epithelium = mild
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
7
Q
Describe the histology of HPV infected cells in the cervix.
A
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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