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Y3 OBS AND GYNAE > Pathology of Cervix, Vulva and Vagina > Flashcards

Pathology of Cervix, Vulva and Vagina Flashcards

1
Q

What is the ectocervix? What epithelium is it composed of?

A

Vaginal portion of the cervix, seen on internal examination

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2
Q

What is the endocervix?

A

Lowermost portion of the uterus

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3
Q

Describe the lining of the ectocervix

A

Non-keratinising stratified squamous epithelium with basal and parabasal cells

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4
Q

Describe the lining of the endocervix

A

Simple columnar epithelium that secretes mucous via cilia

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5
Q

What is the transformation zone? What happens to the position of this zone?

A

Squamocolumnar junction between ectocervical and endocervical epithelia
Alters during menarche, pregnancy and menopause

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6
Q

What is the clinical significance of the transformation zone?

A

Most common place on the cervix for abnormal cells to develop

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7
Q

How does cervical erosion occur?

A

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

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8
Q

How are Nabothian follicles formed?

A

When stratified squamous epithelium of the ectocervix grows over the simple columnar epithelium of the endocervix

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9
Q

State the two main types of pathology of the cervix and give examples

A

Inflammatory (cervicitis, polyp)

Neoplastic (CIN, squamous or adenocarcinoma)

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10
Q

What is cervicitis?

A

Non-specific acute or chronic inflammation resulting in subepithelial reactive lymphoid follicles in the cervix

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11
Q

How can cervicitis cause infertility in the long-term?

A

Simultaneous silent fallopian tube damage

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12
Q

What are the most common causes of cervicitis?

A

Commonly, a sexually-transmitted infection
Chlamydia trachomatis
Herpes simplex virus

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13
Q

Cervical polpys are premalignant. True/ False?

A

False

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14
Q

What is a cervical polyp? How do they present?

A

Localised inflammatory outgrowth

Bleeding if ulcerated

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15
Q

List risk factors for neoplastic changes of the cervix

A

Persistence of HPV (many sexual partners)
Vulnerability of SCJ (age of 1st intercourse, use of oral contraceptives, avoidance of barrier contraceptives)
Smoking
Immunosuppression

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16
Q

List the main presentations of HPV, in order of risk

A

Genital warts
Cervical intra-epithelial neoplasia
Cervical cancer

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17
Q

What types of HPV are associated with genital and vulvar warts?

A

Type 6

Type 11

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18
Q

What types of HPV are associated with cervical neoplasia?

A

Type 16

Type 18

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19
Q

Describe the pathological appearance of genital warts

A

Thickened papillomatous squamous epithelium Cytoplasmic vacuolation (koilocytosis)

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20
Q

Describe the pathological appearance of CIN

A

Infected flat epithelium

Signs of koilocytosis

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21
Q

Outline the timeline of progression of HPV to cervical cancer

A

HPV –> CIN: 6 months to 3 years

CIN –> cervical cancer: 5-20 years

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22
Q

What is the main risk factor for progression of HIV to cervical cancer?

A

Persistant exposure to HPV infection

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23
Q

What is cervical intra-epithelial neoplasia?

A

A preinvasive stage of cervical cancer occuring at transformation zone which involves dysplasia of squamous cells

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24
Q

How is CIN typically detected?

A

Asymptomatic

Detected by cervical screening

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25
List the key histological factors that identify the severity of cervical intra-epithelial neoplasia
Delay in maturation/differentiation of immature basal cells Nuclear abnormalities (hyperchromasia, increased N:C ratio, pleomorphism) Excess mitotic activity above basal layer (abnormal mitotic forms)
26
How is CIN graded?
How deep the cell changes go into the surface of the cervix: CIN 1,2,3
27
Describe the pathological appearance of CIN1
Basal third of epithelium occupied by abnormal cells
28
Describe the pathological appearance of CIN2
Abnormal cells extend to middle third of epithelium
29
Describe the pathological appearance of CIN3
Abnormal cells occupy full thickness of epithelium
30
Outline the prevalence of the main types of malignant cervical tumours
Invasive squamous carcinomas: 75-95% | Endocervical adenocarcinoma: 5-25%
31
List the stages of invasive squamous carcinoma
``` 1A1: depth up to 3mm, width up to 7mm 1A2: depth up to 5mm, width up to 7mm 1B: confined to cervix 2: spread to adjacent organs 3: Involvement of pelvic wall 4. Distant mets or involvement of rectum or bladder ```
32
List symptoms of early invasive squamous carcinoma
Usually asymptomatic
33
List symptoms of late invasive squamous carcinoma
Abnormal bleeding (PCB, PMB, IMB) Brownish or blood-stained vaginal discharge Pelvic pain Haematuria, urinary problems Ureteric obstruction, acute renal failure
34
List common sites of local spread in SCC
``` Uterine body Vagina Bladder Ureters Rectum ```
35
List common sites of lymphatic spread in SCC
Pelvic nodes | Paraortic nodes
36
List common sites of haematogenous spread in SCC
Liver Lungs Bone
37
What are the grading classifications used in SCC?
Well differentiated Moderately differentiated Poorly differentiated Indifferentiated/ anaplastic
38
State the two main types of cervical glandular lesions
Cervical glandular intra-epithelial neoplasia (CGIN) | Endocervical adenocarcinoma
39
What is cervical glandular intra-epithelial neoplasia?
Preinvasive phase of endocervical adenocarcinoma originating from the endocervical epithelium
40
List risk factors for endocervical adenocarcinoma
Young women Later onset of sexual activity Smoking HPV 18
41
Adenocarcinoma and squamous carcinoma of the cervix can occur simultaneously. True/ False?
True | Known as adenosquamous carcinomas
42
List management options for cervical cancer
Surgery (LLETZ for early cancer, hysterectomy) Radiotherapy (external beam, brachytherapy) Chemotherapy (neoadjuvant, concomitant, palliative)
43
List other types of HPV driven disease
Vulvar intrapeithelial neoplasia (VIN) Vaginal intraepithelial neoplasia (VaIN) Anal intraepithelial neoplasia (AIN)
44
Define the bimodal presentation of VIN
Young women: multifocal, recurrent, persistant | Older women: great risk of progression
45
Describe Paget's disease of the vulva?
Skin cancer derived from glandular cells on the skin of the vulva characterised by a red, crusting, itchy rash
46
What is vulvar invasive squamous carcinoma?
A well differentiated malignant tumour, typically found in elderly women, presenting as an ulcer or exophytic mass
47
What is an important prognostic factor in vulvar invasive squamous carcinoma?
Spread to inguinal lymph nodes
48
Outline the management of vulvar invasive squamous carcinoma
Radical vulvectomy | Inguinal lymphadenectomy
49
What infection is a common form of vulvar disease, particularly in diabetics?
Candida
50
What is a Bartholin's gland abscess?
Bartholin's gland, located on either side of the opening of the vagina, becomes obstructed forming a cyst that can become infected and painful
51
List other types of non-neoplastic epithelial disorders that con form on the vulva
``` Lichen sclerosis (itchy white patches) Lichen planus (itchy rash) Psoriasis ```
52
What group of women typically get vulvar atrophy?
Post-menopausal women
53
List the main types of vaginal neoplastic pathology
Vaginal intraepithelial neoplasia Squamous carcinoma Melanoma
54
What group of women typically get invasive squamous carcinoma of the vagina?
Elderly women
55
How might vaginal melanoma present?
Pigmented lesion, similar to a polyp
56
What is the first-line treatment for 1A1 disease?
Local excision(LLETZ) +/- pelvic lymph node dissection
57
What is the first-line treatment for 1A2-1B1 stage disease?
>2cm, not desiring fertility = hysterectomy (non-surgical = chemoradiation) <2cm, desiring fertility = radical trachelectomy
58
What is the first-line treatment for 1B2-2A stage disease?
Radical hysterectomy +lymphadenectomy
59
What is the first-line treatment for 2B-4A stage disease?
Chemoradiation
60
What is the first-line treatment for 4B stage disease?
Combination chemotherapy
61
What is the first-line treatment for a pregnant women at any stage?
MDT care | Delivery at 35 weeks

Y3 OBS AND GYNAE (44 decks)

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