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REPRO > Pathology of Cervix, Vulva and Vagina > Flashcards

Pathology of Cervix, Vulva and Vagina Flashcards

1
Q

What is the vagina lined by

A

Stratified Squamous epithelium

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2
Q

Describe the layers of the ectocervix from INSIDE out

A

BM>basal cells>parabasal cells>intermediate cells>superficial cells>Exfoliating cells

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3
Q

What is the transformation zone?

A

Squamo-columnar junction between ectocervical (squamous) and endocervical (columnar) epithelia

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4
Q

Where is the transformation zone?

A
  • just before the external OS of cervix

- lower cervix

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5
Q

Site for CIN

A

-90% IN TRANSFORMATION ZONE

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6
Q

What is cervical ectropion?

What may is present as?

A
  • Endocervical cells begin to grow on the ectocervix
  • Exposure of delicate endocervical epithelium to acid environment of vagina leads to physiological squamous metaplasia
    .
    .
    .
    .
    .
    bleeding (before and after sex) , discharge (with streaks of blood) , dyspareunia
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7
Q

What are Nabothian follicles?

A

-mucus producing glands on the cervix - benign structures in the cervix

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8
Q

What are neoplastic lesions of the cervix?

A
  • CIN (cervical Intra-epithelial neoplasia)

- Cervical cancer (Squamous CA and adenoCA)

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9
Q

Name inflammatory lesions of the cervix.

A

Cervicitis

cervical polyp

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10
Q

What is the % Cervical cancer is caused by HPV?

A

75%

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11
Q

What cells does HPV infect?

A
  • epithelial cells in the cervical mucosa

- —-HPV DNA integrates into cellular genome causing CANCER

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12
Q

Most common HIGH risk HPV types

A

16 and 18

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13
Q

Who is at HIGH RISK of Cervical cancer

A
  • smoking (3x risk)
  • immunosuppresion
  • age at first intercourse
  • long term use of oral contraceptives
  • non-use of barrier contraception (ask those despite use of pills)
  • having multiple sex partners
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14
Q

Is CIN malignant?

A

NO

  • it is still INTRA- epithelial; epithelium is intact !
  • BUT it is a pre-invasive stage of cervical cancer
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15
Q

What do low risk HPV types cause?

A

Genital Warts
(types 6 and 11)
—-CONDYLOMA ACUMINATA (thickened papillomatous squamous epithelium with cytoplasmic vacuolation)

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16
Q

When is it considered to be malignant?

A
  • when squamous cells break through the epithelium
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17
Q

Symptoms of CIN>

A
  • asymptomatic

- detectable by cervical screening

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18
Q

CIN III is equivalent to _____

A

Squamous cell CA in-situ

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19
Q

When is it deemed to be cancerous?

A
  • evidence of epithelium cells invading the basement membrane —-may grow down as endocervical crypts …?
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20
Q

What is the most common malignant cervical tumors?

A

75-95% is Invasive squamous carcinoma

2nd commonest female cancer worldwide

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21
Q

How does Invasive squamous Ca (ISC) of the cervix develop?

A
  • develops from pre-existing CIN

- –should be preventable by screening

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22
Q

What is the diff. btwn CIN types I,II AND III?

A
  • CIN I: presence of abnormal Mitotic cells in the basal 1/3 of epithelium
  • CIN II: abnormal cells extend to MIDDLE 1/3
  • CIN III: occupies FULL thickness
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23
Q

What are diff. forms of abnormal BLEEDING, seen as SX for invasive ca?

A
  • POST-COITAL
  • brownish/blood stained vaginal discharge
  • contact bleeding (fRIABLE epithelium)
  • post-menopausal
24
Q

Symptoms of invasive carcinoma.

A
  • abnormal bleeding
  • pelvic pain
  • hematuria/UTI
  • ureteric obstruc./ renal failure
25
Q

What is Cervical Glandular Intra-epithelial Neoplasia?

What does CGIN come hand in hand with?

A
  • a pre-invasive phase of ENDOCERVICAL adenocarcinoma
  • a.w CIN
    A.w HPV
26
Q

In which cervical cancer is screening LESS effective?

A

CGIN

  • hard to dx on cervical smear
  • SOMETIMES a.w CIN
27
Q

Other HPV- driven disease?

A
  • Vulvar Intraepithelial Neoplasia, VIN
  • Vaginal Intraepithelial Neoplasia, VaIN
  • Anal Intraepithelial Neoplasia, AIN
28
Q

What are neoplastic lesions of the vulva?

A
  • VIN (vulvar intraepithelium neoplasia)—-a.w Lichen sclerosis
  • Paget’s disease
29
Q

Is VIN a.w HPV?

A
  • OFTEN

not always

30
Q

What is VIN synchronous with?

A
  • often synchronous with CIN and VaIN
31
Q

aRE YOUNGER or older women at risk of vulvar invasive squamous CA?

A

OLDER ! —greater risk of VIN to progress in to isc (but may also arise from NORMAL epithelium)

32
Q

How to treat Vulvar ISC?

A

surgical

  • —radical vulvectomy and inguinal lymphadenopathy –If node +: <60% 5 year survival
  • if node (-)ve= 90% 5 year survival
33
Q

How does vulvar paget’s disease present as?

A
  • painful
  • itchy d.t crusting rash
  • ## oozing
34
Q

Where does the vulvar paget’s disease arise from?

A

sweat gland in skin

35
Q

What can cervicitis be caused by?

A
  • Chlamydia Trachomatis
  • Herpes Simplex Viral infection
  • follicular cervicitis
36
Q

What is a cervical polyp?

A
  • a localized inflammatory OUTGROWTH

- bleeds if ulcerated

37
Q

IS Cerv. polyp a premalignant lesion?

A

no

38
Q

Can cervicitis lead to infertility?

A
  • yes

- d.t simultaneous fallopian tube damage

39
Q

What do the high risk HPV types cause?

A
  • CIN
  • —-infected epithelium remains FLAT
  • —-may show koliocytosis (detected on cervical smear)
40
Q

How long is the progression of HPV infection into HIGH grade CIN?

A

6 MONTHS- 3 YEARS

41
Q

Is the progression of high grade CIN to invasive cancer fast?

A
  • NO

- 5-20 years !

42
Q

What is alarming on smear test results?

A
  • mild dyskaryosis
  • viral fts
    (disproportionate nucleus to cytoplasmic ratio)
43
Q

Where does CIN occur?

And what occurs?

A
  • at the transformation zone
    (may involve a LARGE area)
    —-dysplasia of SQUAMOUS cells
44
Q

What is seen on histology of CIN?

A
  • delay in maturation
    (immune BASAL cells occupying more of epithelium)
  • nuclear abnormalities (hyperchromasia/ ^ nucleocytoplasmic ratio/ pleomorphism)
  • excess mitotic activity (above basal layers/ abnormal mitotic forms)
45
Q

Koliocytosis seen on smear test. What does it suggest?

A
  • HPV infection

halo around dysplastic nucleus

46
Q

How does squamous carcinoma spread?

A
  • local> surrounding organs (uterus/vagina/bladder/bowel)
  • Lymphatic (pelvic and para-aortic nodes)
  • Hematogenous (later stage–>LIVER/LUNGS/BONES)
47
Q

How to classify squamous carcinoma?

A
  • well-differentiated
  • moderately
  • poorly
  • undifferent.
48
Q

What is CGIN?

A
  • cervical glandular intraepithelial neoplasia (CGIN)

- —-it is the PRE-INVASIVE phase of ENDOCERVICAL adenocarcinoma

49
Q

Are the ladies most likely to be younger in endocervical adenocarcinoma or squamous carcinoma?

A
  • adenocarcinoma

- –WORSE prognosis than squamous carcinoma

50
Q

What is the epidemiology of adenocarcinoma?

A
  • HIGHER s.e class
  • later onset of sexual activity
  • smoking
  • HPV 18
51
Q

How does Vulvar intraepithelial neoplasia present as?

A
  • variable
  • 3 grades
    YOUNG women: multifocal, recurrent or PERSISTENT (rx problems)

Olderwomen: RISK of progression to INVASIVE squamous carcinoma

52
Q

Are the VINs well differentiated?

And what is an important prognostic factor?

A
  • most are well differentiated
    (esp. VERRUCOUS)
  • spread to INGUINAL lymph nodes = prognostic factor
53
Q

How does vulvar invasive squamous carcinoma present as?

A
  • THICK, SCALY, bumpy skin
  • area is VERY itchy, red, or darker/lighter
  • enlarged lymph nodes
  • pain on urination
  • burning sensation
54
Q

Name other vulvar lesions.

A

Infections: candida (diabetic) / vulvar warts/ bartholin’s glands abscess

  • non-epithelial d.o: Lichen Sclerosis and other dermatoses (lichen planus/psoriasis)
  • atrophy (post-menopause)
55
Q

How common is Vaginal squamous carcinoma?

A
  • LESS common than cervical and vulvar counterparts (disease of the elderly)
56
Q

How does a vaginal melanoma appear?

A
  • as a polyp
57
Q

How does vulvar invasive squamous carcinoma appear as in an older women?

A
  • ULCER

- EXOPHYTIC mass

REPRO (55 decks)

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