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Repro and Sexual Health > Pathology of Cervix, Vulva and Vagina > Flashcards

Pathology of Cervix, Vulva and Vagina Flashcards

1
Q

divisions of cervix?

A

ectocervix
- external surface at entrance to cervix/uterus
- lined by squamous epithelium
endocervix
- canal inside the cervix leading into the uterus
- glandular epithelium lines

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2
Q

what lines vagina?

A

squamous epithelium

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3
Q

layers of cells in ectocervix from top to bottom?

A 
exfoliating cells 
superficial cells
intermediate cells
parabasal cells
basal cells
basement membrane
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4
Q

what cells of ectocervix are sampled by smear test?

A

exfoliating and supporting cells?

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5
Q

features of endocervix

A

columnar epitheium

cillia

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6
Q

what is the transformation zone?

A

area between old squamo-columnar junction (before menarche) and new squamo-columnar junction (post-menarche)
- junction between endo and ecto cervical epithelia

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7
Q

clinical relevance of transformation zone?

A

site of infection and cancer

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8
Q

what alters the position of TZ?

A

menarche
pregnancy
menopause

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9
Q

what is cervical erosion and what can it cause?

A

exposure of the delicate endocervical epitheium to the acidic environment of the vagina leading to squamous metaplasia
- (can lead to squamous carcinoma?)

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10
Q

what are nabothian follicles?

A

mucous filled cyst on surface of cervix

often happens when squamous epithelium grows over columnar epithelium

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11
Q

what is cervicitis?

A

non-specific acute/chronic inflammation in the cervix
often asymptomatic
can lead to infertility due to simultaneous silent fallopian tube damage

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12
Q

types of cervicitis?

A

follicular cervitis - subepithelial reactive lymphoid follicles present in cervix
chlamydia trachomatis - sexually transmitted
herpes simplex

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13
Q

what is a cervical polyp?

A

localised inflammatory outgrowth
cause of bleeding if ulcerated
not premalignant

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14
Q

types of neoplasia in cervix?

A 
cervical intraepithelial neoplasia (CIN)
cervical cancer (squamous carcinoma, adenocarcinoma)
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15
Q

biggest cause of cervical cancer?

A

HPV

- but can still occur due to other causes

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16
Q

risk factors for CIN?cervical cancer?

A 
persistence of high risk HPV (16 and 18)
- multiple partners increases risk
vulnerable TZ in early reproductive life
- young age at first intercourse
- long term oral contraceptive use
- non-use of barrier contraception
smoking
immunosuppression
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17
Q

what does low risk HPV (6 and 11) cause?

A

genital warts

- condyloma acuminatum: thickened papillomatous squamous epithelium with cytoplasmic vacuolation (koilocytosis)

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18
Q

histological features of CIN due to high risk HPV?

A

infected epithelium remains flat but may show koilocytosis, which can be detected in cervical smears

19
Q

microscopic features of cervical cancer?

A

invasive squamous carcinoma
virus integrated into host DNA
broken through epithelium

20
Q

time line for HPV infection?

A

HPV > high grade CIN = 6 months - 3 years

high grade CIN > invasive cancer = 5-20 years

21
Q

features of abnormal cells on smear?

A

abnormal shape

larger nucleus with more mitotic figures

22
Q

features of CIN?

A 
pre-invasive stage of cervical cancer occuring at TZ
can involve large area
dysplasia of squamous cells
not visible to naked eye
asymptomatic
detectable by cervical screening
23
Q

progression of dysplasia and neoplasia in cervical epithelium?

A

koilocytosis > CIN 1 > CIN 2 > CIN 3 (abnormal cells get further and further towards the surface)

24
Q

histology of CIN?

A 
delay in maturation/differentiation (immature basal cells occupy more of epithelium)
nuclear abnormalities (hyperchromasia, increased nucleocytoplasmic ratio, pleomrphism)
excess mitotic activity
25
Q

features of CIN 1?

A

basal 1/3 of epithelium occupied by abnormal cells

  • raised number of mitotic figures in lower 1/3
  • surface cells quite mature, but nuclei slightly abnormal
26
Q

features of CIN 2?

A

abnormal cells extend into middle 1/3

  • mitoses in middle 1/3
  • abnormal mitotic figures
27
Q

features of CIN 3?

A

abnormal cells occupy full thickness of epithelium

- mitosis, often abnormal, in upper 1/3

28
Q

most common cervical cancer?

A

squamous cell carcinoma

29
Q

staging of cervical cancer?

A

method about to be obsolete

30
Q

symptoms of invasive cervical carcinoma?

A

usually none at microinvasive and early invasive stages so usually just detected at screening
abnormal bleeding (post coital, post menopausal, stained discharge, contact bleeding)
pelvic pain
haematuria/urinary infections
ureteric obstruction/renal failure

31
Q

how might a squamous cervical cancer spread?

A

local > uterine body, vagina, bladder, ureters, rectum
lymphatic (early) > pelvic, para-aortic nodes
haematogenous (late) > liver, lungs, bone

32
Q

how is squamous cervical cancer graded?

A

well differentiated
moderately differentiated
poorly differentiated
undifferentiated/anaplastic

33
Q

what is CGIN?

A

cervical glandular intraepithelial neoplasia
caused by HPV
originates from endocervical epithelium
pre-invasive phase of endocervical adenocarcinoma

34
Q

CGIN vs CIN?

A

can be associated

more difficult to pick up on screening

35
Q

which has a worse prognosis, squamous or adenocarcinoma?

A

adenocarcinoma

36
Q

what is adenocarcinoma associated with?

A

higher socio-economic class
later onset of sexual activity
smoking
HPV, particularly HPV 18

37
Q

name 3 other HPV driven diseases?

A

vulvar intra-epithelial neoplasia (VIN)
vaginal intra-epithelial neoplasia (VaIN)
anal intra-epithelial neoplasia (AIN)

38
Q

features of vulvar intra-epithelial neoplasia?

A

variable, less predictable than CIN
3 grades
bi-modal
- young women = multifocal, recurrent or persistent causing treatment problems
- older women = greater risk of progression to invasive squamous carcinoma
can be HPV related but not always
often synchronous with cervical and vaginal neoplasia

39
Q

features of invasive squamous carcinoma

A

usually elderly women with ulcer or exophytic mass
can arise from normal epithelium or VIN
usually well differentiated
spread to inguinal nodes

40
Q

features of vulvar pagets disease?

A

crusting rash
tumour cells in epidermis containing mucin
mostly no underlying cancer, tumour arises from sweat glands in skin

41
Q

name 3 other types of vulval disease

A

infection (candida, vulvar warts, bartholins gland abscess)
non-neoplastic epithelial disorders (lichen sclerosis and other dermatoses)
atrophy (post-menopausal)

42
Q

3 main vaginal pathologies?

A

VaIN
squamous carcinoma (less common than cervical and vulval)
melanoma (rare)

43
Q

surgical treatment of vulvar invasive squamous carcinoma?

A

radical vulvectomy and inguinal lymphadenopathy

Repro and Sexual Health (63 decks)

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