Pathology of Cervix, Vulva and Vagina Flashcards
what is the ectocervix
on the outside
lined by squamous epithelium
what is the endocervix
on the inside
lined by glandular epithelium
what cells like the vagina
squamous epithelium
what layers make up a normal ectocervix
basement membrane basal cells parabasal cells intermediate cells exfoliating cells
(smear test just scrapes off the surface cells)
what is the transformation zone of the cervix
area between old squamous-columnar junction and new squamocolumnar junction
(see one note for explanation)
when does the transformation zone position change
menarche
pregnancy
menopause
what is the squamous-columnar junction
area where the the ectocervical (squamous) and endocervical (columnar) epithelium meet
what can lead to physiological squamous metaplasia
exposure of delicate endocervical epithelium to acid envorment of the vagina
what are nabothian follicles
dilated endocervical glands - entirely benign
what is cervicitis
inflammation in the cervix
can lead to infertility due to simultaneous silent Fallopian tube damage
causes of cervicitis
non-specific acute/chronic inflammation
follicular cercititic - sub epithelial reactive lymphoid follicles in cervix
chlamydia
Herpes
what is a cervical polyp
localised inflammatory outgrowth
not premalignant
can cause bleeding in ulcerated
what are neoplastic changes in the cervix
Cervical intraepithelial neoplasia (CIN)
Cervical cancer (squamous carcinoma, adenocarcinoma)
what strands of HPV are high risk for causing cervical malignancy
HPV 16
HPV 18
how does HPV cause cervical cancer
HPV replicated inside cervical cells
cause changes in cellular genome leading to cancer
risk factors for cervical cancer
high risk HPV virus
age at first intercourse
long term use of oral contraceptives
non-use of barrier contraception
smoking (3x risk)
immunosuppression
what is intraepithelial neoplasia
lower genital tract cell changes
what does a low risk HPV genital wart look like
thickened ‘papillomatous’ squamous epithelium with cytoplasmic vacuolation (koilocytosis)
(called condyloma acumninatum)
what does high risk HPV (16 and 18) look like (CIN)
infected epithelium remains flat but may show koilocytosis which can be detected in cervical smears
what does HPV infection cervical cancer look like
invasive squamous cancerima
virus integrated into his DNA
epithelium no longer flat?
how long does it take for HPV infection to lead to high grade cervical intraepithelial neoplasia
6months - 3 years
how long does it take high rate cervical intraepithelial neoplasia (CIN) to become invasive cancer
5-20 years
where does CIN occur
transformation zone
(dysplasia of squamous cells)
asymptomatic
detectable by cervical screening
what does CIN look like histologically
delay in maturation/differentiation
(immature basal cells occupy more epithelium)
nuclear abnormalities
excess mitotic activity
what does koilocytosis indicate
HPV infection
what is CIN 1
1/3 of epithelium occupied by abnormal cells
what is CIN 2
abnormal cells extend to middle 1/3 of epithelium
What is CIN 3
abnormal cells occupy full thickness of epithelium
what cancer can CIN lead to
invasive squamous cell carcinoma
what are symptoms of invasive carcinoma
usually none at microinvasive and early invasive stages
abnormal bleeding
- post coital
- post menopausal
- brownish or blood stained vaginal discharge
- contact bleeding
pelvic pain
haemoturia/urinary infections
ureteric obstruction/renal failure
how do you grade squamous carcinoma
well differentiated
moderately differentiated
poorly differentiated
undifferentiated/anaplasic
what is cervical glandular intraepithelial neoplasia
origin from endocervical epithelium
preinvasive phase of endocervical adenocarcinoma
screening less effective, more difficult to diagnose
also caused by HPV virus
what is endocervical adenocarcinoma
cancer arising from glandular endocervix
worse prognosis than squamous carcinoma
increasing incidence particularly in young women
risk factors of adenocarcinoma
HPV - particularly HPV 18
smoking
later onset of sexual activity
what are the other HPV driven diseases
vulval intraepithelial neoplasia (VIN)
vaginal intraepithelial neoplasia (VaIN)
anal intraepithelial neoplasia (AIN)
what are the two types of vulval intraepithelial neoplasia
HPV related
Non-HPV related (often related to inflammatory diseases)
treatment for VIN
surgical removal
will lead to invasive squamous carcinoma and spread to inguinal lymph nodes
what surgery is done for vulvar invasive squamous carcinoma
radical vulvectomy and inguinal lymphadenectomy
what is vulvar Paget’s disease
crusting rash
tumour cells in epidermis, contain mucin
mostly no underlying cancer, tumour arises from sweat gland in skin
what other vulvar diseases can you get
candida
vulvar warts
Bartholin’s gland abscess
lichen sclerosis
lichen plants
psoriasis
post menopausal atrophy
what pathology do you get in the vagina
VaIN - vaginal intraepithelial neoplasia
Squamous carcinoma (less common) disease of elderly
Melanoma - rare, may appear as polyp
