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3 Reproduction > Pathology of Cervix, Vulva and Vagina > Flashcards

Pathology of Cervix, Vulva and Vagina Flashcards

1
Q

what is the ectocervix

A

on the outside

lined by squamous epithelium

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2
Q

what is the endocervix

A

on the inside

lined by glandular epithelium

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3
Q

what cells like the vagina

A

squamous epithelium

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4
Q

what layers make up a normal ectocervix

A 
basement membrane 
basal cells 
parabasal cells 
intermediate cells 
exfoliating cells

(smear test just scrapes off the surface cells)

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5
Q

what is the transformation zone of the cervix

A

area between old squamous-columnar junction and new squamocolumnar junction

(see one note for explanation)

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6
Q

when does the transformation zone position change

A

menarche
pregnancy
menopause

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7
Q

what is the squamous-columnar junction

A

area where the the ectocervical (squamous) and endocervical (columnar) epithelium meet

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8
Q

what can lead to physiological squamous metaplasia

A

exposure of delicate endocervical epithelium to acid envorment of the vagina

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9
Q

what are nabothian follicles

A

dilated endocervical glands - entirely benign

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10
Q

what is cervicitis

A

inflammation in the cervix

can lead to infertility due to simultaneous silent Fallopian tube damage

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11
Q

causes of cervicitis

A

non-specific acute/chronic inflammation

follicular cercititic - sub epithelial reactive lymphoid follicles in cervix

chlamydia

Herpes

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12
Q

what is a cervical polyp

A

localised inflammatory outgrowth

not premalignant

can cause bleeding in ulcerated

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13
Q

what are neoplastic changes in the cervix

A

Cervical intraepithelial neoplasia (CIN)

Cervical cancer (squamous carcinoma, adenocarcinoma)

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14
Q

what strands of HPV are high risk for causing cervical malignancy

A

HPV 16

HPV 18

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15
Q

how does HPV cause cervical cancer

A

HPV replicated inside cervical cells

cause changes in cellular genome leading to cancer

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16
Q

risk factors for cervical cancer

A

high risk HPV virus

age at first intercourse

long term use of oral contraceptives

non-use of barrier contraception

smoking (3x risk)

immunosuppression

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17
Q

what is intraepithelial neoplasia

A

lower genital tract cell changes

18
Q

what does a low risk HPV genital wart look like

A

thickened ‘papillomatous’ squamous epithelium with cytoplasmic vacuolation (koilocytosis)

(called condyloma acumninatum)

19
Q

what does high risk HPV (16 and 18) look like (CIN)

A

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

20
Q

what does HPV infection cervical cancer look like

A

invasive squamous cancerima

virus integrated into his DNA

epithelium no longer flat?

21
Q

how long does it take for HPV infection to lead to high grade cervical intraepithelial neoplasia

A

6months - 3 years

22
Q

how long does it take high rate cervical intraepithelial neoplasia (CIN) to become invasive cancer

A

5-20 years

23
Q

where does CIN occur

A

transformation zone

(dysplasia of squamous cells)

asymptomatic

detectable by cervical screening

24
Q

what does CIN look like histologically

A

delay in maturation/differentiation
(immature basal cells occupy more epithelium)

nuclear abnormalities

excess mitotic activity

25
Q

what does koilocytosis indicate

A

HPV infection

26
Q

what is CIN 1

A

1/3 of epithelium occupied by abnormal cells

27
Q

what is CIN 2

A

abnormal cells extend to middle 1/3 of epithelium

28
Q

What is CIN 3

A

abnormal cells occupy full thickness of epithelium

29
Q

what cancer can CIN lead to

A

invasive squamous cell carcinoma

30
Q

what are symptoms of invasive carcinoma

A

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

31
Q

how do you grade squamous carcinoma

A

well differentiated
moderately differentiated
poorly differentiated
undifferentiated/anaplasic

32
Q

what is cervical glandular intraepithelial neoplasia

A

origin from endocervical epithelium

preinvasive phase of endocervical adenocarcinoma

screening less effective, more difficult to diagnose

also caused by HPV virus

33
Q

what is endocervical adenocarcinoma

A

cancer arising from glandular endocervix

worse prognosis than squamous carcinoma

increasing incidence particularly in young women

34
Q

risk factors of adenocarcinoma

A

HPV - particularly HPV 18
smoking
later onset of sexual activity

35
Q

what are the other HPV driven diseases

A

vulval intraepithelial neoplasia (VIN)

vaginal intraepithelial neoplasia (VaIN)

anal intraepithelial neoplasia (AIN)

36
Q

what are the two types of vulval intraepithelial neoplasia

A

HPV related

Non-HPV related (often related to inflammatory diseases)

37
Q

treatment for VIN

A

surgical removal

will lead to invasive squamous carcinoma and spread to inguinal lymph nodes

38
Q

what surgery is done for vulvar invasive squamous carcinoma

A

radical vulvectomy and inguinal lymphadenectomy

39
Q

what is vulvar Paget’s disease

A

crusting rash

tumour cells in epidermis, contain mucin

mostly no underlying cancer, tumour arises from sweat gland in skin

40
Q

what other vulvar diseases can you get

A

candida
vulvar warts
Bartholin’s gland abscess

lichen sclerosis
lichen plants
psoriasis

post menopausal atrophy

41
Q

what pathology do you get in the vagina

A

VaIN - vaginal intraepithelial neoplasia

Squamous carcinoma (less common) disease of elderly

Melanoma - rare, may appear as polyp

3 Reproduction (49 decks)

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