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Repro and Sexual Health > Pathology of cervix, vulva and vagina > Flashcards

Pathology of cervix, vulva and vagina Flashcards

1
Q

What are the different types of the cervix?

A

Ectocervix
Endocervix
Transitional Zone

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2
Q

What lines the ectocervix and endocervix respectively?

A

Ectocervix; squamous epithelium

Endocervix; glandular epithelium

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3
Q

What makes up the epithelium of the cervix?

A 
Basement membrane 
Basal cells
Parabasal cells 
Intermediate cells 
Superficial cells 
Exfoliating cells
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4
Q

What is the TZ zone of the cervix?

A

Squamo-columnar junction between ectocervix and endocervical epithelia

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5
Q

What will physiological things in life alters the position of the TZ?

A

Menarche
Pregnancy
Menopause

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6
Q

What is a cervical erosion?

A

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

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7
Q

What is a nabothian follicle?

A

Dilated endocervical glands which form a polypoid structure

Entirely benign

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8
Q

What is cervicitis?

A

Asymptomatic
Can lead to infertility due to simultaneous silent fallopian tube damage
Non-specific acute/ chronic inflammation

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9
Q

What is follicular cervicitis?

A

Sub epithelial reactive lymphoid follicles present in cervix

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10
Q

What are the different types of inflammatory pathology of the cervix?

A 
Cervicit
Follicular cervicitis
Chlamydia trachomatis
Herpes Simplex Viral Infection 
Cervical polyp
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11
Q

What is a cervical polyp?

A

Localised inflammatory outgrowth
Cause of bleeding if ulcerated
Not premalignant

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12
Q

What are the neoplastic pathologies of the cervix?

A

Cervical Intraepithelial Neoplasia (CIN)

Cervical cancer; squamous or adenocarcinoma

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13
Q

What are the high risk HPV strains?

A

16
18
(31,33,35,45,48)

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14
Q

What are risk factors for CIN?

A

High risk HPV
Vulnerability of SC junction in early reproductive age
Smoking
Immunosuppression

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15
Q

What increases the risk of vulnerability of SC junction in early reproductive age?

A

Age at first intercouse
Long term use of oral contraception
Non use of barrier contraception

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16
Q

How does HPV cause cervical cancer?

A

Infects epithelial cells in the cervical mucosa

HPV DNA integrates into the cellular genome resulting in cancer

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17
Q

What strains of HPV cause genital warts?

A

6 and 11

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18
Q

What is a condyloma acuminatum?

A

Thickened papillomatous squamous epithelium with cytoplasmic vacuolation
Condyloma acuminata refers to anogenital warts caused by human papillomavirus (HPV). The most common strains of HPV that cause anogenital warts are 6 and 11

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19
Q

What is a koilocytosis?

A

A type of epithelial cell that develops following a human papillomavirus (HPV) infection. Koilocytes are structurally different from other epithelial cells

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20
Q

Why is a CIN not a cancer?

A

Not broken through the basal layer

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21
Q

Describe the appearance of CIN?

A

Infected epithelium remains flat, but may show koilocysosis which can be detected in cervical smears

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22
Q

Describe a CIN 3?

A

Squamous cell carcinoma in situ

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23
Q

What is the time lines for HPV and high grade CIN infection?

A

HPV infection can transform into high grade CIN in 6 months to 3 years
High grade CIN can transform to invasive cancer within 5-20 years

24
Q

What is CIN?

A 
Pre-invasive stage of cervical cancer 
Occurs in TZ 
Can involve large area
Dysplasia of squamous cell
Not visible by naked eye
Asymptomatic 
Detectable by cervical screening
25
Q

What is the histology of CIN?

A

Delay in maturation/ differentiation; immature basal cells occupy more epithelium
Nuclear abnormality; hyperchromasia, increased nucleocytoplasmic ratio, pleomorphism
Excess mitotic activity; situated above basal layers, abnormal mitotic figures

26
Q

How is CIN graded?

A

1 to 3

27
Q

Describe CIN 1

A

Basal 1/3rd of epithelium occupied by abnormal cells
Raised number of mitotic figures in lower 1/3rd
Surface cells quite mature, but nuclei slightly abnormal

28
Q

Describe CIN 2

A

Abnormal cells extend to middle 1/3rd
Mitoses in middle 1/3rd
Abnormal mitotic figures

29
Q

Describe CIN 3

A

Abnormal cells occupy full thickness of epithelium

Mitosis, often abnormal in upper 1/3rd

30
Q

What is the commonest form of cervical cancer?

A

Invasive squamous carcinoma

31
Q

What will squamous carcinoma of the cervix arise from?

A

Pre-existing CIN therefore most cases should be preventable by screening

32
Q

What is the staging system of invasive squamous carcinoma?

A

FIGO
If lymph nodes involved; a lymphadenectomy will be done
If tumour spread past cervix; radiochemo

33
Q

What are the symptoms of invasive carcinoma?

A

Abnormal bleeding; post coital, post menopausal, brown or red stained vaginal discharge, contact bleeding
Pelvic pain
Haematuria/ urinary infections
Ureteric obstruction/ renal failure

34
Q

Where will squamous carcinoma of the cervix spread locally?

A 
Uterine body 
Vagina
Bladder
Ureters
Rectum
35
Q

Where will squamous carcinoma of the cervix spread lymphatically?

A

Early to pelvic and para-aortic nodes

36
Q

Where will squamous carcinoma of the cervix spread hematogenously?

A

Late; liver, lungs and bone

37
Q

How is squamous carcinoma of the cervix graded?

A

Well differentiated
Moderately differentiated
Poorly differentiated
Undifferentiated/ anaplastic

38
Q

What is CGIN?

A

Cervical Glandular Intraepithelial Neoplasia
Origin from endocervical epithelium
Pre-invasive phase of endocervical adenocarcinoma

39
Q

What is the epidemiology of endocervical adenocarcinoma?

A 
5-25% of cervical ca
Increased incidence, particularly in young women 
Worse prognosis than squamous carcinoma
Higher SE class
Later onset of sexual activity 
Smoking
HPV 18 incriminated
40
Q

What are other HPV driven disease in the genital tract?

A

Vulvar intraepithelial neoplasia
Vaginal intraepithelial neoplasia
Anal intraepithelial neoplasia

41
Q

What is dyskaryosis?

A

Abnormal nucleus found in a cervical smear sample

42
Q

Who does vulvar intraepithelial neoplasia affect?

A

Bimodal;
Young women; multifocal, recurrent, persistent
Older women; greater risk of malignant transformation

43
Q

What is VIN usually synchronous with?

A

CIN

VaIN

44
Q

Who does vulvar invasive squamous carcinoma tend to affect?

A

Elderly women

Presents with an ulcer or exophytic mass

45
Q

What is the most important prognostic factor for vulvar invasive squamous carcinoma?

A

Spread to inguinal lymph nodes

46
Q

What is the treatment for vulvar invasive squamous carcinoma?

A

Radical vulvectomy

Inguinal lymphadenectomy

47
Q

What is vulvar paget’s disease?

A

Crusting rash
Pinky balloon cells; mucinous cells involving epidermis
Can spread along vulva, thigs, anus and vagina
Tumour arises from sweat gland in skin

48
Q

What infections can affect the vulva?

A

Candida; diabetics
Vulvar warts (6 & q11)
Bartholin’s gland abscess

49
Q

What are non-neoplastic epithelial disorders of the vulva?

A

Lichen sclerosis
Lichen planus
Psoriasis

50
Q

Who can vulvar atrophy affect?

A

Post menopausal women; treat with topical oestrogen

51
Q

What pathology can affect the vagina?

A

VaIN
Squamous carcinoma
Melanoma; appears as a polyp

52
Q

What is the management of women with a borderline dyskaryosis at a cervical smear?

A

Lab perform a reflex high HPV test on cytology;
If HPV +ve, woman referred for colposcopy within 6 weeks
If HPV -ve; returned to routine screening

53
Q

What is the management of women with high grade dyskaryosis/ suspected invasive cancer at a cervical smear?

A

Referred to colposcopy for app within 2 weeks

54
Q

What is colposcopy?

A

Cervix is assessed in detail using colposcopy

55
Q

What is the colposcopist looking for at colposcopy?

A

Abnormal changes in cervix which may indicate pre-cancerous changes (CIN)

56
Q

How is CIN identified at colposcopy?

A

Acetic acid can be applied and abnormal areas turn white

If iodine applied; normal tissue stains dark brown and precancerous will not stain

57
Q

What happens following an inadequate cervical cytology sample/

A

Repeat cervical cytology no less than 3 months after
If 3 consecutive cervical cytology samples are inadequate, the woman should be referred to colposcopy for an app within 6 weeks

Repro and Sexual Health (77 decks)

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