Pathology of female Genitalia 1: Vulva, Vagina, Cervix Uteri

Question 1

What are the four most common classifications of Vulval diseases

Answer 1

• Cysts
• Non-neoplastic epithelial disorders
• Infection/inflammatory conditions
• Neoplasms

Question 2

Which cyst of the vulva has the most clinical importance?

Answer 2

Bartholin’s Cyst

Question 3

How does a cyst of Bartholin’s Gland form?

Answer 3

This happens when the duct is occluded and fluid builds up within the gland.

Infection leads to abscess formation

Question 4

How is a cyst of Bartholin’s Gland treated?

Answer 4

It is excised and left permanently open by a procedure called- Marsupialization

Question 5

What are the symptoms of a cyst of Bartholin gland

Answer 5

pain and local discomfort

Question 6

What is HPV

Answer 6

Human Papilloma Virus is a small DNA virus that can be classified as low risk or high risk types

Question 7

List the low risk HPV serotypes

Answer 7

6 and 11

Question 8

What clinical features are seen in the low-risk HPV serotypes?

Answer 8

Benign warts

Question 9

List the high-risk HPV serotypes

Answer 9

16 and 18

Question 10

What clinical features are observed in the high-risk HPV serotypes?

Answer 10

Cervical Cancer

Question 11

What are the features of HPV infected epithelium cells

Answer 11

Koilocytosis: low grade squamous intra-epithelial lesion
- perinuclear halo
- hyperchromatic “raisin like nucleus”
- bi or multi-nucleated

Question 12

Genital Warts are scientifically known as

Answer 12

Condylomata Acuminata

Question 13

Genital Warts caused by HPV types 6/11 are classified as low grade lesions also given the abbreviation

Answer 13

CIN 1 (LSIL)
Cervical intraepithelial neoplasia 1 (low-grade squamous intraepithelial lesion)

Question 14

Describe the progression of low-grade HPV

Answer 14

The viral DNA does not integrate into host genome .

It exists as free extrachromosomal forms within the nucleus

Question 15

HPV types 16/18 are high grade lesions and are classified as what grade cervical intraepithelial neoplasia

Answer 15

Grade ii and iii
High-grade squamous intraepithelial lesions

Question 16

Describe the progression of High grade HPV

Answer 16

The virus integrates its DNA in the host cell genome of the vulva/cervix

Question 17

How does high-grade HPV develop into cancer

Answer 17

1) Viral DNA replication independent of host DNA
2) disturbs HPV E2 gene
3) E2 gene down regulation of E6 and E 7 lost
4) Activate cyclin E Inc. cell proliferation

(E6 and E7 genes block host tumour suppressor proteins p53 and RB1 in host cells- increasing tumour cell production)

Question 18

List three examples of benign neoplasms that affect the vulva

Answer 18

• Skin adnexal tumours
• haemangiomas
• leiomyomas

Question 19

Describe the appearance of anogenital warts

Answer 19

Verrucous (wart-like)
Papillomatous (benign) lesions

Question 20

Describe the histology of anogenital warts

Answer 20

stratified squamous epithelium on vascular connective tissue stalks

Question 21

True or False
HPV Condylomata Acuminata is pre malignant

Answer 21

False
it is NOT pre malignant

Question 22

Malignant Neoplasms of the viulva account for what percentage of all genital cancers

Answer 22

3% (not common)

Question 23

Majority of malignant neoplasms of the vulva are what type of carcinoma

Answer 23

Squamous Cell Carcinoma

Question 24

What are the three classifications of Vulval Intraepithelial Neoplasms

Answer 24

VIN 1 - lower 1/3
(mild dysplasia)
VIN ii - lower 2/3
(mod dysplasia)
VIN iii- >lower 2/3 (severe dysplasia)

Question 25

Majority of VIN III lesions occur in what age group

Answer 25

40-60years

Question 26

Vulval intraepithelial neoplasia type iii is most commonly associated with what HPV serotype

Answer 26

High grade - 16

Question 27

What is the gross appearance of Vulval Intraepithelial Neoplasia III

Answer 27

Leucoplakia single or multiple white patches or plaques

Question 28

What pathology accounts for >90% of invasive vulval malignancies

Answer 28

Invasive squamous cell carcinoma

Question 29

What age group is invasive squamous cell carcinoma seen in

Answer 29

post menopausal

Question 30

Describe the tumours seen in Invasive Squamous cell carcinoma

Answer 30

Slow growing destructive ulcerative may be multifocal

Question 31

What is the most common metastatic site for invasive squamous cell carcinoma

Answer 31

Inguinal lymph nodes

Question 32

What is the treatment for vulval invasive squamous cell carcinoma

Answer 32

Sugical +/- radiotherapy

Question 33

What is the estimated prognosis for a patient with vulva invasive squamous cell carcinoma with inguinal metastases

Answer 33

5-year survival

Question 34

90% of primary vaginal malignancies are...

Answer 34

Squamous cell carcinoma (Most vaginal malignancies are an extension from cervical squamous cell cancers)

Question 35

What are the three main pathologies of the cervix uteri?

Answer 35

Inflammation Polyps Carcinoma

Question 36

Cervical cancer is the ..... most common cancer in women in the world

Answer 36

4th

Question 37

Cervical cancer is the ..... most common cancer in women in Jamaica

Answer 37

2nd

Question 38

List 7 risk factors for cervical cancer

Answer 38

- early stage first coitus - multiple sex partners - multiparity - low socio-economic status -History of STD's -Cigarette smoking -Immunosuppression

Question 39

Where in terms of histology does cervical cancer begin

Answer 39

at the Squamocolumnar transformation zone

Question 40

What is the grading system used for Cervical Carcinoma

Answer 40

Cervical intraepithelial neoplasia (CIN) I- mild CIN II- moderate CIN III- severe

Question 41

Based on the Bethesda Grading system what CIN grade is a LSIL (low grade squamous intraepithelial lesion)

Answer 41

CIN I

Question 42

Based on the Bethesda Grading System what CIN grade is a HSIL (high grade squamous intraepithelial lesion)

Answer 42

CIN II and III

Question 43

Describe the histology of Invasive Squamous Cell Carcinoma in the cervix

Answer 43

polypoid, papillary, nodular, ulcerating

Question 44

Invasive Squamous Cell Carcinoma locally invades which structures

Answer 44

- vagina - parametrium - bladder - rectum

Question 45

What is the most often cause of death in invasive squamous cell carcinoma of the cervix

Answer 45

Uraemia

Question 46

How many stages of cervical cancer are there and name them

Answer 46

7 Stage 0 Stage I Stage Ia Stage Ib Stage II Stage III Stage IV

Question 47

Describe Stage O Cervical Ca

Answer 47

Cervical Intraepithelium Neoplasm III CIN III

Question 48

Describe Stage 1 Cervical Ca

Answer 48

Confined to the cervix

Question 49

Describe stage 1a of Cervical Ca

Answer 49

Microinvasion

Question 50

Describe stage 1b of Cervical CA

Answer 50

Invasive (frankly)

Question 51

Describe STage II of Cervical Ca

Answer 51

Upper 2/3 of vagina is involved

Question 52

Describe Stage III of cervical Ca

Answer 52

lower 2/3 of vagina involved and pelvic wall

Question 53

Describe Stage IV of cervical ca

Answer 53

extends to pelvis, bladder, rectum

Question 54

What is the treatment for Stage o Cervical Ca

Answer 54

remove via lasertherapy, cryoRx

Question 55

What is the recommended treatment for Stage 1 a Cervical Ca

Answer 55

Total Hysterectomy

Question 56

What is the recommended treatment for Stage 1b Cervical CA

Answer 56

Radical hysterectomy with radiotherapy

Question 57

What is the recommended treatment for Stage 1b to Stage IV CA

Answer 57

RAdiotherapy

Question 58

WHat is the prognosis for a patient with stage I Cervical Ca with negative node infiltration

Answer 58

90% 5yr survival

Question 59

WHat is the screeing method for Cervical Ca

Answer 59

Pap Smear

Question 60

Describe the procedure done in a pap smear

Answer 60

Cervix is scraped with Ayre's spatula Smeared on a Slide Stained Examined