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Urogenital System > Pathology of female Genitalia 1: Vulva, Vagina, Cervix Uteri > Flashcards

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

1
Q

What are the four most common classifications of Vulval diseases

A
  • Cysts
  • Non-neoplastic epithelial disorders
  • Infection/inflammatory conditions
  • Neoplasms
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2
Q

Which cyst of the vulva has the most clinical importance?

A

Bartholin’s Cyst

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3
Q

How does a cyst of Bartholin’s Gland form?

A

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

Infection leads to abscess formation

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4
Q

How is a cyst of Bartholin’s Gland treated?

A

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

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5
Q

What are the symptoms of a cyst of Bartholin gland

A

pain and local discomfort

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6
Q

What is HPV

A

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

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7
Q

List the low risk HPV serotypes

A

6 and 11

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8
Q

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

A

Benign warts

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9
Q

List the high-risk HPV serotypes

A

16 and 18

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10
Q

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

A

Cervical Cancer

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11
Q

What are the features of HPV infected epithelium cells

A

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

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12
Q

Genital Warts are scientifically known as

A

Condylomata Acuminata

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13
Q

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

A

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

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14
Q

Describe the progression of low-grade HPV

A

The viral DNA does not integrate into host genome .

It exists as free extrachromosomal forms within the nucleus

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15
Q

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

A

Grade ii and iii
High-grade squamous intraepithelial lesions

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16
Q

Describe the progression of High grade HPV

A

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

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17
Q

How does high-grade HPV develop into cancer

A

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)

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18
Q

List three examples of benign neoplasms that affect the vulva

A
  • Skin adnexal tumours
  • haemangiomas
  • leiomyomas
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19
Q

Describe the appearance of anogenital warts

A

Verrucous (wart-like)
Papillomatous (benign) lesions

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20
Q

Describe the histology of anogenital warts

A

stratified squamous epithelium on vascular connective tissue stalks

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21
Q

True or False
HPV Condylomata Acuminata is pre malignant

A

False
it is NOT pre malignant

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22
Q

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

A

3% (not common)

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23
Q

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

A

Squamous Cell Carcinoma

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24
Q

What are the three classifications of Vulval Intraepithelial Neoplasms

A

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

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25
Q

Majority of VIN III lesions occur in what age group

A

40-60years

26
Q

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

A

High grade - 16

27
Q

What is the gross appearance of Vulval Intraepithelial Neoplasia III

A

Leucoplakia
single or multiple white patches or plaques

28
Q

What pathology accounts for >90% of invasive vulval malignancies

A

Invasive squamous cell carcinoma

29
Q

What age group is invasive squamous cell carcinoma seen in

A

post menopausal

30
Q

Describe the tumours seen in Invasive Squamous cell carcinoma

A

Slow growing
destructive
ulcerative
may be multifocal

31
Q

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

A

Inguinal lymph nodes

32
Q

What is the treatment for vulval invasive squamous cell carcinoma

A

Sugical +/- radiotherapy

33
Q

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

A

5-year survival

34
Q

90% of primary vaginal malignancies are…

A

Squamous cell carcinoma

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

35
Q

What are the three main pathologies of the cervix uteri?

A

Inflammation
Polyps
Carcinoma

36
Q

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

37
Q

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

38
Q

List 7 risk factors for cervical cancer

A
  • early stage first coitus
  • multiple sex partners
  • multiparity
  • low socio-economic status
    -History of STD’s
    -Cigarette smoking
    -Immunosuppression
39
Q

Where in terms of histology does cervical cancer begin

A

at the Squamocolumnar transformation zone

40
Q

What is the grading system used for Cervical Carcinoma

A

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

41
Q

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

42
Q

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

A

CIN II and III

43
Q

Describe the histology of Invasive Squamous Cell Carcinoma in the cervix

A

polypoid, papillary, nodular, ulcerating

44
Q

Invasive Squamous Cell Carcinoma locally invades which structures

A
  • vagina
  • parametrium
  • bladder
  • rectum
45
Q

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

46
Q

How many stages of cervical cancer are there and name them

A

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

47
Q

Describe Stage O Cervical Ca

A

Cervical Intraepithelium Neoplasm III CIN III

48
Q

Describe Stage 1 Cervical Ca

A

Confined to the cervix

49
Q

Describe stage 1a of Cervical Ca

A

Microinvasion

50
Q

Describe stage 1b of Cervical CA

A

Invasive (frankly)

51
Q

Describe STage II of Cervical Ca

A

Upper 2/3 of vagina is involved

52
Q

Describe Stage III of cervical Ca

A

lower 2/3 of vagina involved and pelvic wall

53
Q

Describe Stage IV of cervical ca

A

extends to pelvis, bladder, rectum

54
Q

What is the treatment for Stage o Cervical Ca

A

remove via lasertherapy, cryoRx

55
Q

What is the recommended treatment for Stage 1 a Cervical Ca

A

Total Hysterectomy

56
Q

What is the recommended treatment for Stage 1b Cervical CA

A

Radical hysterectomy with radiotherapy

57
Q

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

A

RAdiotherapy

58
Q

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

A

90% 5yr survival

59
Q

WHat is the screeing method for Cervical Ca

60
Q

Describe the procedure done in a pap smear

A

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

Urogenital System (17 decks)

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