Pathology of the Cervix, Vagina and Vulva

Question 1

What are the different epitheliums seen in the cervix, vagina and vulva?

Answer 1

Endocervix - Columnar epithelium,
Ectocervix, vagina and vulva - Squamous epithelium.
Squamous metaplasia in transformation zone between endo and ecto-cervix

Question 2

Name the following cells

Answer 2

Squamous cells

Question 3

Name the following cells

Answer 3

Intermediate cells

Question 4

Name the following cells

Answer 4

Endocervical cells

Question 5

What are some infections which can affect the cervix, vagina and vulva?

Answer 5

• Human papilloma virus,
• Chlamydia trachomatis,
• Gonorrhoea,
• Herpes simplex virus (genital warts)
• Trichomonas vaginalis,
• Candida albicans,
• Actinomycin,
• Bacterial vaginosis

Question 6

Briefly describe features of cervical polyps

Answer 6

Almost always benign but can be large. May bleed post coitally

Question 7

Describe features of cervical screening

Answer 7

• Designed to pick up precancerous changes (dyskaryosis) which are called cervical intraepithelial neoplasia (CIN).
  -For women aged 20-60 every 3 years

Question 8

What are the different smear results?

Answer 8

Negative: Repeat in 3 years,
Borderline nuclear abnormality: Repeat in 6 mo. (x3 BNA then refer to colposcopy)
Dyskaryosis of any severity: Refer to colposcopy,
Features of invasion: Urgent referral to colposcopy.

Question 9

What is colposcopy?

Answer 9

Diagnostic procedure which gives illuminated magnified view of cervix, vagina and vulva

Question 10

What does borderline nuclear change with koilocytosis suggest?

Answer 10

A HPV infection. Koilocytes have a darker, larger nuclei with pale area around the nucleus.

Question 11

Describe histological features of dyskaryosis and what it indicated?

Answer 11

Nuclear enlargement, dense hyperchromasia and coarse chromatin clumping. It indicates cervical intraepithelial neoplasm

Question 12

What is CIN?

Answer 12

Dysplasia in cervical biopsies.
Low grade = CIN1,
High grade = CIN2 or CIN3

Question 13

What are the features of large loop excision of transformation zone?

Answer 13

It can be diagnostic and theraputic without much impact on the individual, and doesn’t affect infertility

Question 14

What is the premalignant change that occurs to the endocervical glandular epithelium?

Answer 14

cervical Glandular Intraepithelial Neoplasia (cGIN). It is HPV associated

Question 15

Post menopausal bleeding should be?

Answer 15

Referred to gynae for hysteroscopy/endometrial biopsy

Question 16

What are the symptoms of cervical cancer?

Answer 16

• Post coital bleeding,
• Intermenstrual bleeding,
• Irregular vaginal bleeding,
• Pain
• Or no symptoms at all

Question 17

What are some risk factors for cervical cancer?

Answer 17

• Human papilloma virus - present in at least 95% cancers. Vaccinations given to 12-13yr old girls,
• Age at first sexual intercourse,
• Number of sexual partners,
• Smoking,
• Method of contraception,
• Immunosupression,
• Circumcision in males is protective

Question 18

What defines an invasive squamous carcinoma and what is the treatment?

Answer 18

When the neoplastic cells cross the basement membrane.
Early cancers can be treated with LETZ, simple or radical hysterectomy. Advanced cancers may require radio/chemo-therapy

Question 19

What are the different cervical cancers?

Answer 19

• Most common is squamous cell carcinoma,
• Adenocarcinoma,
• Clear cell carcinoma
• Adenosquamous carcinoma

Question 20

What inflammatory conditions can affect the vulva?

Answer 20

Any that affect hair-bearing skin elsewhere can affect the vulva, eg, eczema, psoriasis, allergic dermatitis

Question 21

What are some possible infections of the vulva?

Answer 21

• Vulval warts (HPV 11),
• Candida,
• Folliculitis,
• Bartholin’s abscess

Question 22

What are different vulval cysts?

Answer 22

• Epidermal inclusion cyst,
• Bartholin’s cyst

Question 23

What is leukoplakia?

Answer 23

These are white plaques which may present benign, premalignant or malignant lesions.

Question 24

What are different tumours of the vulva?

Answer 24

The most common is invasions squamous cell. Usually related to high risk HPV 16/18. The precancerous stage is called vulval intraepithelial neoplasia.
Others include: Neurofibromas, angiomas, skin adenexal tumours, carcinomas, melanomas, sarcomas.
SCC associated with dermatoses (adjacent squamous hyperplasia/lichen sclerosus common).

Question 25

What is VaIN?

Answer 25

Premalignancy in vagina called Vaginal intraepithelial neoplasm