Pathology of the Cervix, Vagina and Vulva Flashcards
What are the different epitheliums seen in the cervix, vagina and vulva?
Endocervix - Columnar epithelium,
Ectocervix, vagina and vulva - Squamous epithelium.
Squamous metaplasia in transformation zone between endo and ecto-cervix
Name the following cells
Squamous cells
Name the following cells
Intermediate cells
Name the following cells
Endocervical cells
What are some infections which can affect the cervix, vagina and vulva?
- Human papilloma virus,
- Chlamydia trachomatis,
- Gonorrhoea,
- Herpes simplex virus (genital warts)
- Trichomonas vaginalis,
- Candida albicans,
- Actinomycin,
- Bacterial vaginosis
Briefly describe features of cervical polyps
Almost always benign but can be large. May bleed post coitally
Describe features of cervical screening
- Designed to pick up precancerous changes (dyskaryosis) which are called cervical intraepithelial neoplasia (CIN).
-For women aged 20-60 every 3 years
What are the different smear results?
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.
What is colposcopy?
Diagnostic procedure which gives illuminated magnified view of cervix, vagina and vulva
What does borderline nuclear change with koilocytosis suggest?
A HPV infection. Koilocytes have a darker, larger nuclei with pale area around the nucleus.
Describe histological features of dyskaryosis and what it indicated?
Nuclear enlargement, dense hyperchromasia and coarse chromatin clumping. It indicates cervical intraepithelial neoplasm
What is CIN?
Dysplasia in cervical biopsies.
Low grade = CIN1,
High grade = CIN2 or CIN3
What are the features of large loop excision of transformation zone?
It can be diagnostic and theraputic without much impact on the individual, and doesn’t affect infertility
What is the premalignant change that occurs to the endocervical glandular epithelium?
cervical Glandular Intraepithelial Neoplasia (cGIN). It is HPV associated
Post menopausal bleeding should be?
Referred to gynae for hysteroscopy/endometrial biopsy
What are the symptoms of cervical cancer?
- Post coital bleeding,
- Intermenstrual bleeding,
- Irregular vaginal bleeding,
- Pain
- Or no symptoms at all
What are some risk factors for cervical cancer?
- 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
What defines an invasive squamous carcinoma and what is the treatment?
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
What are the different cervical cancers?
- Most common is squamous cell carcinoma,
- Adenocarcinoma,
- Clear cell carcinoma
- Adenosquamous carcinoma
What inflammatory conditions can affect the vulva?
Any that affect hair-bearing skin elsewhere can affect the vulva, eg, eczema, psoriasis, allergic dermatitis
What are some possible infections of the vulva?
- Vulval warts (HPV 11),
- Candida,
- Folliculitis,
- Bartholin’s abscess
What are different vulval cysts?
- Epidermal inclusion cyst,
- Bartholin’s cyst
What is leukoplakia?
These are white plaques which may present benign, premalignant or malignant lesions.
What are different tumours of the vulva?
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).
What is VaIN?
Premalignancy in vagina called Vaginal intraepithelial neoplasm
