Pathology of the Cervix, Vagina & Vulva Flashcards
What type of epithelium lines the ectocervix? [1]
non-keratinising stratified squamous epithelium
What type of epithelium lines the endocervix? [1]
columnar (glandular) epithelium
Describe the changes in the cervix after puberty [2]
- with the growth of the cervix, the squamo-columnar junction is everted into the vagina
- the squamous epithelium adapts to the vaginal environment by squamous metaplasia in the transformation zone
What happens to the pubertal changes of the cervix at menopause? [1]
they get reversed
Where do most cervical neoplasia develop?
transformation zone
(zone of unstable differentiation)
Describe the process and role of cervical cytological screening? [2]
- samples cells from the cervical transformation zone using a speculum 5/6 times turn clockwise in cervix
- used to detect changes associated with HPV infection and cervical intraepithelial neoplasia
What is dyskaryosis and what is it suggestive of? [2]
- dyskaryosis = nuclear abnormalities
- suggestive of cervical intraepithelial neoplasia (CIN) and prompts referral to colposcopy clinical for biopsy
Describe the age ranges for cervical screening [2]
- women aged 25-50 every 3 years
- women aged 50-65 every 5 years
What are the 4 steps involved in colposcope examination? [4]
- cervix visualised
- washed with acetic acid
- iodine is applied + green light filter
- abnormal area can be biopsed or treatment given at the time or at a further appointment
List the 5 colposcopic features of micro-invasive lesions of the cervix [5]
- densely staining acetowhite lesion & often large volume lesions
- atypical vessels, suspicious of invasion
- “Pollarded” vessels → thick calibre with no visible branching on the surface
- poor iodine uptake
- may bleed easily
What are the prevalent strains of HPV in Scotland? [4]
- HPV 16 + 18 = cervical cancer
- HPV 6 + 11 = genital warts
Describe the 2 types of HPV genes and their actions [5]
- early genes E1-E7
- interact with intracellular molecules to interfere with cell proliferation machinery to replicate the virus
- late genes L1+L2
- encode capsid proteins
- disruption of cell cycle checkpoints may contribute to accumulation of oncogenic mutations and carcinogenesis
What are the symptoms of cervical cancer? [5]
- post-coital bleeding
- bleeding from vagina after sex
- intermenstrual bleeding
- irregular vaginal bleeding
- pain
- can be asymptomatic
Describe the relation between CIN and development of cancer [2]
- invasive squamous carcinoma of the cervix almost always develops from a pre-existing CIN, but not all CIN will be squamous cancer
- CIN II and CIN III are more likely to progress than CIN I
Atrophic Vaginitis
- Cause? [1]
- Signs & Symptoms? [5]
- caused by low oestrogen after menopause (not cancer)
- signs & symptoms:
- discomfort
- dyspareunia (painful sex)
- bleeding
- polyps
- cysts
What cancers can develop in the vagina? [3]
- VAIN (vaginal intraepithelial neoplasia)
- squamous carcinoma
- primary cancers of cervix or vulva can also involve the vagina
List 5 infections that can develop in the vagina [5]
- yeast (candida, thrush)
- bacterial vaginosis
- C. trichomonas vaginalis
- actinomyces
- herpes simplex
Name 5 skin conditions that can affect the vulva [5]
- inflammatory dermatoses and skin tumours occurring at other sites may also occur in the vulva
- skin tags
- melanocytic nevi
- benign cysts
What can candidiasis (thrush) in the vulva be associated with? [2]
- pregnancy
- diabetes
How can Bartholin’s vestibular gland cysts get infected? [1]
- they may become infected with abscess formation
Name 2 non-infective inflammatory conditions that can develop in the vulva and name which one is associated with anogenital skin in females and vulval squamous carcinoma [3]
- Lichen planus
- Lichen sclerosus
- associated with anogenital skin in females (genital warts) and vulval squamous carcinoma
Describe the features of squamous cell carcinoma (SCC) associated with vulval interepithelial neoplasia (VIN) [4]
- occurs in females <60yrs
- assoicated with high incidence of lower genital tract neoplasia, particularly
- CIN
- invasive cervical cancer
- usually related to high risk type HPV 16/18
- warty or basaloid cancers
Describe the features of SCC associated with Dermatoses [4]
- occurs in females >60yrs
- most of the cancer is well-differentiated and keratinising
- not associated with HPV infection or VIN
- adjacent squamous hyperplasia and/or lichen sclerosis is common
