Pathology of the cervix, vulva and vagina Flashcards
What lines the endocervix?
Columnar epithelium
What lines the ectocervix?
Squamous epithelium
What is the transformation zone?
Physiological squamous metaplasia occurs between the endocervix and the ectocervix
What infections affect the cervix?
- Human papilloma virus
- Chlamydia trachomatis
- Gonorrhoea
- Herpes simplex virus
- Trichomonas vaginalis
- Candida albicans
- Actinomyces
- Bacterial vaginosis
What is a symptom soft cervical polyps
Post coital bleeding
What is the objective of cervical screening?
- To pick up precancerous changes in cervical smears so patients can be referred for colposcopy and treatment
- Reduce the number of women who develop invasive cervical cancer and die
What is the name for pre-cancerous changes in cervical smears?
Dyskaryosis
Who should get cervical screening?
- Women 20-60
* Once every 5 years
What happens if a smear result comes back as abnormal?
Patient sent to colposcopy where the cervix is examined and usually biopsied
What are precancerous changes called in cervical biopsy?
Cervical intraepithelial neoplasia
What should you do if a smear result comes back as borderline nuclear abnormality?
- Repeat in 6 months
* 3x then refer for colposcopy
What is the appearance of koilocytosis?
- Nuclear enlargement
- Clear space around the nucleus
- Abnormal membrane contour
- Stains dark
When do you see koilocytosis?
After HPV infection
What is dyskaryosis?
- Nuclear enlargement
- Dense hyperchromasia
- Coarse chromatin clumping
What is CIN?
Dysplasia or neoplasia in cervical biopsies that are confined to the epithelium, can be low grade CIN1 or high grade, CIN2 or 3
What is cGIN?
- Endocervical glandular epithelium
- cervical Glandular Intraepithelial Neoplasia
- Malignant change from glandular epithelium is adenocarcinoma
What should you refer a woman with post-menopausal bleeding for?
A hysteroscopy or an endometrial biopsy
What are the symptoms of cervical cancer?
- Post coital bleeding
- Intermenstrual bleeding
- Irregular vaginal bleeding
- Pain
- Can be asymptomatic
What are the risk factors of cervical cancer?
- Age at first sexual intercourse
- Number of sexual partners
- Smoking
- Oral contraception vs barrier
- Immunosuppression
- Circumcision in males is protective
When do you get invasive squamous cell carcinoma?
When the neoplastic cells are no longer confined to the basement membrane
What is the treatment of early cervical cancer?
Surgically e.g. LETZ, simple or radical hysterectomy
What is the most common cervical cancer?
Squamous cell carcinoma
What inflammatory conditions affect the vulva?
- Any inflammatory condition that affects hair bearing skin elsewhere
- Psoriasis, eczema, allergic dermatitis
What are the vulval infections?
- Vulval warts
- Candida
- Infection in hair follicles
- Bartholins abscess
- Epidermal inclusion cyst
- Bartholin’s cysts (obstruction of bartholin’s duct)
What may leukoplakia represent?
They are white plaques: benign, premalignant or malignant conditions
What are the tumours affecting the vulva?
- All of them are rare:
- Neurofibromas
- Angiomas
- Skin adenexal
- Carcinomas
- Melanomas
- Sarcomas
