Pathology of the cervix, vulva and vagina

Question 1

What lines the endocervix?

Answer 1

Columnar epithelium

Question 2

What lines the ectocervix?

Answer 2

Squamous epithelium

Question 3

What is the transformation zone?

Answer 3

Physiological squamous metaplasia occurs between the endocervix and the ectocervix

Question 4

What infections affect the cervix?

Answer 4

• Human papilloma virus
• Chlamydia trachomatis
• Gonorrhoea
• Herpes simplex virus
• Trichomonas vaginalis
• Candida albicans
• Actinomyces
• Bacterial vaginosis

Question 5

What is a symptom soft cervical polyps

Answer 5

Post coital bleeding

Question 6

What is the objective of cervical screening?

Answer 6

• 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

Question 7

What is the name for pre-cancerous changes in cervical smears?

Answer 7

Dyskaryosis

Question 8

Who should get cervical screening?

Answer 8

• Women 20-60

* Once every 5 years

Question 9

What happens if a smear result comes back as abnormal?

Answer 9

Patient sent to colposcopy where the cervix is examined and usually biopsied

Question 10

What are precancerous changes called in cervical biopsy?

Answer 10

Cervical intraepithelial neoplasia

Question 11

What should you do if a smear result comes back as borderline nuclear abnormality?

Answer 11

• Repeat in 6 months

* 3x then refer for colposcopy

Question 12

What is the appearance of koilocytosis?

Answer 12

• Nuclear enlargement
• Clear space around the nucleus
• Abnormal membrane contour
• Stains dark

Question 13

When do you see koilocytosis?

Answer 13

After HPV infection

Question 14

What is dyskaryosis?

Answer 14

• Nuclear enlargement
• Dense hyperchromasia
• Coarse chromatin clumping

Question 15

What is CIN?

Answer 15

Dysplasia or neoplasia in cervical biopsies that are confined to the epithelium, can be low grade CIN1 or high grade, CIN2 or 3

Question 16

What is cGIN?

Answer 16

• Endocervical glandular epithelium
• cervical Glandular Intraepithelial Neoplasia
• Malignant change from glandular epithelium is adenocarcinoma

Question 17

What should you refer a woman with post-menopausal bleeding for?

Answer 17

A hysteroscopy or an endometrial biopsy

Question 18

What are the symptoms of cervical cancer?

Answer 18

• Post coital bleeding
• Intermenstrual bleeding
• Irregular vaginal bleeding
• Pain
• Can be asymptomatic

Question 19

What are the risk factors of cervical cancer?

Answer 19

• Age at first sexual intercourse
• Number of sexual partners
• Smoking
• Oral contraception vs barrier
• Immunosuppression
• Circumcision in males is protective

Question 20

When do you get invasive squamous cell carcinoma?

Answer 20

When the neoplastic cells are no longer confined to the basement membrane

Question 21

What is the treatment of early cervical cancer?

Answer 21

Surgically e.g. LETZ, simple or radical hysterectomy

Question 22

What is the most common cervical cancer?

Answer 22

Squamous cell carcinoma

Question 23

What inflammatory conditions affect the vulva?

Answer 23

• Any inflammatory condition that affects hair bearing skin elsewhere
• Psoriasis, eczema, allergic dermatitis

Question 24

What are the vulval infections?

Answer 24

• Vulval warts
• Candida
• Infection in hair follicles
• Bartholins abscess
• Epidermal inclusion cyst
• Bartholin’s cysts (obstruction of bartholin’s duct)

Question 25

What may leukoplakia represent?

Answer 25

They are white plaques: benign, premalignant or malignant conditions

Question 26

What are the tumours affecting the vulva?

Answer 26

• All of them are rare:
• Neurofibromas
• Angiomas
• Skin adenexal
• Carcinomas
• Melanomas
• Sarcomas