Pathology of the Cervix, Vulva and Vagina Flashcards
What is the Transformation zone (TZ)?
Squamo-columnar junction between ectocervical (squamous) and endocervical (columnar) epithelia
What physiological things can alter the position of the TZ?
Menarche
Pregnancy
Menopause
What is cervical erosion?
Exposure to delicate endocervical epithelium to acid environment of the vagina which leads to physiological squamous metaplasia
What is Cervicitis?
Often asymptomatic
Can lead to infertility due to simultaneous silent fallopian tube damage
What is follicular cervicitis?
Sub. epithelial reactive lymphoid follicles present in cervix
What is Chlamydia trachomatis?
STI
What is a Cervical polyp?
Localised inflam outgrowth
Cause of bleeding if ulcerated
Not premalignant
What are types of cervical cancer?
Squamous carcinoma
Adenocarcinoma
Cervical Intraepithelial Neoplasia
What are risk factors for CIN/cervical cancer?
HPV Age at first intercourse Long term oral contraceptive Non-use of barrier contraception Smoking Immunosuppresion
What HPV cause genital warts?
6 and 11
What are genital warts?
Condyloma acuminatum: thickened papilomatous squamous epithelium with cytoplasmic vacuolation (koilocytosis)
What HPV causes CIN?
16 and 18
WHat is CIN?
Infected epithelium remains flat, but may show koilocytosis, which can be detected in cervical smears
What is cervical cancer?
Invasive squamous carcinoma: virus integrated into host DNA
Describe CIN?
Pre-invasive stage of cervical cancer Occurs at the TZ Can involve large areas Dysplasia of squamous cells Not visible to naked eye Asymptomatic Detectable on cervical smear
Describe CIN I
basal 1/3 of epithelium occupied by abnormal cells
Raised numbers of mitotic figures in lower 1/3
Surface cells quite mature, but nuclei slightly abnormal
Describe CIN II
Abnormal cells extend to middle 1/3
Mitoses in middle 1/3
Abnormal mitotic figures
Describe CIN III
Abnormal cells occupy full thickness of epithelium
Mitoses, often abnormal, in upper 1/3
Describe Invasive Squamous Carcinoma (ISC)
75-95% of malignant cervical tumours
2nd commonest female cancer
Develop from pre-existing CIN so should be preventable by screening
What is the 5 year survival rate for cervical cancer in Scotland?
70.1%
What is stage 1A1 ISC?
depth up to 3mm, width up to 7mm
What is stage 1A2 ISC?
depth up to 5mm
width up to 7mm
Low risk of metastases
What is stage 1B ISC?
Confined to the cervix
What is stage 2 ISC?
Spread to adjacent organs (vagina, uterus etc.)
What is stage 3 ISC?
Involvement of pelvic wall
What is stage 4 ISC?
Distant metastases or involvement of rectum or bladder
What are symptoms of invasive carcinoma?
usually none at microinvasive and early invasive stages (detected at screening) Abnormal bleeding Pelvic plain Haematuria/Urinary infections Ureteric obstruction/Renal failire
Describe the bleeding seen in invasive carcinoma?
Post coital
Post-menopausal
Brownish or blood stained vaginal discharge
Contact bleeding - friable epithelium
Where does squamous carcinoma metastasise to via local spread?
Uterine body Vagina Bladder Ureters Rectum
Where does squamous carcinoma metastasise to via lymphatic spread? (early)
Pelvic
para-aortic nodes
Where does squamous carcinoma metastasise to via haematogenous spread? (late)
Liver
Lungs
Bone
How is squamous carcinoma graded?
Well differentiated
Moderately differentiated
Poorly differentiated
Undifferentiated / anaplastic
What is CGIN?
Cervical Glandular Intraepithelial Neoplasm
Describe Cervical Glandular Intraepithelial Neoplasm
Origin from endocervical epithelium
Preinvasive phase of endocervical adenocarcinoma
Screening less effective
Can be assoc. with CIN
What has a worse prognosis; Squamous carcinoma or Endocervical adenocarcinoma?
Endocervical adenocarcinoma
What are risk factors for Adenocarcinoma?
Higher S.E. class
Later onset sexual activity
Smoking
HPV, esp. 18
Name 3 other HPV driven diseases
Vulvar Intraepithelial Neoplasia (VIN)
Vaginal Intraepithelial Neoplasia (VaIN)
Anal Intraepithelial Neoplasia (AIN)
What does Vulvar Intraepithelial Neoplasia have an association with?
Paget’s disease
Describe VIN in young women?
Often multifocal
Recurrent or persistent causing treatment problems
Describe VIN in older women?
Greater risk of progression to invasive squamous carcinoma
What is VIN often synchronous with?
Cervical and vaginal neoplasia (CIN and VaIN)
Describe Vulvular Invasive Squamous carcinoma
Usually elderly women
Ulcer or exophytic mass
Can arise from normal epithelium or VIN
Where does Vulvular Invasive Squamous carcinoma spread to?
Inguinal lymph nodes
What is the treatment of Vulvular Invasive Squamous carcinoma?
Surgical - radical vulvectomy and inguinal lymphadecnectomy
What is the 5 year survival of Vulvular Invasive Squamous carcinoma for node +ve and node -ve?
Node +ve = <60%
Node -ve = 90%
Describe Vulvar Paget’s disease
Crusting rash
Tumour cells in epidermis, contain mucin
Mostly no underlying cancer, tumour arises from sweat gland in skin
