Pathology of the cervix, vulva and vagina Flashcards
layers from the top to the bottom of a normal ectocervix
exfoliating cells superficial cells intermediate cells parabasal cells basal cells basement membrane
what is the transition zone in the cervix and what happens to it during life
squamo columnar junction between squamous and columnar epithelium
alters during life as a physiological response to menarche, pregnancy, menopause
what is cervical erosion
exposure of delicate endocervical epithelium to acid environment of vagina leads to physiological squamous metaplasia
what is a nabothian follicle/cyst
endocervical glands that have expanded into mucous cysts and can form assess or polyps
where does the transition zone sit in children and during pre monarchy and where does it go after puberty
what happens to it after menopause
sits higher up
moves out of the endocervix onto the surface of the cervix
retracts after menopause up the cervical canal
symptoms of cervicitis and what can it lead to and why
often asymptomatic
can lead to infertility due to simultaneous silent fallopian tube damage
what is cervicitis
non specific acute/chronic inflammation
what is follicular cervicitis
sub epithelial reactive lymphoid follicles present in the cervix
what is a cervical polyp
what can it lead to to
is it malignant
localised inflammatory growth
cause of bleeding if ulcerated
no and not pre malignant either - benign
what does cervical intraepithelial neoplasia lead to
commonest precursor for squamous cervical carcinoma
types of HPV involved in cervical cancer
16 and 18
risk factors for CIN/cervical cancer
HPV 16 and 18
vulnerability of SC junction in early repro life - age at first intercourse, long term use of oral contraceptives, non use of barrier contraception
smoking 3x risk
immunosuppression
HPV 6 and 11 can lead to what
condyloma acuminatum - thickened papillomatous squamous epithelium with cytoplasmic vacuolation (koliocytosis)
HPV 16 and 18 can lead to what
cervical intraepithelial neoplasia CIN
infected epithelium remains flat but may show koliocytosis which can be detected in cervical smears
what else can HPV cause
cervical cancer - invasive squamous carcinoma - virus integrated into host DNA
time taken for a HPV infection to become high grade CIN
time taken for high CIN to become invasive cancer
6 months - 3 years
5-20 years
prevalence of HPV infection in 15-25 y olds 25-35 >35 most people develop what what increases the risk of disease
30-50% 10-20% 5-15% immunity persistance
CIN is what were does it occur what does it involve cells can it be seen symptoms/signs what is done to detect it
pre invasive stage of cervicle cancer occurs at transformation zone can involve large area zsyplasia of squamous cells not visible by naked eye asymp detectable by screening
what are the stages the cells go through to become cancerous
normal squamous epithelium koilocytosis CIN 1 CIN 2 CIN 3
histology of CIN shows what
delay in maturation/differential - immature basal cells occupying more of the epithelium
nuclear abnormality - hyperchromasia, increased nucleocytoplasmic ration, pleomorphism
excess mitotic activity - situated above basal layer, abnormal mitotic forms
CIN I
CIN II
CIN III
basal 1/3 epithelium occupied by abnormal cells - raised number of mitotic figures in lower 1/3
surface cells mature but nuclei slightly abnormal
abnormal cells extend to middle 1/3 - mitosis in middle 1/3, abnormal mitotic figures
abnormal cells occupy full thickness of epithelium - mitosis, often abnormal in upper 1/3
invasive squamous carcinoma is what percentage of malignant cervical tumours
how common is it
who is common in
develops from what and why is this useful
75-95%
2nd most commonest female cancer
increasingly detected in younger women, often found in early stage, some are ra[idly progressive tumours
developer form pre existing CIN therefore most cases should be preventable by screening
invasive squamous cancer stage 1a1 1a2 1b 2 3 4
depth up to 3mm, width up to 7mm
depth up to 5mm, width up to 7mm. low risk of lymph mets
confined to cervix
spread to adjacent structures
involvement of pelvic wall
distant mets or involvement of rectum or bladder
symptoms of of invasive carcinoma
abnormal bleeding - post coitus, post menopausal, brownish or blood stained vaginal discharge, contact bleeding
pelvic pain
haematuria/UTIs
ureteric obstruction /renal failure
local spread of squamous carcinoma
lymphatic spread
haematogenous spread
uterine body, vagina, bladder, ureters, rectum
(early) pelvic, para aortic nodes
(late) - liver, lungs, bone
grading of invasive squamous carcinoma
well differentiated
moderately differentiated
poorly differentiated
undifferentiated/anaplastic
cervical glandular intra epithelial neoplasia origin what is it diagnosis compared to squamous cancer screening assoc with what
from endocervical epithelium
preinvasice phase of endocervical adenocarcinoma
more difficult to diagnose on a cervical smear than squamous
screening is less effective
sometimes assoc with CIN
endocervical adenocarcinoma is what percentage of cervical cancers
who
type
prognosis
5-25%
young women
mixed - adeno and squamous - adenosquamous?
worse prognosis than squamous
epidemiology of adenocarcinoma
later onset of sexual activity
smoking HPV 18 esp
vulvuar intra epithelial neoplasia
HPV linked but not always
pagets disease
two types of VIN
young - multifocal, recurrent or persistent treatment problems
older - greater risk of progression to invasive squamous carcinoma
vulvar invasive squamous carcinoma who where from mostly are what spread treatment
elderly, ulcer/exophytic mass normal epithelium or form VIN well differentiated inguinal LNs surgical - radical vulvectomy and inguinal lymphadenectomy
vulvar pages disease has what kind of rash
tumour cells where
crusting rash
epidermis, contain mucin
mostly no underlying cancer, tumour arises from sweat glands in skin
