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Repro > Pathology of the cervix, vulva and vagina > Flashcards

Pathology of the cervix, vulva and vagina Flashcards

1
Q

layers from the top to the bottom of a normal ectocervix

A 
exfoliating cells
superficial cells
intermediate cells
parabasal cells
basal cells
basement membrane
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2
Q

what is the transition zone in the cervix and what happens to it during life

A

squamo columnar junction between squamous and columnar epithelium

alters during life as a physiological response to menarche, pregnancy, menopause

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3
Q

what is cervical erosion

A

exposure of delicate endocervical epithelium to acid environment of vagina leads to physiological squamous metaplasia

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4
Q

what is a nabothian follicle/cyst

A

endocervical glands that have expanded into mucous cysts and can form assess or polyps

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5
Q

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

A

sits higher up
moves out of the endocervix onto the surface of the cervix
retracts after menopause up the cervical canal

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6
Q

symptoms of cervicitis and what can it lead to and why

A

often asymptomatic

can lead to infertility due to simultaneous silent fallopian tube damage

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7
Q

what is cervicitis

A

non specific acute/chronic inflammation

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8
Q

what is follicular cervicitis

A

sub epithelial reactive lymphoid follicles present in the cervix

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9
Q

what is a cervical polyp
what can it lead to to
is it malignant

A

localised inflammatory growth
cause of bleeding if ulcerated
no and not pre malignant either - benign

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10
Q

what does cervical intraepithelial neoplasia lead to

A

commonest precursor for squamous cervical carcinoma

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11
Q

types of HPV involved in cervical cancer

A

16 and 18

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12
Q

risk factors for CIN/cervical cancer

A

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

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13
Q

HPV 6 and 11 can lead to what

A

condyloma acuminatum - thickened papillomatous squamous epithelium with cytoplasmic vacuolation (koliocytosis)

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14
Q

HPV 16 and 18 can lead to what

A

cervical intraepithelial neoplasia CIN

infected epithelium remains flat but may show koliocytosis which can be detected in cervical smears

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15
Q

what else can HPV cause

A

cervical cancer - invasive squamous carcinoma - virus integrated into host DNA

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16
Q

time taken for a HPV infection to become high grade CIN

time taken for high CIN to become invasive cancer

A

6 months - 3 years

5-20 years

17
Q 
prevalence of HPV infection in 15-25 y olds
25-35
>35
most people develop what 
what increases the risk of disease
A 
30-50%
10-20%
5-15%
immunity
persistance
18
Q 
CIN is what 
were does it occur 
what does it involve 
cells
can it be seen 
symptoms/signs 
what is done to detect it
A 
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
19
Q

what are the stages the cells go through to become cancerous

A 
normal squamous epithelium 
koilocytosis 
CIN 1
CIN 2
CIN 3
20
Q

histology of CIN shows what

A

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

21
Q

CIN I
CIN II
CIN III

A

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

22
Q

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

A

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

23
Q 
invasive squamous cancer
stage 1a1
1a2
1b
2
3
4
A

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

24
Q

symptoms of of invasive carcinoma

A

abnormal bleeding - post coitus, post menopausal, brownish or blood stained vaginal discharge, contact bleeding

pelvic pain

haematuria/UTIs

ureteric obstruction /renal failure

25
Q

local spread of squamous carcinoma
lymphatic spread
haematogenous spread

A

uterine body, vagina, bladder, ureters, rectum

(early) pelvic, para aortic nodes
(late) - liver, lungs, bone

26
Q

grading of invasive squamous carcinoma

A

well differentiated
moderately differentiated
poorly differentiated
undifferentiated/anaplastic

27
Q 
cervical glandular intra epithelial neoplasia origin 
what is it 
diagnosis compared to squamous cancer 
screening 
assoc with what
A

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

28
Q

endocervical adenocarcinoma is what percentage of cervical cancers
who
type
prognosis

A

5-25%
young women
mixed - adeno and squamous - adenosquamous?
worse prognosis than squamous

29
Q

epidemiology of adenocarcinoma

A

later onset of sexual activity

smoking HPV 18 esp

30
Q

vulvuar intra epithelial neoplasia

A

HPV linked but not always

pagets disease

31
Q

two types of VIN

A

young - multifocal, recurrent or persistent treatment problems
older - greater risk of progression to invasive squamous carcinoma

32
Q 
vulvar invasive squamous carcinoma who 
where from 
mostly are what 
spread
treatment
A 
elderly, ulcer/exophytic mass
normal epithelium or form VIN
well differentiated 
inguinal LNs
surgical - radical vulvectomy and inguinal lymphadenectomy
33
Q

vulvar pages disease has what kind of rash

tumour cells where

A

crusting rash
epidermis, contain mucin
mostly no underlying cancer, tumour arises from sweat glands in skin

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