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Reproduction > Pathology of the Cervix, Vulva and vagina > Flashcards

Pathology of the Cervix, Vulva and vagina Flashcards

1
Q

describe the histology of a normal ectocervix from BM up?

-any nuclear change as the layers become more superficial?

A 
Exfoliating cells 
Superficial cells
Intermediate cells
Parabasal cells
Basal cells
Basement membrane

-small mature nuclear closer to the surface?

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2
Q

endocervix

  • communicates with what?
  • composed of what?
A
  • communicates with the endometrial cavity

- fibroblasts, smooth muscle and epithelium

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3
Q

what is the transformation zone?

-position?

A

squamo-columnar junction between ectocervical (squamous) and endocervical (columnar) epithelium

-changes throughout life as a result of physiological response to: menarche (higher up pre menarche)
pregnancy
menopause (retracts back up)

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4
Q

what causes squamous metaplasia?

A

cervical erosion- delicate endocervical epithelium to acid environment of the vagina leads to physiological squamous metaplasia

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5
Q

what is a nabothian follicle?

A

endocervical glands that have expanded into mucous cysts, they can form masses or polyps

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6
Q

Cervicitis

  • give 4 causes?
  • complication?
A

-non specific acute or chronic inflammation
follicular cervicitis- sub epithelial reactive lymphoid follicles present in cervix
chlamydia
Herpes simplex virus infection

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7
Q

What is a cervical polyp?

A

localised inflammatory outgrowth

might cause bleeding if ulcerated

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8
Q

give the types of neoplastic cervical pathology?

A 
cervical intraepithelial neoplasia
Cervical cancer (squamous carcinoma or Adenocarcinoma)
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9
Q

risk factors for CIN/Cervical cancer?

A

-HPV 16 &18, many sexual partners ^ risk

vulnerability of SC junction in early reproductive life (age at first intercourse, long term use oral contraceptives, non-use of barrier contraception)

smoking & immunosuppression

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10
Q

types of HPV infection

  • low risk for cancer?
  • high risk?
  • when does HPV infection become cancer?
  • prevalence of HPV infection?
  • appearence on smear of HPV infection?
A

-genital warts, type 6&11
condyloma Acuminatum: thickened papillomatous squamous epithelium with cytoplasmic vacuolation (koilocytosis)

-cervical intraepithelial neoplasia, types 16&18
infected epithelium remains flat but may show koilocytosis (seen in smears)

  • becomes an invasive squamous carcinoma when it breaks through the BM, the virus is integrated into the host DNA
  • much higher levels in the younger age groups

-look for an irregular nuclear outline, think about changes in the nuclear to cytoplasm ratio (more nucleus)
cells might have 3 nuclei- common to HPV

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11
Q

Cervical intraepithelial Neoplasia

  • definition?
  • occurs where?
  • detected via?
  • histology of CIN-what can be seen in terms of differentiation, nuclear abnormalities and mitotic activity?
  • give the 3 categories of CIN
A
  • the pre invasive stage of cervical cancer
  • at the transformational zone
  • screening, see dysplasia of squamous cells

-Delay in maturation/differentiation: immature basal cells occupying more of the epithelium
nuclear abnormalities: hyperchromasia, inc nucleocytoplasmic ratio, pleomorphism
Excess mitotic activity:
situated above basal layers
abnormal mitotic forms

-CIN I
basal 1/3 of epithelium occupied by abnormal cells (raised no. of mitotic figures in lower 1/3 the surface cells are quite mature but nuclei slightly abnormal)
CIN II
abnormal cells extend to middle 1/3 (mitosis in middle 1/3 and abnormal mitotic figures)
CIN III
abnormal cells occupy full thickness of epithelium (mitosis often abnormal in upper 1/3)

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12
Q

Invasive squamous carcinoma

  • develops from what?
  • 5 yr survival?
  • give the stages and describe each
  • presentation? (6)
  • sites of mets? (3)
  • grading? (4)
A
  • pre-existing CIN so should be preventable by screening
  • 70.1%
-Stage 1
1A1: depth of up to 3mm, width up to 7mm
1A2: depth of up to 5mm, with up to 7mm
1B: confined to cervix
Stage 2
spread to adjacent organs
stage 3
involvement of the pelvic wall
Stage 4
distant mets or involvement of rectum or bladder

-asymptomatic in early stages when micro invasive
abnormal bleeding: post coital, post menopausal, brownish or blood stained vaginal discharge, contact bleeding
+pelvic pain
haematuria/UTI
ureteric obstruction/renal failure

-local (uterine body, vagina, bladder, ureters, rectum)
Lymphatic (pelvic/para-aortic nodes)
haematogenous (liver,lungs,bone)

-Well differentiated
Moderately differentiated
Poorly differentiated
Undifferentiated / anaplastic

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13
Q

Cervical Glandular intraepithelial neoplasia

  • origin?
  • what is it?
  • screening?
A
  • endocervical epithelium
  • pre invasive phase of endocervical adenocarcinoma
  • is less effective, harder to diagnose than squamous
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14
Q

Endocervical adenocarcinoma

  • occurs in what groups?
  • histology?
A

-higher SE class
later onset of sexual activity
smoking
HPV 18

-cribriform growth

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15
Q

name 3 other HPV driven diseases?

A

Vulvar Intraepithelial Neoplasia (VIN)
Vaginal Intraepithelial Neoplasia (VaIN)
Anal Intraepithelial Neoplasia (AIN)

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16
Q

Vulval intraepithelial neoplasia

  • grades?
  • bimodal: explain?
  • occurs with what?
A
  • three grades like CIN
  • young women: often multifocal, recurrent or persistent causing treatment problems

Older women: greater risk of progression to invasive squamous carcinoma

-might be HPV related
Often synchronous cervical & vaginal neoplasia

17
Q

Vulvar invasive squamous carcinoma

  • affect whom?
  • arises from?
  • histology?
  • spread to where?
  • treatment?
A
  • elderly women, appears as an ulcer or exophytic mass
  • normal epithelium or VIN
  • well differentiated
  • inguinal node spread
  • radical vulvectoy & inguinal lymphadenectomy
18
Q

vulvar paget’s disease

  • presents as what?
  • histology?
  • arises from where?
A
  • crusting rash
  • tumour cells in the epidermis, contain mucin
  • mostly no underlying cancer, tumour arises from sweat gland in skin
19
Q

Vulval disease

  • give 3 infections of the vulva
  • give 3 non neoplastic epithelial disorders
  • post menopausal problem?
A

-Candida
vulvar warts
Bartholins gland abscess

-lichen sclerosis
Lichen planus
Psoriasis

-Atrophy

20
Q

give 3 vaginal neoplasms

A

VaIN :Vaginal intraepithelial neoplasia. May also have cervical and vulval lesions.

Squamous carcinoma: Less common than cervical and vulval counterparts. A disease of the elderly.

Melanoma: Rare. May appear as a polyp.

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