Pathology of the Cervix, Vulva and Vagina Flashcards
What are the cell layers of the normal ectocervix?
exfoliating; superficial; intermediate; parabasal; basal; basement membrane
What type of epithlium is ectocervical?
squamous
What type of epithelium is the endocervical epithelia?
columnar
What does the position of TZ change in response to?
menarche; pregnnayc; menopause
What si the transformation zone?
squamou-columnar junction between ectocervical and endocevical epithelia
What is a cervical erosion?
exposure of delicate endocervical epithelium to acid environemnt of vagina leads to physiologyical squamous metaplasia
Why can cervicitis lead to infertility?
pt is often asymptomatic and can often have simultaneous silent fallopian tube damage
What folllicular cervicitis?
sub epithelial reactive lymphoid follicles present in cervix
What are hte cases of cervicitis?
chlamydia and HSV
What is a cervical polyp?
localised inflammatory outgrowth
What is the prognosis of a cervical polyp?
not premalignant
When can cervical polyps cause bleeding?
if ulcerate
What are the types of cervical caner?
squamous carcinoma; adenocarcinoma
What are hte risk factors for CIN and cervical cancer?
high risk HPV (16 and 18)- many partenrs increases this risk; vulnerability of SC junction in early repro life; smoking; immunosuppression
What can cahnge the vulnerability of the SC junction in early repro life?
age at first intercourse; long term use of COP’;non-use of barrier contraception
What types of HPV cause genital warts?
6 and 11
What other name are genital warts known by?
condyloma acuminatum
Dscribe the histopathology of genital warts?
thickened papillomatous squamous peithlium with cytoplasmic vaculoation====koilocytosis
What is seen on histopathology with cervical intraepithelial neoplasia?
infection epithelium reamins flat but may show koilocytosis which can be detected in cervical smears
What causes invasive squamous carcinoma?
virus has integrated into host DNA
How long does it take HPV infection to become a high grade CIN?
6 months - 3years
How long does it take a high grade CIN to become an invasive cancer?
5-20 years
What is the cumulative prevalence of HPV infection?
80%
What is CIN?
pre-invasive stage of cervical cancer
Where does cervical intraepithelial neoplasia?
transformtion zone
what factors are invovled in grading CIN on histology?
delay in maturation/differentiation; nuclear abnormalities; excess mitotic activity
What is seen with a delay in maturation.differentiation?
immature basal cells occupying more of epithelium
What nuclear abnormalties are seen in CIN?
hyperchomasia; increased nucleocytoplasmic ratio; pleomorphism
What is excess mitotic activity?
situated above basal layers; abnormal mitotic forms
What is CIN 1 defined as?
basal 1/3rd of epithlium occupied by abnormal cells; surface cells uite mature but nuclei slightly abnormal
What is CIN2 defined as?
abnormal cells extend to middle 1/3rd
What is CIN3 deinfed as?
abnormal cells occupy full thickenss of epithlium
What isthe most common type of cervical cancer?
invasive squmous carcinoma
What does invasive squmoua carinoma develop from?
pre-existing CIN
What is stage 1A1 of invasive squamous carcinoma of cervix ?
depth upto 3mm; width upto 7mm
What is stage 1A2 of invasive squamous carinoma of cervix?
depth upto 5mm, width upto 7mm
What is stage 1B of invasive squmous carcinoma of hte cervix?
confined to cervix
Waht is stage 2 of invasive squmous carcinoma of hte cervix?
spread to adjacent organs
What is stage 3 of invasive squmous carcinoma of hte cervix?
involvemtn fo pelvic wall
What is stage 4 of invasive squmous carcinoma of hte cervix?
distant mets or involvemtn of rectum or bladder
What are the symtpoms of invasive carinoma of the ervix?
abnormal bleeding; pelvic pain; haematuria/UTIs; ureteric obstruction/renal failure
What type of abnormal bleeding can you get with cervical cancer?
post-coital; post-menopausal; brownish or blood stained vaginal discharge; contact bleeding-friable epithelium
What is the local spread of squmous cervical carcinoma?
uterine body; vagina; bladder; uretersl rectum
What is the early spread of squmous carcinoma of the cervix?
lymphatic–pelvic and para-aortic nodes
What is hte late spread of cervical squmous carcinoma?
haematogenous
What does cervical glandular intraepithelial neoplasia originate from?
endocervical epithelium
What is CGIN the preinvasive phase for?
endocervical adenocarcinoma
What is the prognosis of adenocarinoma vs squmous carinoma of the cervix?
worse compared to squamosu
What are the RF for adenocarincoma of the cervix?
higher SE class; later onset of sexual activity; smoking; esp. HPV 18
What are the other pelvic HPV driven disease?
vulvar intraepithelial neoplasia; vaginal intraepithelial neoplasia; anal intraepithelial neoplasia
What is vulval intraepithelial neoplasia like in young women?
often multifocal, recurrent or persisten causing treatment problems
what is vulvar intraepithelial neoplasia like in old women?
greater risk of pgression to invasive squamous carcinoma
What nodes does vulvar invasive squamous carcinoma ten to spread to?
inguinal lymph ndoes
What is the most important prognostic factor in vulvar invasive squmous carcinoma?
spread to inguinal nodes
Who gets vulvar invasive squmoua carcinoma?
elderly women
What is the appearnace of vulvar squmoua carcinoma?
ulcer or exophytic mass
What does vulvar squmous carcinoma arise from?
normal epithelium or VIN
What is seen with vulvar Paget’s disease?
crusting rash
What is found within the vulvar Paget’s disease?
mucin
What does the tumour in vulvar pagets disease arise from?
sweat gland in skin
What may be foudn if a patient has vaginal intraepithelaila neoplasia?
also have cervical and vulval lesions
How may melanomain the vagina appear?
polyp
