Pathology of the Cervix, Vulva and Vagina Flashcards
Describe the cells of a normal endocervix.
Single layer of ciliated mucin-secreting epithelium, sitting on a basement membrane with stroma underneath
List the 6 different cell layers of a normal ectocervix (out to in).
- Exfoliating cells
- Superficial cells
- Intermediate cells
- Parabasal cells
- Basal cells
- Basement membrane
Where is the ‘transformation zone’?
Cervix
Describe the transformation zone.
Squamo-columnar junction between ectocervical (squamous) and endocervical (columnar) epithelia
In what stages of a woman life does the transformation zone alter?
- Menarche
- Pregnancy
- Menopause
What is cervical erosion?
Exposure of delicate endocervical epithelium to acid environment of vagina leads to physiological squamous metaplasia
What is the characteristic sign of cervical erosion?
** Nabothian follicles **
What is metaplasia?
One type of epithelium transforms into another type of epithelium
Can squamous metaplasia be physiological?
Yes
Cervicitis can be ____________
Asymptomatic
What is cervicitis?
Inflammation of the cervix
What complication can cervicitis lead to?
Infertility, due to simultaneous silent fallopian tube damage
What can the inflammation in cervicitis be?
Non-specific acute/chronic
In follicular cervicitis, what can be seen on the cervix?
Sub-epithelial reactive lymphoid follicles
Name 2 infections which can lead to cervicitis.
- Chlamydia trachomatis (sexually transmitted).
* Herpes Simplex Viral infection.
What is a cervical polyp?
A localised inflammatory outgrowth in the cervix
Can a polyp cause bleeding?
Yes, if it is ulcerated
Is a polyp premalignant?
NO
What 2 neoplastic changes can occur in the cervix?
- Cervical Intraepithelial Neoplasia (CIN).
* Cervical Cancer:
What are the 2 main types of cervical cancer?
- Squamous carcinoma.
* Adenocarcinoma
What type of virus is HPV?
A DNA virus
What strains of HPV are responsible for 70% of all cervical cancers?
16 and 18
Between 10-30 years after being infected with HPV, a small proportion of women will go on to develop cancer
T
What HPV strains are high risk?
16, 18, 31, 33, 35, 45, 48
What increases your risk of getting HPV?
Multiple sexual partners
When is the ( squamocolumnar)SC junction of the vagina vulnerable?
In early reproductive life
What factors make the SC junction more vulnerable?
- Age at first intercourse.
- Long term use of oral contraceptives.
- Non-use of barrier contraception.
Does smoking increase the risk of cervical cancer?
Yes, it increases risk by 3x
HPV causes _________ warts
Genital
What HPV types cause genital warts?
6 and 11
Is HPV 6 and 11 low or high risk?
Low
What is Condyloma Acuminatum?
Thickened ‘papillomatous’ squamous epithelium with cytoplasmic vacuolation (‘koilocytosis’)
What type of HPV causes CIN?
High risk HPV – types 16 and 18
Describe the typical histological appearance of CIN.
Infected epithelium remains flat, but may show koilocytosis, which can be detected in cervical smears.
What type of cervical cancer does HPV cause?
Invasive squamous carcinoma.
What does virus integrate into?
Host DNA
What is the usual time frame in which HPV infection becomes high grade CIN?
6 months - 3 years
How long does it take for high grade CIN to develop into invasive cancer?
5-20 years
What is the cumulative prevalence of HPV in a lifetime?
80%
Most people develop immunity for HPV
T
What increases the risk of HPV disease?
PERSISTENCE !!!