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Reproductive & Sexual Health > Pathology of the Cervix, Vulva and Vagina > Flashcards

Pathology of the Cervix, Vulva and Vagina Flashcards

1
Q

What are the layers of the normal ectocervix?

A

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

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2
Q

What is present on the surface of the normal endocervix?

A

Cilia

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3
Q

What is the transformation zone?

A

Squamo-columnar junction between ectocervical (squamous) and endocervical (columnar) epithelia

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4
Q

When does the position of the TZ alter during life? (physiological)

A

Menarche Pregnancy Menopause

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5
Q

What is cervical erosion?

A

Exposure of delicate endocervical epithelium to acid environment of vagina, leading to physiological squamous metaplasia.

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6
Q

What are nabothian follicles?

A

Mucus producing gland on surface of the cervix

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7
Q

What are the inflammatory pathologies of the cervix?

A

Cervicitis Cervical polyp

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8
Q

What are the neoplastic pathologies of the cervix?

A

Cervical intraepithelial neoplasia (CIN) Cervical cancer

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9
Q

How does cervicitis present?

A

Often asymptomatic, can cause infertility due to simultaneous silent Fallopian tube damage

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10
Q

What is follicular cervicitis?

A

Sub-epithelial reactive lymphoid follicles present in cervix

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11
Q

What are the causes of cervicitis?

A

Chlamydia trachomatis Herpes simplex viral infection

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12
Q

What is a cervical polyp?

A

Localised inflammatory outgrowth

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13
Q

What can cervical polyps cause?

A

Bleeding if ulcerated

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14
Q

What are the types of cervical cancer?

A

Squamous carcinoma Adenocarcinoma

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15
Q

HPV has a ______, _____ stranded DNA, protected by ____ proteins.

A

HPV has a circular, double stranded DNA, protected by capsid proteins.

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16
Q

More than __ HPV subtypes are known, HPV __ & __ cause 70% of all cervix cancers.

A

More than 100 HPV subtypes are known, HPV 16 & 18 cause 70% of all cervix cancers.

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17
Q

How does HPV infection cause cancer?

A

Infection by HPV infects epithelial cells in the cervical mucosa. HPV DNA integrates into the cellular genome when causing cancer.

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18
Q

What increases risk of CIN?

A

Many sexual partners

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19
Q

How does the vulnerability of SC junction in early reproductive life contribute to CIN/cervical cancer?

A

Age at first intercourse Long term use of oral contraceptives Non-use of barrier contraception

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20
Q

What are the risk factors for CIN/cervical cancer?

A

Persistence of High risk HPV types (16, 18) Vulnerability of SC Junction in early reproductive life Smoking: 3x risk Immunosuppression

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21
Q

Describe the appearance of HPV 6 and 11 infection?

A

Genital warts Conduloma acuminatum: thickened papillomatous squamous epithelial with cytoplasmic vacuolation (koilocytosis)

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22
Q

Describe infection with HPV 16 & 18

A

Infected epithelium remains flat, but may show koilocytosis- which can be detected in cervical smears

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23
Q

HPV infection –> High grade CIN (_ _____- _ ____)

A

HPV infection –> High grade CIN (6 months- 3 years)

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24
Q

High grade CIN –> Invasive cancer ( _ to __ years)

A

High grade CIN –> Invasive cancer ( 5 to 20 years)

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25
Q

What is CIN?

A

Cervical intraepithelial neoplasia- pre-invasive stage of cervical cancer

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26
Q

Where does CIN occur?

A

Transformation zone. Can involve large area

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27
Q

What is seen in CIN?

A

Dysplasia of squamous cell

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28
Q

How can CIN be detected?

A

Asymptomatic- detected by cervical screening

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29
Q

What is the progression from Normal squamous epithelium to CIN 3?

A

Normal squamous epithelium Koilocytosis CIN 1 CIN 2 CIN 3

30
Q

What is seen in histology of CIN?

A
  • delay in maturation/differentiation
  • nuclear abnormalities
  • excess mitotic activity
31
Q

What is seen as a result of delay in maturation/differentiation in CIN?

A

Immature basal cells occupying more of epithelium

32
Q

What nuclear abnormalities are seen in CIN?

A
  • hyperchromasia
  • Increased nucleocytoplasmic ratio
  • pleomorphism
33
Q

What is seen as a result of excess mitotic activity in CIN?

A

Situated above basal layers

Abnormal mitotic forms

34
Q

Often _______ (indicating HPV infection) also present.

CIN is graded I-III depending on _____ of;

  • delay in ______/_________
  • ______ abnormalities
  • excess ______ activity
A

Often koilocytosis (indicating HPV infection) also present.

CIN is graded I-III depending on severity of;

  • delay in maturation/differentiation
  • nuclear abnormalities
  • excess mitotic activity
35
Q

What is CIN I?

A

Basal 1/3 of epithelium occupied by abnormal cells.

  • Raised numbers of mitotic figures in lower 1/3*
  • Surface cells quite mature but nuclei slightly abnormal.*
36
Q

What is CIN II?

A

Abnormal cells extend to middle 1/3

  • mitoses in middle 1/3
    • abnormal mitotic figures*
37
Q

What is CIN III?

A

Abnormal cells occupy full thickness of epithelium

Mitosis, often abnormal present in upper 1/3

38
Q

What percentage of CIN III progress to invasion?

A

12%

39
Q

What cancer makes up 75-95% of malignant cervical tumours?

A

Invasive squamous carcinoma

40
Q

What does invasive squamous carcinoma develop from?

A

Pre-existing CIN

41
Q

What are the stages of invasive squamous carcinoma?

A
  • Stage 1A1- depth up to 3mm, width up to 7mm
  • Stage 1A2- depth up to 5mm, width up to 7mm
  • Stage 1B- confined to cervix
  • Stage 2- spread to adjacent organs (vagina, uterus etc)
  • Stage 3- involvement of pelvic wall
  • Stage 4- distant metastases or involvement of rectum or bladder
42
Q

What are the symptoms of invasive carcinoma?

A
  • Usually none at microinvasive and early invasive stages (Detected at screening)
  • Abnormal bleeding
    • post coital
    • post menopausal
    • brownish or blood stained vaginal discharge
    • contact bleeding- friable epithelium
  • pelvic pain
  • haematuria/urine infections
  • ureteric obstruction/renal failure
43
Q

Describle local spread of squamous carcinoma

A

Uterine body, vagina, bladder, ureters, rectum

44
Q

Describe lymphatic spread of squamous carcinoma

A

Pelvic, para-aortic nodes

45
Q

Describe haematogenous spread of squamous carcinoma?

A

Liver, lungs, bone

46
Q

How does squamous carcinoma spread?

A

Local

Lymphatic

Haematogenous

47
Q

How is squamous carcinoma graded?

A

Well differentiated

Moderately differentiated

Poorly differentiated

Undifferentiated/anaplastic

48
Q

What is cervical glandular intraepithelial neoplasia?

A

Preinvasive phase of endocervical adenocarcinoma

49
Q

What is the origin of CGIN?

A

Endocervical epithelium

50
Q

Why is CGIN missed?

A

More difficult to pick up on smear

51
Q

Describe the prognosis of endocervical adenocarcinoma?

A

Worse than squamous carcinoma

52
Q

Endocervical carcinoma are responsible for _-__% of cervical cancer

Some are _____ (________) arise from a common cell of origin

A

Endocervical carcinoma are responsible for 5-25% of cervical cancer

Some are mixed (adenosquamous) arise from a common cell of origin

53
Q

What is the epidemiology of adenocarcinoma?

A

Higher S.E class

Later onset of sexual activity

Smoking

HPV- particularly 18

54
Q

What diseases are driven by HPV?

A
  • vulvar intraepithelial neoplasia- VIN
  • Vaginal intraepithelial neoplasia- VaIN
  • Anal intraepithelial neoplasia, AIN
55
Q

What is VIN also known as?

A

Paget’s disease

unusual kind of skin cancer that arises from glandular cells. This disease appears as a red, velvety area with white islands of tissue on the vulva.

56
Q

What is the epidemiology (age) of VIN?

A
  • bimodal
    • young women: often multifocal, recurrent or persistent causing treatment problems
    • older women: greater risk of progression to invasive squamous carcinoma
57
Q

CIN often presents with?

A

synchronus CIN & VaIN

58
Q

What is vulvar invasive squamous carcinoma?

A

Arises from normal epithelium or from VIN

Usually presents in elderly women, ulcer or exophytic mass

59
Q

Vulvar invasive squamous carcinoma are usually ____ differentiated (______ are an extremely painful well differentiated type)

A

Vulvar invasive squamous carcinoma are usually well differentiated (verrucous are an extremely painful well differentiated type)

60
Q

What is the most important prognostic factor for vulvar invasive squamous carcinoma?

A

Spread to inguinal lymph nodes

61
Q

What is the treatment for vulvar invasive squamous carcinoma?

A

Radical vulvectomy and inguinal lymphadencetomy

62
Q

What is the prognosis for vulvar invasive squamous carcinoma?

A

90% 5 year survival- node negative

<60% 5 year survival- node positive

63
Q

Descreibe the presentation of vulvar paget’s disease?

A

Crusting rash

64
Q

What does tumour arise from in vulvar paget’s disease?

A

Sweat gand in skin

Tumour cells in epidermis, contain mucin

65
Q

What are some infectious vulval diseases?

A
  • Candida (Particularly diabetics)
  • Vulvar warts (HPV 6 & 11)
  • Bartholin’s gland abscess (blockage of gland duct)
66
Q

What are some non-neoplastic epithelial disorders of the vulva?

A
  • lichen sclerosis
  • other dermatoses
    • lichen planus
    • psoriasis
67
Q

What causes atrophy of the vulva?

A

Post-menopause

68
Q
  • VaIN :Vaginal intraepithelial neoplasia.
  • May also have _____ and _____ lesions.
A
  • VaIN :Vaginal intraepithelial neoplasia.
  • May also have cervical and vulval lesions.
69
Q

Squamous carcinoma: Less common than _____ and _____ counterparts. A disease of the _____.

A

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

70
Q

Melanoma is ____ and may appear as a ______

A

Melanoma is rare and may appear as a polyp

Reproductive & Sexual Health (54 decks)

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