Pathology of the Cervix, Vulva, Vagina Flashcards
What causes cervicitis?
Which infection is the most concerning?
Mostly caused by STIs (C. trachomatis, N. gonorrhea)
HPV infection important due to high risk types
What is this?
Cervical polyps
What are cervical polyps?
What are they characterized by?
Benign polyps arising from endocervical glands
Characterized by glandular or metaplastic squamous epithelium
What causes neoplasms of the cervix?
Typically HPV in cause
Immature cells of transformation zone more susceptible to HPV
Pap smear samples transformation zone
What is this?
What distinguishes eachs stage?
Progression from normal to cervical intraepithelial neoplasia
Subdivided into CIN 1 (low grade), CIN 2 and CIN 3 (high grade)
CIN 1: Basal 1/3rd of epithelium with dysplastic cells
CIN 2: 2/3rd of epithelium with dysplasia
CIN 3: Full thickness dysplasia
What is the importance of CIN?
What causes it?
What are the pathological characteristics?
What are the diagnostic steps to screen for it?
Precancerous lesions of cervix
CIN is preceded by HPV infection
Typically HPV is cleared but persisting HPV causing neoplasia of the cervix
Nuclear atypia, increased nuclear/cytoplasmic ratio, abundant mitoses
Colposcopy is the next test following a positive pap smear to eval for CIN
What is this?
How common is it?
How are the outcomes?
Squamous cell carcinoma of the Cervix
75% of cervical cancer
Markedly decreased mortality rates due to use of pap smears
What glandular lesion of the cervix exists?
How frequent is it?
How does it arise?
What is the clinical issues?
Adenocarcinoma of the cervix
Comprises 20% of all cervical cancer
Carcinoma arising in the endocervical glands
More difficult to sample by pap smear due to the crypts/folds in the cervical canal
What is the pathogenesis of HPV?
HPV infection occurs in the most immature squamous cells of the basal layer, replication of HPV DNA takes place in more differentiated overlying squamous cells
Squamous cells at this stage of maturation do not normally replicate DNA, but HPV-infected squamous cells do, as a consequence of expression of two potent oncoproteins encoded in the HPV genome called E6 and E7
E6 and E7 proteins bind and inactivate two critical suppressors, p53 and Rb, respectively
High-risk HPV strains: 16 and 18, account for 70% of cases of CIN and cervical carcinoma
What is the screening for HPV?
21 to 65 with cytology every 3 years or 30 to 65 with cytology and HPV testing every 5 years
What can cause vulvitis?
What is veulvar vestibulitis?
Infection of vulva can be from bacterial, fungal, viral organisms
Eg: Gonorrhea, syphilis, HSV, HPV, candida, molluscum contagiosum
Vulvar vestibulitis – Non-specific chronic inflammation of the mucosal surfaces of the vulva
What is this?
Lichen sclerosus
Which age group is at risk for lichen sclerosus?
How does skin appear?
What risk is it associated with?
What features are with it?
Occurs in premenarchal and postmenopausal age group
Skin is very pruritic and thin: “parchment paper” appearance
1-5% develop squamous cell carcinoma
Fibrotic dermis, loss of skin appendages, chronic inflammatory cell infiltrate
What is this?
Lichen simplex chronicus
What is lichen simplex chronicus secondary to?
How does it appear?
What is it characterized by?
What is its risk for carcinoma?
Secondary to chronic inflammation and itching
Appears thickened (hyperkeratotic) and with white plaques (leukoplakia)
Characterized by thickened epithelium with chronic inflammation
No known predilection for carcinoma
What is this?
What is it associated with?
How is it graded?
VIN - Precancerous lesion of the vulva
Associated with high risk types of HPV
VIN 1-3 (Same grading as cervix)
What is this?
How frequent is it?
Who is at risk?
What are the subtypes?
Invasive squamous cell carcinoma of vulva
90% of vulvar malignancies are invasive squamous cell cancer
Occurs in the menopausal age group
Subtypes:
Preceded by VIN
Preceded by reactive changes (lichen sclerosis)
What is the many other type of vulvar carcinoma? What does it arise from?
Adenocarcinoma
From the Bartholin glands
What is this?
How does it manifest?
What is it characterized by?
Paget’s disease (extramammary)
Red scaly plaques on the labia
Characterized by large pale glandular cells in the epidermis
What causes vaginitis?
Bacterial, fungal, viral, parasitic infections
What is the vaginal precursor to squamous dysplasia?
How frequent is it?
What can it progress to?
HPV associated vaginal intraepithelial neoplasia – precursor lesion
Subdivided into VAIN 1 (low grade), VAIN 2, VAIN 3
More rare than VIN/CIN
VAIN progresses to invasive squamous carcinoma
What carcinoma is related to DES?
What is its precursor?
Clear cell carcinoma of the vagina
Related to maternal DES exposure while in-utero
Vaginal adenosis is seen with DES exposure and is a precursor
What is this?
Who does it affect?
What type of mass?
Where else can it be seen?
What is it characterized by?
Sarcoma botryoides (embryonal rhabdomyosarcoma)
Infants, young children < 5 yo.
Soft polyploidy masses in the vagina
Also be seen in the urinary bladder and bile ducts
Characterized by primitive cells
