Pathology of the Female Reproductive Tract 2

Question 1

For some malignant neoplasms a ‘pre-malignant’ state is identified - What is this state termed?

Answer 1

Dysplasia

Question 2

Dysplasia

Answer 2

• For some malignant neoplasms a ‘pre-malignant’ state is identified
• There is an accumulation of cells which look somewhat like malignant cells but do not invade the basement membrane
• Dysplastic lesions may (but don’t always) progress to invasive malignancy
• Recognising dysplastic lesions allows early treatment before invasion occurs

Question 3

Define Dysplasia

Answer 3

disordered growth and differentiation characterised by increased proliferation (more mitoses), atypia of cells and decreased differentiation

Question 4

Dysplastic lesions may (but don’t always) progress to invasive …

Answer 4

Dysplastic lesions may (but don’t always) progress to invasive malignancy

Question 5

Recognising … lesions allows early treatment before invasion occurs

Answer 5

Recognising dysplastic lesions allows early treatment before invasion occurs

Question 6

… on the left, … on the right

Answer 6

Stratified Squamous epithelium- left, dysplastic epihelium - right

Question 7

Dysplasia has lots of different terminology for the same process - e.g for cervix:

Answer 7

• Generic: Dysplasia
• UK: Cervical intra-epithelial neoplasia (CIN)
• US: Squamous intra-epithelial lesion (SIL)

Question 8

Different degrees of dysplasia may be recognised microscopically

Answer 8

Question 9

The … of dysplasia may predict the likelihood of developing invasive malignancy

Answer 9

The degree of dysplasia may predict the likelihood of developing invasive malignancy

Question 10

Dysplasia often occurs in sites where there is …

Answer 10

Dysplasia often occurs in sites where there is metaplasia

Question 11

Dysplasia often occurs in sites where there is metaplasia

• squamous metaplasia of the cervical … zone
• squamous metaplasia of the … epithelium
• glandular metaplasia of the … oesophagus

Answer 11

• squamous metaplasia of the cervical transformation zone
• squamous metaplasia of the bronchial epithelium
• glandular metaplasia of the distal oesophagus

Question 12

Cells at the surface of … epithelium are different from those at the surface of normal epithelium

Answer 12

Cells at the surface of dysplastic epithelium are different from those at the surface of normal epithelium

Question 13

What degree of dysplasia? (CIN I,II OR III)

Answer 13

CIN I

Question 14

What degree of dysplasia? (CIN I,II OR III)

Answer 14

CIN II

Question 15

What degree of dysplasia? (CIN I,II OR III)

Answer 15

CIN III

Question 16

For CIN1, the risk of progression to CIN 3 is… and to Squamous cell carcinoma is…

Answer 16

11, to SCC is 1

Question 17

For CIN2, the risk of progression to CIN 3 is… and to Squamous cell carcinoma is…

Answer 17

22, SCC 5

Question 18

For CIN3, the risk of progression to Squamous cell carcinoma is…

Answer 18

40%

Question 19

What is a PAP test?

Answer 19

• Sampling cells from surface of the cervix
  
  • Pap tests detect abnormal cervical cells, including precancerous cervical lesions, as well as early cervical cancers.

Question 20

Normal constituents of a smear

• What 3 cell types? (arrows)

Answer 20

• Endocervical cells (top)
• Squamous cells (middle)
• Metaplastic cells (bottom)

Question 21

Normal surface cells have a … nucleus and lots of … (cervix)

Answer 21

Normal surface cells have a small nucleus and lots of cytoplasm

Question 22

Dysplastic cells have a higher ratio of … size to … volume, and the nuclei show the same features that we associate with … (Cervix)

Answer 22

Dysplastic cells have a higher ratio of nuclear size to cytoplasmic volume, and the nuclei show the same features that we associate with malignancy (Cervix)

Question 23

Normal or dysplastic cells? (Cervix)

Answer 23

dysplastic (large nucleus, small cytoplasm vol)

Question 24

The difference between dysplasia and carcinoma is invasion through the … …

Answer 24

The difference between dysplasia and carcinoma is invasion through the basement membrane

Question 25

... infection causes CIN and cervical cancer

Answer 25

**HPV** infection causes CIN and cervical cancer

Question 26

_Human Papillomavirus_ * Human Papillomaviruses (HPVs) infect ... * Confined to ... site of infection without viraemia * Over ... HPV types, some of which infect the anogenital mucosa * ... stranded DNA virus 7.9Kbp

Answer 26

* Human Papillomaviruses (HPVs) infect **epithelium** * Confined to **local** site of infection without viraemia * Over **130** HPV types, some of which infect the anogenital mucosa * **Double** stranded DNA virus 7.9Kbp

Question 27

HPVs may be grouped according to ... association with ...

Answer 27

HPVs may be grouped according to **risk** association with **malignancy**

Question 28

_HPVs may be grouped according to risk association with malignancy_ * High Risk HPV * 16,18,31,33,35,39,45,51,52,56,58,59,68 * Low Risk HPV * 6,11,40,42,43,44,54,61,72,81

Answer 28

* High Risk HPV * 16,18,31,33,35,39,45,51,52,56,58,59,68 * Low Risk HPV * 6,11,40,42,43,44,54,61,72,81

Question 29

_Strategies to prevent cervical cancer_ * .... Vaccination * Population based ... * Cervical sample ... test * Cervical sample ... * ...scopy * Treatment of high grade ... * Large Loop Excision of the ... Zone

Answer 29

* **HPV** Vaccination * Population based **screening** * Cervical sample **HPV** test * Cervical sample **cytology** * **Colposcopy** * Treatment of high grade **dysplasia** * Large Loop Excision of the **Transformation** Zone

Question 30

_HPV positive oropharnygeal cancer increases: Cervical cancer prevented by screening_

Answer 30

Question 31

Cervical cancer is predominantly a disease of the ... world

Answer 31

Cervical cancer is predominantly a disease of the **developing** world

Question 32

Main 2 types of High Risk HPV ...

Answer 32

16, 18

Question 33

Main 2 types of Low Risk HPV ...

Answer 33

6,11

Question 34

... cancer is presently most common in North America and Europe

Answer 34

**Endometrial** cancer is presently most common in North America and Europe

Question 35

The incidence of cervical cancer has been ... (in europe)

Answer 35

The incidence of cervical cancer has been declining (in europe)

Question 36

The reduction in incidence of cervical cancer has been paralleled by reduced ...

Answer 36

The reduction in incidence of cervical cancer has been paralleled by reduced **mortality**

Question 37

_Age specific mortality rates - cervical cancer_

Answer 37

Question 38

What is a colposcopy?

Answer 38

Colposcopy is a medical diagnostic procedure to examine an illuminated, magnified view of the cervix as well as the vagina and vulva.

Question 39

The incidence and mortality of cervical cancer in the UK have ..., particularly since the early 1980s

Answer 39

The incidence and mortality of cervical cancer in the UK have decreased, particularly since the early 1980s

Question 40

* The incidence and mortality of cervical cancer in the UK have decreased, particularly since the early 1980s * In the UK this follows the introduction of the ...

Answer 40

* The incidence and mortality of cervical cancer in the UK have decreased, particularly since the early 1980s * In the UK this follows the introduction of the **NHS cervical screening programme**

Question 41

What is the birth cohort effect?

Answer 41

The birth cohort effect is defined as the variation in the prevalence of age-related maculopathy that arises from the different exposures of each birth cohort.

Question 42

Cervical Cancer - Birth Cohort Effect

Answer 42

* The incidence and mortality of cervical cancer in the UK have decreased, particularly since the early 1980s * In the UK this follows the introduction of the NHS cervical screening programme * A birth cohort effect exists, believed to reflect the different exposure to HPV at the time women reached the age of sexual debut * HPV vaccination is creating new birth cohorts

Question 43

... vaccination is creating new birth cohorts

Answer 43

**HPV** vaccination is creating new birth cohorts

Question 44

Age standardised incidence rates of endometrial cancer (UK 1993-2016)

Answer 44

Question 45

_Age specific incidence rates. - cervical cancer_ * 2 peaks represent ...

Answer 45

birth cohort effect * *The separate peaks in cervical cancer incidence reflect a birth cohort effect* * *This happens when a group of people experience different circumstances to those born immediately before or after* * *An increase in cervical cancer incidence and mortality was seen in women reaching the age of sexual debut during WW1 and again in WW2*