Pathology of the Vulva, Cervix and Vagina

Question 1

Describe the anatomy of the cervix

Answer 1

• Before puberty, ectocervix is non-keratinising stratified squamous epithelium and endocervix is lined by columnar epithelium
• After puberty the squamo-columnar junction is everted into the vagina and the squamous epithelium adapts to the vaginal environment by squamous metaplasia int he transformation zone
• These changes are reversed at the menopause

Question 2

What condition can low oestrogen after the menopause lead to in the vagina?

Answer 2

• Atrophic vaginitis with discomfort, dyspareunia, and bleeding

Question 3

What is CIN?

Answer 3

• Replacement of normal squamous epithelium by neoplastic squamous cells
• Basement membrane remains intact
• Neoplastic cells have intense staining (hyperchromasia), greater variability (pleomorphism) and fail to mature normally as they migrate from base to surface

Question 4

What are the stages of CIN?

Answer 4

• CIN1 (immature and dividing cells confined to basal 1/3 of epithelium)
• CIN2 (immature and dividing cells confined to basal 2/3 of epithelium)
• CIN3 (immature and dividing cells persist to surface)

Question 5

Discuss HPV

Answer 5

• Early genes E1-E7 interact with intracellular molecules to interfere with cell proliferation machinery to replicate the virus
• Late genes L1-L2 encode capsid proteins
• Disruption of cell cycle checkpoints may contribute to oncogenic mutations and carcinogenesis
• High risk types 16 and 18 are strongly associated with CIN2, CIN3 and cervical cancer

Question 6

What are the risk factors for cervical adenocarcinoma?

Answer 6

• Early age at first intercourse
• Number of sexual partners
• Low socioeconomic status
• HPV infection

Question 7

What are the stages of cervical cancer?

Answer 7

• Stage 1 (confined to cervix)
• Stage 2 (invades beyond cervix)
• Stage 3 (to pelvic wall, ureters or lower vagina)
• Stage 4 (to bladder, rectum or beyond pelvis)