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MHD II Test 3 > Pathology of the Vulva, Vagina, and Cervix > Flashcards

Pathology of the Vulva, Vagina, and Cervix Flashcards

1
Q

Cervix Histology

  1. Exocervix
  2. Endocervix
  3. Where do they meet?
  4. What happens to where they meet over time?
  5. Define Endocervical Canal
A
  1. covered by stratified non-keratinizing squamous epithelium
  2. covered by columnar, mucus secreting epithelium
  3. Squamocolumnar junction
  4. junction moves, moves out to ectropion in young adult, regresses in adults
  5. connects the internal and external Os
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2
Q

Cervix- Transformation Zone

  1. Define
  2. What happens here most often?
A
  1. endocervical canal that immediately follows the squamo-columnar junction; columnar cells replaced by squamous epithelium (squamous surface w/ underlying glandular cells)
  2. most cervical dysplasias arise in this zone
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3
Q

Cervical Squamous Epithelium

  1. Four layers
  2. What causes the squamous cells to mature? how?
  3. Describe maturation process
  4. What creates the acidic environment in the vagina?
A
  1. Superficial Squamous cells, Intermediate Squamous cells, Parabasal cells, Basal cells
  2. estrogen causes them to take up glycogen
  3. cells move from basal to upper layer, become superficial cells and shed
  4. Shed cells release glycogen which is used by vaginal flora to grow and produces the drop in pH
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4
Q

Histo on Smear

  1. Superficial Squamous cells
  2. Intermediate cells
  3. Metaplastic Cells
A
  1. smal, pyknotic nuclei
  2. larger nucleus
  3. roughly same size nucleus as intermediate cells, but smaller cytoplasm
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5
Q

Cervicitis

  1. What is non-significant inflammation?
  2. What is significant inflammation caused by?
  3. What are complications of significant inflamm?
  4. What is the morphology of significant inflamm?
A
  1. mild chronic cervical inflammation
  2. organisms (gonococci, chlamydiae, mycoplasmas, Herpes viruses)
  3. complciations arise in pregnancy/labor; sexual transmission
  4. surface erosion, neutrophil and lymphocyte infiltrates, and reactive or reparative epithelial changes
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6
Q

Smear

  1. What is seen in acute cervicitis?
  2. Herpes cervicitis?
  3. Bacterial vaginitis
A
  1. inflammatory cells
  2. infected cells are multinucleated
  3. epithelial cell covered by numerous bacteria
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7
Q

Cytology (pap smear)

  1. Define
  2. What does it screen for?
  3. What does it detect?
A
  1. microscopic examination of cells scraped from cervical mucosa
  2. mainly for squamous cell lesion
  3. treatable precursor lesions (cervical intraepithelial neoplasia, CIN); prevents and makes early diagnosis of cervical cancer
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8
Q

Cervical Intraepithelial Neoplasia (CIN) and Cervical Carcinoma

  1. Associated with what infection?
  2. Risk factors (7)
A
  1. HPV
  2. Depends on both host and virus characteristics;
    Early age at 1st intercourse
    Multiple sexual partners
    Increased parity
    Male partner with multiple previous partners
    High-risk HPV types and persistent detection of high risk HPV types*
    Oral contraceptives and nicotine
    Genital infections (chlamydia)
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9
Q

Classification of Cervical Squamous Dysplasia

  1. Where do they arise most frequently?
  2. 2 types/ 3 grades
  3. What is condyloma accuminatum? Associated with what?
A
  1. both CIN and cervical cancer: transformation zone
  2. Low grade dysplasia: mild (CIN 1)
  3. High grade dysplasia moderate (CIN 2) and severe dysplasia (CIN 3)
  4. low grade dysplasia; always assoc w/ low risk HPV types
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10
Q

HPV types

  1. based on
  2. Low risk types (2); associated with what?
  3. High risk types (2); what do these do?
A
  1. DNA sequences and subgroups
  2. 6,11; associated w/ condylomas, usually regress; rarely persist
  3. 16,18; regress or persist or progress to precancerous lesions
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11
Q

Gross Morphology of Cervix Dysplasia in Colposcopic Examination

  1. Condyloma
  2. CIN I
  3. CIN II/III
A
  1. acetowhite plaques on cervix
  2. punctuations on cervix
  3. mosaic pattern on the cervix
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12
Q

Koilocytes

  1. Define
  2. Morphologic features (4)
A
  1. squamous cells infected by HPV
  2. nuclear enlargement, irregularity of nuclear membrane contour, hyperchromasia, clear halo around the nucleus (perinuclear halo)
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13
Q

Histopathology of Cervical Lesions

  1. Condyloma
  2. CIN I
  3. CIN II
  4. CIN III
A
  1. raised lesion w/ koilocytes
  2. flat lesions w/ koilocytes- flat candyloma
  3. variable nuclear size, loss of cell polarity, hyperchromasia, and high N/C ratio; atypia in >1/3 epithelium
  4. same as 3, but atypia in >2/3 epithelium
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14
Q

Types of Cervical Carcinoma (3)

A
  1. Squamous cell carcinoma (most common)
  2. Adenocarcinoma (2nd most common)
  3. Small Cell Carcinoma
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15
Q

Epidemiology of Cervical Squamous cell Carcinoma

  1. How common?
  2. Why have rates declined?
A
  1. most common histologic type of cervical cancer

2. Pap test screening and early detection of pre-invasive lesions

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16
Q

Cervical Squamous Cell Carcinoma

  1. Gross look
  2. Histo look
A
  1. may be exophytic growth (may protrude out vagina), may be ulcerated
  2. invasive cancer cells with desmoplastic stroma (may have keratin pearls)
17
Q

Cervical Adenocarcinoma

  1. How common
  2. What is it commonly associated with?
  3. Pathogenesis
A
  1. 2nd most common, recent increased incidence/detection
  2. 60% of gland lesions are associated with squamous lesion
  3. similar to squamous lesions (HPV)
18
Q

Cervical Adenocarcinoma

  1. associated with which HPV type?
  2. Define in Situ
  3. Define invasive
  4. Carcinoma in Situ Histo look (3)
  5. Invasive Histo look
A
  1. HPV 18
  2. malignant neoplastic cells confined to endocervical glands only, no stromal invasion
  3. malignant cells infiltrate the surrounding stromal tissue
  4. pseudostratified nuclei, cytologic atypia, mitoses
  5. confluent growth pattern, invasive tumor glands
19
Q

Cervical Cancer Staging

  1. Stage 0
  2. Stage 1
  3. Stage 2
  4. Stage 3
A
  1. carcinoma in situ
  2. confined to cervix
  3. extends beyond cervic but not to pelvic wall, involves vagina but not lower 1/3
  4. extends to pelvic wall, involves lower 1/3 of vagina
  5. extends beyond true pelvis or involves bladder or rectum
20
Q

HPV vaccination

  1. Made up of
  2. Targets which subtypes?
  3. how long does protection last?
  4. Recommended for whom?
A
  1. non-infectious, DNA free, virus like particles
  2. 16 and 18
  3. up to 5 yrs, maybe longer
  4. young females before onset of sexual activity
21
Q

Vulvar Epithelial Disorders: Lichen sclerosis

  1. AKA
  2. Neoplastic?
  3. When does it occur?
  4. Gross look
  5. Histo look?
  6. Increased risk of what?
A
  1. Chronic Atrophic Vulvitis
  2. non-neoplastic
  3. any age, most common in postmenopausal pts
  4. smooth white plaque, resembles parchment paper, atropic epithelium
  5. thinning of epidermis, sclerotic stroma, and dermal inflammation
  6. advanced disease associated w/ increased risk of developing squamous cell carcinoma
22
Q

Vulvar Epithelial Disorders:Lichen Simplex Chronicus

  1. AKA
  2. Neoplastic?
  3. Gross look
  4. Histo look
  5. Other symptom?
A
  1. hyperplastic dystrophy
  2. no
  3. leukoplakia, hypertrphic, elevated lesion
  4. epithelial thickening, expansion of stratum granulosum, dermal lymphocytic infiltrates and hyperkeratosis
  5. pruritis, can lead to nonspecific condition due to chronic scratching
23
Q

Vulvar Intraepithelial Neoplasm (VIN)

  1. define
  2. analagous to
  3. Classification
  4. Associated with
  5. Risk of malignancy is higher in whom?
A
  1. spectrum of dysplastic changes in vulvar skin
  2. dysplasia of cervix
  3. Low grade (mild dysplasia (VIN 1), candyloma), high grade (moderate (VIN 2) or severe dysplasia (VIN3)), carcinoma in situ
  4. HPV infection, most often HPV 16, less often 18 and 31
  5. older or immunosuppressed women
24
Q

VIN: Histo and Gross look

  1. Low grade dysplasia
  2. High Grade dysplasia
A
  1. cauliflower growth (grossly)

2. not much cellular maturation, mitoses outside of basal layer; larger involvement grossly

25
Q

Carcinoma of Vulva

  1. How common?
  2. Who gets it?
  3. What kind of carcinoma most common?
  4. What are 30% associated with?
A
  1. uncommon, 1/8 of cervical cancer
  2. 2/3 occur in women >60
  3. squamous cell carcinoma
  4. HPV
26
Q

Congenital Anomalies: Define

  1. Atresia
  2. Septate Vagina
  3. Gartner duct cysts
A
  1. total absence
  2. occurs with failure of total fusion of the muellerian ducts
  3. mesomephric cyst
27
Q

Gartnert Cyst

  1. Location
  2. Derived from
  3. Gross look
  4. Histo look
  5. Sequelae
A
  1. lateral wall of vagina
  2. Wolffian duct
  3. 1-2 cm fluid flyuid cyst
  4. cyst wall covered by cuboidal or flattened nonciliated epithelial cells; has some pink material
  5. asymptomatic in most, may become infection
28
Q

Vaginal Adenosis

  1. Define
  2. What is seen clinically?
  3. Histo look
  4. Exposure to what causes it? when?
  5. How often does it become malignant? what does it become?
A
  1. remnant of cervical type glandular epithelium in vagina
  2. red, granular areas adjacent to normal pale pink vaginal mucosa
  3. columnar mucinous epithelium; endocervical mucosa in vagina biopsy
  4. Diethylstilbestrol (DES) in utero
  5. very rare, clear cell carcinoma
29
Q

Clear Cell carcinoma Histo look (3)

A

Cyst pattern, some papillae, Hobnail nuclei

30
Q

Vaginal Intraepithelial Neoplasia (VAIN): Histo

  1. Low Grade
  2. High Grade
A
  1. Koilocytes

2. abnormal cells going up to the top

31
Q

Vagina: Squamous Cell Carcinoma

  1. How common is primary cancer?
  2. Risk factors (2)
  3. Gross look
  4. Where do lesions in upper 1/3 metastasize?
  5. Where do lesions in the lower 2/3 metastasize?
A
  1. very uncommon, usually metastasis
  2. previous SCC of vulva or cervix
  3. plaque like mass
  4. regional inguinal iliac nodes
  5. inguinal nodes

MHD II Test 3 (14 decks)

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