Pathology - Vulva, Cervix and Vagina Flashcards
what two cells are normally seen on a cervical smear?
cervical squamous cells
endocervical cells
what is cervicitis?
inflammation of the cervix
how does cervicitis often present?
often asymptomatic
how can cervicitis cause infertility?
causes silent Fallopian tube damage
what is a cervical polyp?
localised inflammatory outgrowth in the cervix
when can cervical polyps bleed?
if they become ulcerated
what is CIN?
cervical intraepithelial neoplasia
how long does it take for HPV infection to cause high grade CIN?
6 months - three years
how long does it take for high grade CIN to progress to invasive cancer?
5-20 years
what is the pre-invasive stage of cervical cancer called?
CIN
where does CIN occur?
the transformation zone of the cervix
what is the pathological process behind CIN?
dysplasia of cervical squamous cells
how does CIN present?
asymptomatic
detected on smear testing
what is seen on histology of CIN?
immature basal cells occupying more of the epithelium than normal
nuclear abnormalities
excess mitotic activity
what nuclear abnormalities can be seen in CIN?
hyperchromasia
increased nuclear:cytoplasmic ratio
pleomorphism
what are the grades for CIN?
I
II
III
define CIN I
abnormal cells in the basal third of the epithelium
define CIN II
abnormal cells extend into the middle third of the epithelium
define CIN III
abnormal cells occupying the full thickness of the epithelium
what are some risk factors for cervical cancer?
high risk HPV infection
smoking
immunosuppression
what is the most common malignant cervical tumour?
cervical invasive squamous carcinoma
what does cervical invasive squamous carcinoma develop from?
pre-existing CIN
how can cases of cervical invasive squamous carcinoma be prevented?
detection of CIN on screening
what are the possible symptoms of cervical invasive squamous carcinoma?
abnormal bleeding pelvic pain Haematuria UTIs ureteric obstruction renal failure
where can cervical invasive squamous carcinoma spread to locally?
uterine body vagina bladder ureters rectum
when does lymphatic spread occur in cervical invasive squamous carcinoma?
early in disease
where can cervical invasive squamous carcinoma spread via the lymphatic route?
pelvic and para-aortic nodes
when does haematogenous spread occur in cervical invasive squamous carcinoma?
late in disease
where can cervical invasive squamous carcinoma spread via the haematogenous route?
liver
lungs
bone
what are the four grades of cervical invasive squamous carcinoma?
well differentiated
moderately differentiated
poorly differentiated
undifferentiated/anaplastic
what does CGIN stand for?
cervical glandular intraepithelial neoplasia
where does CGIN originate?
endocervical epithelium of the cervix
what is the preinvasive phase of endocervical adenocarcinoma?
CGIN
what are some risk factors for endocervical adenocarcinoma?
higher SE class
later onset of sexual activity
smoking
HPV
what does VIN stand for?
vulval intraepithelial neo[lasia
what is VIN a precursor for?
HPV driven SCC of the vulva
who is most commonly affected by vulvar invasive squamous carcinoma?
elderly women
how does vulvar invasive squamous carcinoma present?
ulcer or exophytic mass
what is the most important prognostic factor for vulvar invasive squamous carcinoma?
spread to inguinal lymph nodes
what is the surgical treatment for vulvar invasive squamous carcinoma?
radical vulvectomy and inguinal lymphadenectomy
how does vulvar Paget’s disease present?
crusting rash
pruritis
pain
