Preneoplastic and malignant pathology of cervix uterina Flashcards
How consist uterine cervix?
The cervix connects the body of the uterus to the vagina (birth canal). The part of the cervix closest to the body of the uterus is called the endocervix(glandular cells - cylindrical epithelium monostratificato) products cervical mucus . The part next to the vagina is the exocervix (or ectocervix)-non keratinized stratified squamous cells. Here you can find lactobacils. These 2 cell types meet at a place called the transformation zone.The exact location of the transformation zone changes as you age and if you give birth. Most cervial cancers begins here.
how consist exocervix?
Non keratinized stratificated squamous epithelium
- stratum basale
- stratum parabasale
- stratum intermedium
- stratum superficiale
How consist endocervix?
It is simple(monostratificated) cylindrical epithelium
- tall columnar cells with basophilic nucleus, granular cytoplasm with mucins acidic / neutral
(Secretion of apo / merocrine) - columnar ciliated cells
- neuroendocrine cells
- cells cubic reserve
What is colposcopy?
https://www.youtube.com/watch?v=f3-L9qBf0PA
Colposcopy (kol-POS-kuh-pee) is a procedure to closely examine your cervix, vagina and vulva for signs of disease. During colposcopy, your doctor uses a special instrument called a colposcope.
Your doctor may recommend colposcopy if your Pap test has shown abnormal results. If your doctor finds an unusual area of cells during colposcopy, a sample of tissue can be collected for laboratory testing (biopsy).
o cia italu variantas:
Colposcopy is the examination of the cervix and vagina with a speculum(skėtiklis) particular
(Colposcope), which provides excellent lighting, a three-dimensional view and a
magnification up to 40 times. For carcinoma of the cervix is an examination of the second level
or Execution
cervical change during development
Reproductive age, especially during menstruation or pregnancy, can occur eversion -an outward rotation: when it comes to ectropion is massive) cylindrical epithelium level junction: this can determine, with time and in particular because of the acidity of the environment, a squamous metaplasia endocervix (therefore, the replacement with the squamous epithelium cylindrical multilayered). At this point, the junction seems to date, since the area has gone down to match metaplasia: but, in fact, is not a lift, but a metaplasia. It should be considered a modification of the normal woman of reproductive age, although this area transformation may be more susceptible to evolution dysplastic or neoplastic.
To understand that it is in the presence of a squamous metaplasia rather than of a pavement epithelium, the
presence of mucoid glands indicates that you are in the endocervical canal.
At the menopause, however, the junction tends to rise (inversion) within the channel and is no longer
detectable to colposcopy.
In the elderly woman finally exocervical epithelium can undergo keratinization
Carcinoma classification
Cervical cancers and cervical pre-cancers are classified by how they look under a microscope. The main types of cervical cancers are squamous cell carcinoma and adenocarcinoma.
squamous cells carcinoma
Most (up to 9 out of 10) cervical cancers are squamous cell carcinomas. These cancers form from cells in the exocervix and the cancer cells have features of squamous cells under the microscope. Squamous cell carcinomas most often begin in the transformation zone (where the exocervix joins the endocervix).
adenocarcinoma
Most of the other cervical cancers are adenocarcinomas. Adenocarcinomas are cancers that develop from gland cells. Cervical adenocarcinoma develops from the mucus-producing gland cells of the endocervix. Cervical adenocarcinomas seem to have become more common in the past 20 to 30 years.
squamous cell dysplasia
The squamous dysplasia originates from basal cells immature(nesubrendusių), among which there are stem cells. Is classified in two ways:
• System CIN (squamous intraepithelial neoplasia)
- System Bethesda: SIL (squamous intraepithelial lesion)
CIN
System CIN (squamous intraepithelial neoplasia) is the oldest
- CIN 1: mild. It affects the lower third of the epithelium
- CIN 2: moderate. Affects 2/3 of the epithelium
- CIN 3: severe. It affects the epithelium full thickness and can also affect the glands below. It is associated with parakeratosis. Moreover, in these cases, you begin to encounter processes microinvasività
bethesda system
SIL (squamous intraepithelial lesion) is newer and born from the fact that, by a therapeutic point of view, moderate cases presented uncertainties.
- L-SIL: low grade (CIN 1)
- H-SIL: high grade (CIN 2- 3)
LSIL
L-SIL: low grade (CIN 1). It is characterized by koilocytosis, nuclear atypia, decreased
polarity, increased basal cell and mitosis and involvement of the third baseline. It can
present evolution variable:
Regression (62%): therefore, conization is not indicated, unless dysplasia
is not very widespread
Resistance (22%)
Progression (16%): in these two cases, the attitude is more rational expectation
H-SIL
H-SIL: high-grade (CIN 2 and 3). It is a carcinoma in situ, however, can be invasive (22%
to 5 years) and, therefore, conization is justified. It is characterized by the presence of cells
basaloid immature than the third baseline, nuclear pleomorphism, decreased polarity
and increased mitosis in all layers (the koilocytosis may be present or not)
glandular dysplasia
glandular dysplasia (EGD: endocervical glandular dysplasia) may progress to adenocarcinoma
- L-EGD: low degree: characterized by
Profile normal glandular or irregularly convoluted at times
Epithelial hyperplasia with decreased muciparità and can
pseudostratificazione
- H-EGD: high degree: it is characterized by:
Lumi tight with glands against or branched / cribrose
Hyperplasia of the surface
Pseudostratificazione and nuclear atypia with mitosis
- Ca. in situ: AIS (adenocarcinoma in situ
classification
- Squamous cell carcinoma (80%): stratified squamous epithelium originates, and especially from areas
dysplasia - Adenocarcinoma (15%): originates from endocervical glands
- other (5proc)
symptoms of squamous cells CA
Initial phase: is asymptomatic or manifested by:
- Leucorrhoea
- Bleeding if mixed with whites, give the picture of characteristic “Whites to washing meat”
- Pain
Late phase: involvement of adjacent organs:
- Pollakiuria
- Hematuria
- Constipation or diarrhea
- Rectorragy
- Tenesmus
how old women can be affected?
Epidemiology: cervical cancer affects women aged 20 and senile age, particularly among
30 and 50 years
risk factors
- Early sexual activity
- ** sexual promiscuity(number of partners)**
- multiparita
- first pregnancy in young age and labour
- ** HPV infection: 16,18,31,33**
- smoking
- relapsing(recidyvuojantis) Vaginitis
- Cervicitis
- Leukoplakia
- laceration of the cervix
HPV
Incubation variable from 3 weeks to 8 months
or tendency to spread throughout the epithelium
or infection
Asymptomatic in 80% of cases
Symptomatic in 20%
Aspects macroscopic tumor
- Form vegetating exophytic
- nodular form endophytic
- Form ulcerative exo / endophytic
dissemination
- for continuity or contiguity: local spread: other areas of the cervix, vagina,
cardinal ligament, vagina, pelvic wall, bladder and rectum
- lymphocytic: iliac, obturator, hypogastric
Pap test (technica)
for preclinical and early diagnosis of cervix Ca. After the first sexual intercourse/25 years old
- introduction of the speculum into vagina
- sampling inside uterus with Ayre spatula
- sampling internal cervix canal with cytobrush
- material smeared on glass slides and fixed/ into solution
- coloration with Papanicolau
- observation with microscope
Pap classes
- Negative (previously Class I): This is a negative smear with no abnormal or unusual cells seen. The smear is clean and clear of any inflammatory cells and is easy for the pathologist to read as not having any evidence of malignancy (cancer).
- Atypical (previously Class II): This is further broken down into two terms: Atypical squamous cells, cannot exclude high grade lesions (ASC-H) and atypical squamous cells of uncertain significance (ASC-US). With these smears it is more difficult for the pathologist to unequivocally say that it is negative. There may be evidence of regeneration of cells on the cervix or changes in the cells related to infections or the trauma of childbirth. Depending on other descriptions the pathologist uses, you may need treatment for infection, a repeat Pap smear, special DNA testing, observation, or further diagnostic testing with colposcopy. Your doctor will tell you what steps to take. Some type of follow-up is needed.
- Low-grade squamous intraepithelial lesion (previously Class III, mild dysplasia): This classification is for abnormal cells, which may be considered as mild dysplasia or with mild “premalignant” potential. This same category would be used if there is any sign of the human papilloma (wart) virus. Dysplasia is a precancerous change, and this finding requires further evaluation. If left alone, these changes may revert to normal, may stay the same, or may progress to malignancy over a period of years. The interval for the development of malignancy from dysplasia is variable but commonly felt to be as little as 3 or most likely as long as 10 years. Office colposcopy, a special technique using a microscope to look at the cervix, will probably be recommended. Biopsies will be performed. If only mild changes are confirmed, usually no treatment is required. However, more frequent Pap smears will be needed. In some instances of large lesions or persistent changes, treatment will be recommended.
- High-grade squamous intraepithelial lesion (previously Class III, moderate to severe and Class IV): This classification is indicative of a high degree of precancerous change. The changes in the cells are severe enough to warrant very prompt and complete evaluation with colposcopy. Treatment with freezing or excision of the abnormality is usually needed.
- Cancer (previously Class V): This classification indicates a high probability of cancer and again, warrants prompt and complete evaluation to determine the extent of the problem. A plan of treatment for best results can be determined.
Bethesda classification iš paskaitos
- normale
- normale con alterazioni reattive
- L- SIL
- H- SIL
- Carcinoma squamoso
- Adenocarcinoma
- A.S.C.U.S. cellule squamose atipiche di significato indeterminato
- AGUS cellule ghiandolari atipiche di significato indeterminato
