vulval and cervical pathology

Question 1

normal or abnormal smear

Answer 1

normal

Question 2

what is this

Answer 2

normal endocervix

Question 3

normal or abnormal smear

Answer 3

normal

Question 4

inflammatory conditions of the cervix

Answer 4

-cervicitis
-cervical polyp

Question 5

causes of cervicitis

Answer 5

-follicular cervicitis
-chlamydia
-herpes simplex

Question 6

neoplastic conditions of the cervix

Answer 6

-cervical intraepithelial neoplasia
-cervical cancer

Question 7

risk factors for cervical cancer

Answer 7

-presence of high risk HPV (16 and 18)
-many sexual partners
-early age of first intercourse
-long term use of oral contraceptives
-non-use of barrier contraception
-smoking
-immunosuppression

Question 8

what is this

Answer 8

cervical intraepithelial neoplasia: high risk HPV

infected epithelium shows kilocytes

Question 9

what is this

Answer 9

cervical cancer
-squamous cell carcinoma

Question 10

how long can it take for HPV infection to become a high grade CIN

Answer 10

6 months - 3 years

Question 11

how long does it take for high grade CIN to become invasive cancer

Answer 11

5-20 years

Question 12

what is CIN

Answer 12

Question 13

what are you looking for on histology of CIN

Answer 13

-delay in maturation/differentiation
-nuclear abnormalities
-excess mitotic activity
-often kilocytosis

Question 14

what is CIN I

Answer 14

basal 1/3 of epithelium occupied by abnormal cells

Question 15

what is CIN II

Answer 15

abnormal cells extend to the middle 1/3

Question 16

what is CIN III

Answer 16

abnormal cells occupy full thickness of epithelium

Question 17

what is this

Answer 17

CIN I

Question 18

what is this

Answer 18

CIN 2

Question 19

what is this

Answer 19

CIN 3

Question 20

most common type of cervical cancer

Answer 20

squamous carcinoma
-develops from pre-existing CIN, therefore most cases should be preventable by screening

Question 21

symptoms of invasive carcinoma

Answer 21

Question 22

where can squamous carcinoma spread

Answer 22

-uterine body
-vagina
-bladder
-ureters
-rectum
-lymphatics (pelvic, para-aortic)
-haematogenous (liver, lungs, bone)

Question 23

grading of squamous cell carcinoma

Answer 23

Question 24

what is cervical glandular intraepithelial neoplasia (CGIN)

Answer 24

-origin from endocervical epithelium
-the preinvasive phase of endocervical adenocarcinoma

Question 25

is CGIN more or less difficult to diagnose on smears than sqaumous

Answer 25

more difficult

Question 26

what is this

Answer 26

high grade CGIN

Question 27

who usually gets endocervical adenocarcinoma

Answer 27

young women

Question 28

name some other HPV-driven diseases

Answer 28

Question 29

what is VIN (vulval intraepithelial neoplasia) a precursor of

Answer 29

hpv driven SCC

Question 30

what is differentiated VIN a precursor of

Answer 30

hpv independent vulval scc -higher risk of invasive malignancy than hpv driven

Question 31

who gets VIN

Answer 31

-young women -older women (bimodal)

Question 32

what does vulvar invasive squamous carcinoma present as

Answer 32

in elderly women, ulcer or exophytic mass

Question 33

where does vulvar invasive squamous carcinoma spread to

Answer 33

inguinal lymph nodes

Question 34

surgical treatment for vulvar invasive squamous carcinoma

Answer 34

-radical vulvectomy -inguinal lymphadenectomy

Question 35

what is vulvar paget's disease

Answer 35

Question 36

where can vulvar paget's disease spread from

Answer 36

-colorectal -urothelial

Question 37

what is VaIN

Answer 37

vaginal intraepithelial neoplasia -may also have cervical and vulval lesions