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Reproduction > Vulval, Vaginal and Cervical Pathology > Flashcards

Vulval, Vaginal and Cervical Pathology Flashcards

1
Q

What is cervical erosion?

A

Exposure of the delicate endocervical epithelium to the acidic environment of the vagina leads to physiological squamous metaplasia

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2
Q

What are the most common infective causes of cervicitis?

A

Chlamydia

Gonnorhea

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3
Q

What are the two most high risk subtypes of HPV?

A

16 & 18

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4
Q

What are the risk factors for cervical cancer?

A 
Persistent HPV infection
Age at first sexual intercourse (due to vulnerability of SC junction in early reproductive life)
Long term use of oral contraceptives
Non use of barrier contraception
Immunosuppression (eg HIV)
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5
Q

Which subtypes of HPV cause genital warts?

A

6 and 11

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6
Q

What is Koilocytosis?

A

Presence of Koilocytes in a sample. A Koilocyte is a squamous epithelial cell that has undergone a number of structural changes, which occur as a result of infection of the cell by HPV

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7
Q

How long does it typically take for HPV infection to cause high grade CIN?

A

6 months to 3 years

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8
Q

How long does it typically take for High Grade CIN to turn into invasive cancer?

A

5 - 20 years

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9
Q

What kind of invasive cervical cancer is caused by HPV infection?

A

Invasive squamous carcinoma

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10
Q

Where does CIN occur?

A

At the transformation zone of the cervix

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11
Q

What is CIN?

A

Cervical intraepithelial neoplasia - dysplasia of the squamous cells of the cervix

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12
Q

Describe the histology of CIN

A
  • Immature basal cells occupy more of the epithelium
  • Nuclear abnormalities (eg pleomorphism)
  • Excess mitotic activity situated above basal layers
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13
Q

What is pleomorphism?

A

Variability in the size and shape of cells and/or their nuclei.

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14
Q

On histology from a cervical smear you see that the basal 1/3rd of the epithelium is occupied by abnormal cells. What grade of CIN is this?

A

CIN 1

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15
Q

On histology from a cervical smear you see that the basal 2/3rd of the epithelium is occupied by abnormal cells. What grade of CIN is this?

A

CIN II

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16
Q

On histology from a cervical smear you see abnormal cells throughout the whole sample. What grade on CIN is this?

A

CIN III

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17
Q

What type of cancer does CIN lead to?

A

Invasive squamous carcinoma

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18
Q

If a cervical cancer is at a depth of 3mm with a width of 7mm only in the cervix what stage is it?

A

1A1

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19
Q

If a cervical cancer is at a depth of 5mm with a width of 7mm only in the cervix what stage is it?

A

1A2

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20
Q

If a cervical cancer is confined to the cervix only but is deeper than 5mm, what stage is it?

A

1B

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21
Q

If a cervical cancer has spread to the vagina what stage is it?

A

2

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22
Q

If a cervical cancer has spread to the pelvic wall what stage is it?

A

3

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23
Q

If a cervical cancer has spread to the bladder what stage is it?

A

4

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24
Q

What are the first lymph nodes that squamous cervical carcinoma would spread to?

A

Pelvic and para aortic

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25
Q

How is squamous cervical carcinoma graded?

A

By degree of differentiation (from well differentiated to anaplastic)

26
Q

Where does cervical glandular intraepithelial neoplasia originate from?

A

endocervical epithelium

27
Q

What is cervical glandular intraepithelial neoplasia a precursor for?

A

Endocervical adenocarcinoma

28
Q

Which has a worse prognosis; squamous cervical carcinoma or endocervical adenocarcinoma?

A

Endocervical adenocarcinoma

29
Q

Which type of HPV is particularly related to endocervical adenocarcinoma?

30
Q

What do you do if CIN I is seen on a cervical smear?

A

Watchful waiting

31
Q

What do you do if CIN II is seen on a cervical smear?

A

Cold coagulation

Large loop excision of the transformation zone

32
Q

What do you do if CIN III is seen on a cervical smear?

A

Cold coagulation

Large loop excision of the transformation zone

33
Q

What do you do if CIN II is seen on a cervical smear of a women who would like to get pregnant soon?

A

Cold coagulation of the CIN - this is better at preserving the cervix for child bearing.

34
Q

A 32 year old women has just has a CIN II removed. She is positive for HPV. How often should she have smears?

A

Annually for the next 10 years

35
Q

To where is a patient referred if high grade changes are seen on a smear test?

A

Colposcopy

36
Q

What is done if you see mild dyskariosis on a smear?

A

Repeat smear in 6 months and if abnormal again refer to colposcopy

37
Q

Name 4 neoplasia’s that are HPV driven

A
  1. Cervical Intraepithelial Neoplasia (CIN)
  2. Vulvualr Intraepithelial Neoplasia (VIN)
  3. Vagina Intraepithelial Neoplasia (VaIN)
  4. Anal Intraepithelial Neoplasia (AIN)
38
Q

What is the most common vulval infection?

A

Candida (Thrush)

39
Q

What is the most common type of invasive tumour of the vulva?

A

Squamous cell carcinoma

40
Q

Describe the two groups of vulvar intraepithelial neoplasia

A
  1. Young women
    - Often multifocal
    - Associated with HPV infection
  2. Older women
    - Greater risk of progression to invasive carcinoma
    -
41
Q

What are the first lymph nodes that vulvular squamous carcinoma will spread to?

A

Inguinal lymph nodes

42
Q

What is the treatment for invasive vulvular squamous carcinoma?

A

Radical vulvectomy and inguinal lymphadenectomy

43
Q

What is the most important prognostic factor in vuvlular squamous carcinoma?

A

Lymph node involvement

5 year survival is 90% if node negative but 60% if node positive

44
Q

A 67 year old lady presents with a crusting rash on the vulva. On pathology you see tumour cells in the epidermis which contain mucin

A

Vulvular pagets disease

45
Q

Where does vulvular pagets disease arise from?

A

Sweat gland in skin

46
Q

A 67 year old lady presents with itchiness of her genital area. On examination you see small white patches on the vulva and the skin looks fragile and wrinkly.

A

Lichen Sclerosis

47
Q

What is the treatment for lichen sclerosis?

A

Steroid ointment/cream

48
Q

A 26 year old women presents with a painful lump at the entrance to her vagina. She says it is sore when she has sex or sits down.

A

Infected bartholins cyst

49
Q

What is the underlying cause of atrophic vaginitis?

A

Lack of oestrogen support for vaginal epithelium

50
Q

What is the ectocervix?

A

Lower intravaginal part of the cervox

51
Q

What is the external os?

A

The opening of the cervix into the vagina.

52
Q

What shape is the external os in the cervix in the nulligravida women?

53
Q

What shape is the external os in the cervix in the parous women?

54
Q

What is the endocervix?

A

The cavity of the cervix that connects the internal os with the external os

55
Q

What is the internal os?

A

The opening of the cervix into the uterine cavity

56
Q

What kind of eipthelium lines the ectocervix?

A

Non keratinizing stratified squamous epithelium

57
Q

What kind of epithelium lines the endocervix?

A

Mucin secreting simple columnar epithelium

58
Q

How does vulvular pagets disease present?

A

Red, eczematous skin on the vulva which is itchy and sometimes painful

59
Q

What does dysplasia of cells mean?

A

Potentially reversible change characterized by an:

  • Increase in mitotic rate
  • Atypical cytological features (size, shape, nuclear features)
  • Abnormal organization (cellularity, differentiation, polarity)
60
Q

How are CIN lesions visualised at colposcopy?

A

White patches on the cervix following application of acetic acid

61
Q

What is the most common site of distant metastases from squamous cell cervical cancer?

Reproduction (40 decks)

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