Vulvovaginal and Cervical Pathology Flashcards
What are the layers of the normal ectocervix?
Exfoliating cells Superficial cells Intermediate cells Parabasal cells Basal cells Basement membrane
Describe the normal endocervix?
Single layer glandular epithelium
What is the transformation zone of the cervix?
Squamo-columnar junction between the ectocervical (squamous) and endocervical (columnar epithelium)
When does the transformation zone of the cervix alter in position?
As a physiological response e.g. to menarche, pregnancy, menopause
Define cervical erosion
Physiological exposure of delicate endocervical epithelium to acid environment of vagina leads to physiological squamous metaplasia
What is a nabothian cyst?
A physiologically distended endocervical gland, usually with overlying squamous metaplasia
What are the causes of cervicitis?
Chlamydia
Herpes Simplex
Follicular cervicitis
What damage can cervicitis cause?
Infertility due to silent fallopian tube damage
What is cervical polyp?
Localised inflammatory outgrowth
When can cervical polyps cause bleeding?
If ulcerated
Are cervical polyps premalignant?
No
What is main risk factors for Cervical cancer
High risk HPV types (16, 18)
Vulnerability of SC junction in early reproductive life (young first intercourse, long term OCP use)
Smoking
Immunosuppression
Which types of HPV cause genital warts?
6+11
How do genital warts present?
Thickened papillomatous squamous epithelium with cytoplasmic vacuolation
How long does HPV infection take to create high grade CIN?
6 months-3years
How long does it take for high grade CIN to become invasive cancer?
5-20 years
What is Cervical intraepithelial neoplasia?
Pre-invasive stage of cervical cancer at the transformation zone
Describe the histology of cervical intraepithelial neoplasia?
Delay in maturation/differentiation (immature basal cells) Nuclear abnormalities (Hyperchromasia, pleomorphism, greater nucleocytoplasmic ratio) Excess mitotic activity (Abnormal mitotic forms)
How is Cervical intraepithelial neoplasia graded?
1) basal 1/3 of epithelium occupied by abnormal cells
2) Abnormal cells extend to middle 1/3
3) Abnormal cells occupy full thickness of the epithelium
What can CIN develop into?
Invasive squamous carcinoma
How is invasive squamous cervical carcinoma staged?
Stage 1A1: Depth up to 3mm, width up to 7mm
Stage 1A2: Depth up to 5mm, width up to 7mm
Low risk of lymph node metastases
Stage 1B: Confined to cervix
Stage 2: Spread to adjacent organs
Stage 3: Involvement of pelvic wall
Stage 4: Distant metastases or involvement of rectum or bladder
What are the symptoms of invasive cervical carcinoma?
Usally none in early stages Abnormal bleeding (post coital, post menopausal, blood stained vaginal discharge) Pelvic pain Haematuria/ UTI Ureteric obstruction/renal failure
How does squamous cervical carcinoma spread?
Local- uterine body, vagina, bladder, ureters, rectum
Lymphatic- early, pelvic, para-aortic nodes
Haematogenous- late, liver, lungs, bone
How is squamous carcinoma of the cervix graded?
Well differentiated
Moderately differentiated
Poorly differentiated
Undifferentiated/anaplastic
Where does cervical glandular intraepithelial neoplasia (CGIN) orignate?
Endocervical epithelium
What can CGIN develop into?
Endocervical adenocarcinoma
Which type of cervical cancer has a worse prognosis?
Endocervical adenocarcinoma
What are risk factors for cervical adenocarcinoma?
Smoking
HPV esp 18
Oral Contraceptive Pill
How does vulvar Paget’s disease present?
Crusting rash
Tumour cells in epidermis
How can vaginal melanoma present?
Polyp
What is VaIN?
Vaginal intraepithelial neoplasia- precursor of squamous carcinoma
In which age group is squamous carcinoma of the vagina most common?
Elderly
Which infections are common in the vulval area?
Candida, vulvar warts (HPV 6+11), Bartholins gland abscess
What non neoplastic epithelial disorders are common in the vulval area?
Lichen sclerosis, lichen planus, psoriasis
Which lymph nodes can vulvar incasive squamous carcinoma spread to?
Inguinal lymph nodes
