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Obstetrics and Gynaecology > Vulvovaginal and Cervical Pathology > Flashcards

Vulvovaginal and Cervical Pathology Flashcards

1
Q

What are the layers of the normal ectocervix?

A 
Exfoliating cells
Superficial cells
Intermediate cells
Parabasal cells
Basal cells
Basement membrane
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2
Q

Describe the normal endocervix?

A

Single layer glandular epithelium

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3
Q

What is the transformation zone of the cervix?

A

Squamo-columnar junction between the ectocervical (squamous) and endocervical (columnar epithelium)

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4
Q

When does the transformation zone of the cervix alter in position?

A

As a physiological response e.g. to menarche, pregnancy, menopause

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5
Q

Define cervical erosion

A

Physiological exposure of delicate endocervical epithelium to acid environment of vagina leads to physiological squamous metaplasia

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6
Q

What is a nabothian cyst?

A

A physiologically distended endocervical gland, usually with overlying squamous metaplasia

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7
Q

What are the causes of cervicitis?

A

Chlamydia
Herpes Simplex
Follicular cervicitis

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8
Q

What damage can cervicitis cause?

A

Infertility due to silent fallopian tube damage

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9
Q

What is cervical polyp?

A

Localised inflammatory outgrowth

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10
Q

When can cervical polyps cause bleeding?

A

If ulcerated

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11
Q

Are cervical polyps premalignant?

A

No

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12
Q

What is main risk factors for Cervical cancer

A

High risk HPV types (16, 18)
Vulnerability of SC junction in early reproductive life (young first intercourse, long term OCP use)
Smoking
Immunosuppression

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13
Q

Which types of HPV cause genital warts?

A

6+11

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14
Q

How do genital warts present?

A

Thickened papillomatous squamous epithelium with cytoplasmic vacuolation

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15
Q

How long does HPV infection take to create high grade CIN?

A

6 months-3years

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16
Q

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

A

5-20 years

17
Q

What is Cervical intraepithelial neoplasia?

A

Pre-invasive stage of cervical cancer at the transformation zone

18
Q

Describe the histology of cervical intraepithelial neoplasia?

A 
Delay in maturation/differentiation
(immature basal cells)
Nuclear abnormalities
(Hyperchromasia, pleomorphism, greater nucleocytoplasmic ratio)
Excess mitotic activity
(Abnormal mitotic forms)
19
Q

How is Cervical intraepithelial neoplasia graded?

A

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

20
Q

What can CIN develop into?

A

Invasive squamous carcinoma

21
Q

How is invasive squamous cervical carcinoma staged?

A

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

22
Q

What are the symptoms of invasive cervical carcinoma?

A 
Usally none in early stages
Abnormal bleeding (post coital, post menopausal, blood stained vaginal discharge)
Pelvic pain
Haematuria/ UTI
Ureteric obstruction/renal failure
23
Q

How does squamous cervical carcinoma spread?

A

Local- uterine body, vagina, bladder, ureters, rectum
Lymphatic- early, pelvic, para-aortic nodes
Haematogenous- late, liver, lungs, bone

24
Q

How is squamous carcinoma of the cervix graded?

A

Well differentiated
Moderately differentiated
Poorly differentiated
Undifferentiated/anaplastic

25
Q

Where does cervical glandular intraepithelial neoplasia (CGIN) orignate?

A

Endocervical epithelium

26
Q

What can CGIN develop into?

A

Endocervical adenocarcinoma

27
Q

Which type of cervical cancer has a worse prognosis?

A

Endocervical adenocarcinoma

28
Q

What are risk factors for cervical adenocarcinoma?

A

Smoking
HPV esp 18
Oral Contraceptive Pill

29
Q

How does vulvar Paget’s disease present?

A

Crusting rash

Tumour cells in epidermis

30
Q

How can vaginal melanoma present?

A

Polyp

31
Q

What is VaIN?

A

Vaginal intraepithelial neoplasia- precursor of squamous carcinoma

32
Q

In which age group is squamous carcinoma of the vagina most common?

A

Elderly

33
Q

Which infections are common in the vulval area?

A

Candida, vulvar warts (HPV 6+11), Bartholins gland abscess

34
Q

What non neoplastic epithelial disorders are common in the vulval area?

A

Lichen sclerosis, lichen planus, psoriasis

35
Q

Which lymph nodes can vulvar incasive squamous carcinoma spread to?

A

Inguinal lymph nodes

Obstetrics and Gynaecology (7 decks)

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