Cervical Pathology

Front 1

Dysplasia of cervix

Back 1

Disordered epithelial growth, begins @ basal layer of squamocolumnar junction (transition zone) and extends downward. Classified by CIN - CIN1,2,3 are all different grades of dysplasia and carcinoma in situ is SEVERE dysplasia

Front 2

part of cervix that is ENTIRELY STRATIFIED SQUAMOUS EPI

Back 2

ectocervix

Front 3

part of cervix that is simple columnar

Back 3

endocervix

Front 4

junction between uterus and cervical canal

Back 4

internal os

Front 5

junction between cervix and vagina

Back 5

external os - change from simple columnar to strat squam epithelium

Front 6

koilocytic change + disordered cellular maturation + nuclear atypia + increased mitotic activity within the cervical epithelium

Back 6

cervical intraepithelial neoplasia (CIN)

Front 7

<1/3 thickness of epithelium of cervix with dysplasia

Back 7

CIN1

Front 8

>1/3 but <2/3 thickness of epithelium of cervix with dysplasia

Back 8

CIN2

Front 9

>2/3 but slightly < full thickness of epithelium of cervix with dysplasia

Back 9

CIN3

Front 10

ENTIRE THICKNESS OF EPITHELIUM INVOLVES with SEVERE DYSPLASIA

Back 10

carcinoma in situ

CIN1 --> CIN2 --> CIN3 --> extensive dysplasia --> CIS --> invasive carcinoma...progression is NOT inevitable but occurs in this order

Front 11

With what serotypes of HPV are CIN associated?

Back 11

HPV 16,18

Front 12

What do E6 and E7 proteins do?

Back 12

E6 - inhibits P53

E7 - inhibits Rb

Front 13

Symptoms of CIN?

Back 13

Usually asymptomatic. MAY present as abnormal vaginal bleeding (often postcoital)

Front 14

Risk factors for CIN

Back 14

Multiple sexual partners = #1

smoking, early sexual intercourse, HIV infection

Front 15

Describe cervical koilocytes?

Back 15

wrinkled, "raisinoid" nuclei which have clearing of a perinuclear halo

Front 16

INVASIVE CARCINOMA of the cervix:

- What type of cancer most likely?

- What is the purpose of pap smear?

- Complications?

Back 16

often SCC (80%...but 15% is adenocarcinoma) . Pap smear can catch cervical dysplasia BEFORE it progresses to invasive carcinoma. LATERAL INVASION --> can block ureters, causing renal failure (hydronephrosis + post-renal failure)

Front 17

What is HPV?

Back 17

A sexually transmitted DNA virus that effects the LOWER GENITAL TRACT, esp. the cervix in the TRANSFORMATION ZONE. The infection is eradicated by ACUTE INFLAMMATION, however persistent infection leads to INCREASED RISK FOR CERVICAL DYSPLASIA (CIN). The risk of CIN however depends on SEROTYPE: high risk = 16,18, 31, and 33 as these produce E6 AND E7 proteins

Front 18

Where do you draw cells for a pap smear. What would abnormal cells look like. What confirms the diagnosis of CIN?

Back 18

From the transformation zone (squamocolumnar junction i.e. external os). Abnormal cells will have hyper chromatic nuclei with high N/C ratio. Confirmatory diagnosis requires culposcopy.

Front 19

What major serotypes does the HPV vaccine protect against?

Back 19

HPV 6, 11, 16, 18

Front 20

Describe the development of the squamocolumnar junction?

Back 20

At birth - the squamocolumnar junction is similar to where it is as an adult - IE at the ectocervix.

As a young adult, the columnar epithelium of the dnocervix grows out into the ectocervix, creating an "extropion" with exposed columnar epi.

In an adult, the ectocervix is "restored" as the columnar epithelium undergoes PHYSIOLOGICAL (normal) metaplasia to become squamous epithelium ("transformation zone"). This restores the normal position of the squamocolumnar junction.

Front 21

What is LSIL? HSIL? Which is more likely to occur? Which is more likely to progress to carcinoma?

Back 21

LSIL = low grade squamous intraepithelial lesion. It includes CIN1 only.

HSIL = high grade squamous intraepithelial lesion. It includes CIN2, CIN3, and carcinoma in situ (CIN3).

LSIL is 10x more likely.

HSIL is more likely to progress to carcinoma. 10% persist to carcinoma within 2-10 yrs

Front 22

Back 22

different CINs