Hsr - Cervical Path

Front 1

Small to large (5cm) mass(es) arising in the endocervix & protruding through the os; Soft polyps w/ dilated glands and active stroma

Back 1

Endocervical Polyps
Tx: Simple excision or curettage

Front 2

Endocervical glandular epithelium transformed to squamous epithelium

Back 2

Squamous metaplasia

Front 3

How does cervicitis develop?

Back 3

Epithelium becomes glycogenated, providing a substrate for organisms; Acute & chronic inflammation increase; Cervix becomes colonized by pathogenic or nonpathogenic bacteria

Front 4

List 2 problems of acute or chronic cervicitis.

Back 4

Further sexual transmission; May ascend & cause PID, leading to fertility & pregnancy complications

Front 5

What is the main problem with Paps & why is it still considered a good screening test?

Back 5

Problems w/ sensitivity (false negatives), so not every woman w/ dysplasia will be detected w/ 1 Pap. However, bcs there is a long progression of dysplasia to CA, a dysplasia missed one year should be detected the next. Successful bcs it detects early lesions/ dysplasias, which are highly treatable. If untreated, many of these women will develop cervical CA.

Front 6

What is the difference between cervical dysplasia & cervical CA?

Back 6

Dysplasia involves abnormal changes in the cervical squamous epithelium, but it falls short of CA. It is related to infxn by HPV. Cervical CA's invade surrounding tissues & have the potential to metastasize.

Front 7

Most cervical CA's are __ __ __.

Back 7

Squamous cell carcinomas

Front 8

Which part of the cervix less commonly gives rise to CA? What are cancers of this region called?

Back 8

Endocervical portion; Endocervical adenocarcinoma

Front 9

What role do men play in HPV infection?

Back 9

Women get it from their partners (& vice versa), who harbor it in the penile squamous epithelium. The male tract is much less susceptible to the viral pathologic effect than the female, so detection & tx is rarely undertaken. Squamous cell carcinoma of the penis is related to HPV, but it's a rare dz.

Front 10

What are the host factors that may keep women w/ HPV from getting cervical dysplasia?

Back 10

Immune system, nutritional status, genetic susceptibility

Front 11

Frequency of HPV genital infxn much [more/less] common than cervical dysplasia.

Back 11

More

Front 12

List 4 types of HPV that infect the cervix. Which are high and which are low risk in terms of progression to cervical CA?

Back 12

Low risk: 6 & 11. 60% regress if untreated
High risk: 16 & 18. 60% progress to CA if untreated.

Front 13

What do the low risk HPV's cause?

Back 13

Genital warts

Front 14

What is the difference in oncogenesis of low v high risk HPV?

Back 14

Low risk exists in a free state (episomal). High risk integrates into host DNA, disrupting nl viral self-regulation & allowing expression of viral oncogenes. High risk types can transform cells in culture from nl to precancerous/cancerous

Front 15

Crowded squamous cells, Nuclear enlargement, Hyperchromatic nuclei, Nuclear membrane irregularities

Back 15

Cervical dysplasia

Front 16

ASCUS

Back 16

Atypical Cells of Undetermined Significance; Squamous atypia which falls short of dysplasia; "Atypical" Pap

Front 17

LSIL

Back 17

Low-grade Squamous Intraepithelial Lesion; Mild dysplasia; Corresponds w/ low risk HPV

Front 18

HSIL

Back 18

High-grade Squamous Intraepithelial Lesion; Moderate, severe dysplasia & carcinoma in-situ (CIS); Corresponds w/ high risk HPV

Front 19

How is ASCUS treated?

Back 19

HPV test; Repeat Pap in 4-6m; Colposcopy w/ cervical biopsy

Front 20

How are LSIL & HSIL treated?

Back 20

Colposcopy & cervical biopsies; Laser, cryotherapy, "loop' biopsy, conization depending on severity

Front 21

Why aren't women w/ LSIL & HSIL given HPV testing?

Back 21

Because you already know they have HPV & need treatment. It is helpful for women w/ ASCUS bcs it helps determine which women need further tx.

Front 22

Where do advanced cervical cancers spread to?

Back 22

Adjacent structures (bladder, retum, vagina, peritoneum); Local & distant lymph nodes; Liver, lung, bone marrow

Front 23

What infection are endocervical adenocarcinomas associated with?

Back 23

HPV; 50% co-occurrence w/ HSIL in adjacent squamous epithelium

Front 24

Are adenocarcinomas in-situ or invasive?

Back 24

Can be either

Front 25

Describe the 4 stages of cervical CA.

Back 25

Stage I: carcinoma confined to the cervix. 2: beyond the cervix. 3: reaches pelvic wall. 4: spread to bladder, rectum, metastases

Front 26

Enlarged, hyperchromatic nuclei located near the surface of the epithelium; Nuclear crowding & irregular borders; Koilocytic change (clearing of cytoplasm adjacent to nucleus)

Back 26

LSIL

Front 27

Disordered maturation of squamous epithelium, enlarged nuclei, hyperchromasia, mitotic figures

Back 27

HSIL

Front 28

Keratin/Squamous Pearls (pink, whorled areas)

Back 28

Invasive Squamous Cell Carcinoma

Front 29

Cribriform architecture

Back 29

Endocervical adenocarcinoma

Front 30

Perimenopausal woman, Abdominal pain, Dysmenorrhea, Enlarged, easily palpable uterus

Back 30

Adenomyosis: Disorder in which normal endometrial glands are found w/in the myometrium; Not preneoplastic;

Front 31

ASCUS

Back 31

Atypical Cells of Undetermined Significance; Squamous atypia which falls short of dysplasia; "Atypical" Pap

Front 32

How is ASCUS treated?

Back 32

HPV test; Repeat Pap in 4-6m; Colposcopy w/ cervical biopsy

Front 33

Where do advanced cervical cancers spread to?

Back 33

Adjacent structures (bladder, retum, vagina, peritoneum); Local & distant lymph nodes; Liver, lung, bone marrow

Front 34

What infection are endocervical adenocarcinomas associated with?

Back 34

HPV; 50% co-occurrence w/ HSIL in adjacent squamous epithelium

Front 35

Are adenocarcinomas in-situ or invasive?

Back 35

Can be either

Front 36

Describe the 4 stages of cervical CA.

Back 36

Stage I: carcinoma confined to the cervix. 2: beyond the cervix. 3: reaches pelvic wall. 4: spread to bladder, rectum, metastases

Front 37

Enlarged, hyperchromatic nuclei located near the surface of the epithelium; Nuclear crowding & irregular borders; Koilocytic change (clearing of cytoplasm adjacent to nucleus)

Back 37

LSIL

Front 38

Disordered maturation of squamous epithelium, enlarged nuclei, hyperchromasia, mitotic figures

Back 38

HSIL

Front 39

Keratin/Squamous Pearls (pink, whorled areas)

Back 39

Invasive Squamous Cell Carcinoma

Front 40

Cribriform architecture

Back 40

Endocervical adenocarcinoma

Front 41

Perimenopausal woman, Abdominal pain, Dysmenorrhea, Enlarged, easily palpable uterus

Back 41

Adenomyosis: Disorder in which normal endometrial glands are found w/in the myometrium; Not preneoplastic;

Front 42

How is ASCUS treated?

Back 42

HPV test; Repeat Pap in 4-6m; Colposcopy w/ cervical biopsy

Front 43

Where do advanced cervical cancers spread to?

Back 43

Adjacent structures (bladder, retum, vagina, peritoneum); Local & distant lymph nodes; Liver, lung, bone marrow

Front 44

What infection are endocervical adenocarcinomas associated with?

Back 44

HPV; 50% co-occurrence w/ HSIL in adjacent squamous epithelium

Front 45

Are adenocarcinomas in-situ or invasive?

Back 45

Can be either

Front 46

Describe the 4 stages of cervical CA.

Back 46

Stage I: carcinoma confined to the cervix. 2: beyond the cervix. 3: reaches pelvic wall. 4: spread to bladder, rectum, metastases

Front 47

Enlarged, hyperchromatic nuclei located near the surface of the epithelium; Nuclear crowding & irregular borders; Koilocytic change (clearing of cytoplasm adjacent to nucleus)

Back 47

LSIL

Front 48

Disordered maturation of squamous epithelium, enlarged nuclei, hyperchromasia, mitotic figures

Back 48

HSIL

Front 49

Keratin/Squamous Pearls (pink, whorled areas)

Back 49

Invasive Squamous Cell Carcinoma

Front 50

Cribriform architecture

Back 50

Endocervical adenocarcinoma or LSIL

Front 51

Perimenopausal woman, Abdominal pain, Dysmenorrhea, Enlarged, easily palpable uterus

Back 51

Adenomyosis: Disorder in which normal endometrial glands are found w/in the myometrium; Not preneoplastic;

Front 52

Islands of endometrial glands and stroma; Not atypical or neoplastic, but located in the myometrium

Back 52

Adenomyosis

Front 53

Woman >30yo, abdominal pain, dysfunctional bleeding. May have enlargement or unusual contour of uterus on pelvic exam. May be asymptomatic. Well circumscribed tumor composed of spindly smooth muscle cells that are cytologically benign.

Back 53

Leiomyomas

Front 54

Leiomyoma

Back 54

Benign smooth muscle tumor of the uterine corpus; Extremely common; Not premalignant; Most common benign uterine neoplasms

Front 55

How does placental infecton most often occur? Which organisms are responsible?

Back 55

Usually an ascending infection starting in the mothers lower GIT (E. coli & GpB strep), up vagina & cervix, breaching amniotic membranes & infecting amniotic fluid & potentially the fetus.

Front 56

Chorioamnionitis

Back 56

Ascending GIT infxn from mother spreads to membranes, Neutrophils from mother come in to kill infxn. If fetus >30w old, fetal neuts will also come in (funisitis; neuts from fetus w/in the umbiical vessel walls & surrounding stroma)

Front 57

What are the consequences of placental infection such as chorioamnionitis?

Back 57

Premature rupture of membranes (premature labor) or neonatal sepsis

Front 58

Complete Mole

Back 58

Diploid; formed from the union of an egg w/o a nucleus with 2 sperm, or one sperm that undergoes karyokinesis but not cytokinesis; No embryo is present

Front 59

Gross specimen: abnormal w/ an abundance of grape-like clusters of villous material

Back 59

Complete mole

Front 60

Partial mole

Back 60

Usually triploid; May have an abnormally formed embryo

Front 61

Edematous villi w/ syncytiotrophoblastic hyperplasia, Cisternae

Back 61

Complete or Partial Mole