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61 Cards in this Set

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Small to large (5cm) mass(es) arising in the endocervix & protruding through the os; Soft polyps w/ dilated glands and active stroma
Endocervical Polyps
Tx: Simple excision or curettage
Endocervical glandular epithelium transformed to squamous epithelium
Squamous metaplasia
How does cervicitis develop?
Epithelium becomes glycogenated, providing a substrate for organisms; Acute & chronic inflammation increase; Cervix becomes colonized by pathogenic or nonpathogenic bacteria
List 2 problems of acute or chronic cervicitis.
Further sexual transmission; May ascend & cause PID, leading to fertility & pregnancy complications
What is the main problem with Paps & why is it still considered a good screening test?
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.
What is the difference between cervical dysplasia & cervical CA?
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.
Most cervical CA's are __ __ __.
Squamous cell carcinomas
Which part of the cervix less commonly gives rise to CA? What are cancers of this region called?
Endocervical portion; Endocervical adenocarcinoma
What role do men play in HPV infection?
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.
What are the host factors that may keep women w/ HPV from getting cervical dysplasia?
Immune system, nutritional status, genetic susceptibility
Frequency of HPV genital infxn much [more/less] common than cervical dysplasia.
More
List 4 types of HPV that infect the cervix. Which are high and which are low risk in terms of progression to cervical CA?
Low risk: 6 & 11. 60% regress if untreated
High risk: 16 & 18. 60% progress to CA if untreated.
What do the low risk HPV's cause?
Genital warts
What is the difference in oncogenesis of low v high risk HPV?
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
Crowded squamous cells, Nuclear enlargement, Hyperchromatic nuclei, Nuclear membrane irregularities
Cervical dysplasia
ASCUS
Atypical Cells of Undetermined Significance; Squamous atypia which falls short of dysplasia; "Atypical" Pap
LSIL
Low-grade Squamous Intraepithelial Lesion; Mild dysplasia; Corresponds w/ low risk HPV
HSIL
High-grade Squamous Intraepithelial Lesion; Moderate, severe dysplasia & carcinoma in-situ (CIS); Corresponds w/ high risk HPV
How is ASCUS treated?
HPV test; Repeat Pap in 4-6m; Colposcopy w/ cervical biopsy
How are LSIL & HSIL treated?
Colposcopy & cervical biopsies; Laser, cryotherapy, "loop' biopsy, conization depending on severity
Why aren't women w/ LSIL & HSIL given HPV testing?
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.
Where do advanced cervical cancers spread to?
Adjacent structures (bladder, retum, vagina, peritoneum); Local & distant lymph nodes; Liver, lung, bone marrow
What infection are endocervical adenocarcinomas associated with?
HPV; 50% co-occurrence w/ HSIL in adjacent squamous epithelium
Are adenocarcinomas in-situ or invasive?
Can be either
Describe the 4 stages of cervical CA.
Stage I: carcinoma confined to the cervix. 2: beyond the cervix. 3: reaches pelvic wall. 4: spread to bladder, rectum, metastases
Enlarged, hyperchromatic nuclei located near the surface of the epithelium; Nuclear crowding & irregular borders; Koilocytic change (clearing of cytoplasm adjacent to nucleus)
LSIL
Disordered maturation of squamous epithelium, enlarged nuclei, hyperchromasia, mitotic figures
HSIL
Keratin/Squamous Pearls (pink, whorled areas)
Invasive Squamous Cell Carcinoma
Cribriform architecture
Endocervical adenocarcinoma
Perimenopausal woman, Abdominal pain, Dysmenorrhea, Enlarged, easily palpable uterus
Adenomyosis: Disorder in which normal endometrial glands are found w/in the myometrium; Not preneoplastic;
ASCUS
Atypical Cells of Undetermined Significance; Squamous atypia which falls short of dysplasia; "Atypical" Pap
How is ASCUS treated?
HPV test; Repeat Pap in 4-6m; Colposcopy w/ cervical biopsy
Where do advanced cervical cancers spread to?
Adjacent structures (bladder, retum, vagina, peritoneum); Local & distant lymph nodes; Liver, lung, bone marrow
What infection are endocervical adenocarcinomas associated with?
HPV; 50% co-occurrence w/ HSIL in adjacent squamous epithelium
Are adenocarcinomas in-situ or invasive?
Can be either
Describe the 4 stages of cervical CA.
Stage I: carcinoma confined to the cervix. 2: beyond the cervix. 3: reaches pelvic wall. 4: spread to bladder, rectum, metastases
Enlarged, hyperchromatic nuclei located near the surface of the epithelium; Nuclear crowding & irregular borders; Koilocytic change (clearing of cytoplasm adjacent to nucleus)
LSIL
Disordered maturation of squamous epithelium, enlarged nuclei, hyperchromasia, mitotic figures
HSIL
Keratin/Squamous Pearls (pink, whorled areas)
Invasive Squamous Cell Carcinoma
Cribriform architecture
Endocervical adenocarcinoma
Perimenopausal woman, Abdominal pain, Dysmenorrhea, Enlarged, easily palpable uterus
Adenomyosis: Disorder in which normal endometrial glands are found w/in the myometrium; Not preneoplastic;
How is ASCUS treated?
HPV test; Repeat Pap in 4-6m; Colposcopy w/ cervical biopsy
Where do advanced cervical cancers spread to?
Adjacent structures (bladder, retum, vagina, peritoneum); Local & distant lymph nodes; Liver, lung, bone marrow
What infection are endocervical adenocarcinomas associated with?
HPV; 50% co-occurrence w/ HSIL in adjacent squamous epithelium
Are adenocarcinomas in-situ or invasive?
Can be either
Describe the 4 stages of cervical CA.
Stage I: carcinoma confined to the cervix. 2: beyond the cervix. 3: reaches pelvic wall. 4: spread to bladder, rectum, metastases
Enlarged, hyperchromatic nuclei located near the surface of the epithelium; Nuclear crowding & irregular borders; Koilocytic change (clearing of cytoplasm adjacent to nucleus)
LSIL
Disordered maturation of squamous epithelium, enlarged nuclei, hyperchromasia, mitotic figures
HSIL
Keratin/Squamous Pearls (pink, whorled areas)
Invasive Squamous Cell Carcinoma
Cribriform architecture
Endocervical adenocarcinoma or LSIL
Perimenopausal woman, Abdominal pain, Dysmenorrhea, Enlarged, easily palpable uterus
Adenomyosis: Disorder in which normal endometrial glands are found w/in the myometrium; Not preneoplastic;
Islands of endometrial glands and stroma; Not atypical or neoplastic, but located in the myometrium
Adenomyosis
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.
Leiomyomas
Leiomyoma
Benign smooth muscle tumor of the uterine corpus; Extremely common; Not premalignant; Most common benign uterine neoplasms
How does placental infecton most often occur? Which organisms are responsible?
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.
Chorioamnionitis
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)
What are the consequences of placental infection such as chorioamnionitis?
Premature rupture of membranes (premature labor) or neonatal sepsis
Complete Mole
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
Gross specimen: abnormal w/ an abundance of grape-like clusters of villous material
Complete mole
Partial mole
Usually triploid; May have an abnormally formed embryo
Edematous villi w/ syncytiotrophoblastic hyperplasia, Cisternae
Complete or Partial Mole