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24 Cards in this Set
- Front
- Back
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HPV high risk subtypes
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16, 18, 45, 31 , 33
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Cervical dysplasia transit time if neglected
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– CIN 1 is 5 years
– CIN 2 is 3 years – CIN 3 is 1 year |
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After satisfactory colposcopy for CIN I
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– If tx selected, excisional preferred
– Test for HPV at 12 mos OR do 2 repeat paps at 6 and 12 mos – If repeat ASC or more OR high risk HPV refer back to colpo |
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After unsatisfactory colpo for CIN I
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– Dx excisional procedure (not ablative)
– In pregnant, adolescent, immunosuppressed women may be followed as above |
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After satisfactory colposcopy for CIN II & III
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Excisional or ablative therapy that removes the entire transformational zone
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After unsatisfactory colposcopy for CIN II & III
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– do dx excisional conization
– up to 7% will have occult invasive cervical carcinoma – Margins are risk factor for recurrence/persistent |
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Cervical dysplasia in pregnancy
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– Follow with Pap/colposcopy each trimester
– Bx if suspect cancer – Plan treatment 6 weeks postpartum |
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Tx for cervical carcenoma
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– Stage I is Surgery or Simple hysterectomy
– Stage II is Surgery or Radical Hysterectomy (take LN’s and part of vagina) – Stage III and IV is Radiation |
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False (-) pap
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– Too few abnormal cells
– smears w/ obscuring inflamm or blood limiting evaluation |
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What defines a satisfactory pap
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– in conventional, ³10% of slide has cells
– Thin preps, 5000 cells – Epi or glandular abnormality even if there are less than adequate numbers of cells |
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What defines an unsatisfactory pap
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– Specimen rejected (Improper pt identifiers, Slides received broken)
- Too few squamous cells - poor preservation - Totally obscured by blood |
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(-) for Intraepithelial Lesion or Malignancy pap classification
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– benign cellular changes
– Endometrial cells if >40 yrs (May indicate an endometrial lesion like hyperplasia, carcinoma) |
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Condyloma (Koilocytes) histo
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– Pathgnomonic for HPV (LGSIL in Bethesda)
– Clear cyto, well defined vacuole w/ enlarged, irregular and dark nucleus (binucleation common) |
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SC in situ histo
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3D aggregates of cells w/ little cytoplasm and dark irregular nuclei
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Cervical invasive SCC histo
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– irregular chromatin clumping, prominent nucleoli
– Background may be necrotic |
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ASCUS histo
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– Nuclear enlargement but no hyerchromasia
– Cytoplasmic vacuolization without nuclear abnormalities of HPV – Inflammation induced nuclear enlargement |
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ASC-H histo
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– Small cells with hyperchromatic nuclei too few in number for diagnosis of HSIL
– Atypical squamous metaplasia from endocervical canal |
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AGUS histo
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– Nuclear enlargement w/ minimal hyperchromasia
– Inflamm associated reactive atypia – Metaplasia w/ reactive atypia – Thick clusters of endocervical cells difficult to classify (may be related to sampling device) |
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HPV-mediated carcinogenesis
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– infects basal cells at
– integrates into host DNA – viral oncogenes E6 and E7 over expressed and bind – this -> destruction of proteins from p53 and Rb genes – Proliferating cells acquire additional genetic errors – Clonal selection leads to malignant phenotype |
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Lichen sclerosus
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– vulvar dystrophy
– may be painful, pale white plaques, cause unknown |
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Squamous hyperplasia
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– vulvar dystrophy
– may be pruritic and related to a wide variety of irritants |
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Paget’s disease
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– Glandular tumor cells w/in epidermis that stain for mucin (indicative of their glandular origin)
– Most cases are NOT associated with an underlying adenocarcinoma |
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Nabothian cyst
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benign mucinous cyst-like distension of endocervical glands 2o to obstruction from squamous metaplasia
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Microglandular hyperplasia
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benign prolif of endocervical glands, likely hormonally driven (P stimulation)
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