Repro: Cervical Dysplasia

Front 1

Risk factors for cervical cancer

Back 1

early first intercourse, multiple partners, smoking, immunosuppression (HIV, steroids), DES exposure

Front 2

HPV epi

Back 2

Most common STD globally; 80% adults have by age 50; usually acquired in first decade of sexual activity but most clear w/in 2 years.

Front 3

HPV

Back 3

ds circular DNA virus that infects epithelial cells
40+ types can infect genital tract
low risk 6, 11 cause genital warts
high risk 16, 18, 31, 33, 39, 45 can cause cervical dysplasia, cancer

Front 4

HPV genes

Back 4

7 early genes; E6 and E7 affect host p53 and Rb tumor suppressors
2 late genes
DNA integrates into human genome in cancer

Front 5

Cervical cancer screening guidelines

Back 5

No screening before 21
21-29 every 3 years
30-64 every 3 years or w/ HPV test every 5 years
65+ may discontinue if meet certain criteria

Front 6

ASC-US

Back 6

atypical squamous cells of undetermined significance
-triage w/ HPV test

Front 7

Colposcopy

Back 7

Look at the cervix under microscope and apply acetic acid or Lugol's solution to see dysplastic changes. Take biopsies.

Front 8

Transformation zone

Back 8

juncture btw squamous and columnar. Initially covered by squamous, changes to columnar at puberty and then back to squamous. Most cervical cancer starts here.

Front 9

acetic acid

Back 9

dehydrates cells; abnormal areas appear white due to decreased glycogen.

Front 10

Lugol's

Back 10

iodine taken up by normal cells w/ high glycogen content. Non-staining is abnormal.

Front 11

CIN treatment option

Back 11

Options include observation, ablation, diagnostic excision, hysterectomy

Front 12

Natural hx of CIN

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depends on age/health status
-CIN1: 90% regresses
-CIN3: 90% persists/progresses

Front 13

Gardasil

Back 13

100% effective in preventing HPV/CIN2
targets HPV 6, 11, 16, 18

Front 14

Cervarix

Back 14

90% effective preventing HPV/CIN2
longer immunity?
Targets HPV 16, 18

Front 15

vaccine recommendations

Back 15

Girls 11-12 up to 26 (as young as 9)
Boys
Not for pregnant women
3 doses over 6 months

Front 16

ectocervix histo

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stratified sq epithelium w/ superficial, intermediate, parabasal, basal cell layers

Front 17

histologic differences btw cell layers

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basal cells have higher N:C ratio; superficials have more abundant cyto

Front 18

endocervix histo

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columnar mucinous epithelium

Front 19

transformation zone

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dynamic region w/ sq metaplasia and active cell turnover
**most common site of origin for cervical dysplasia, carcinoma, so want to sample this area on pap.

Front 20

changes in cervix

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squamocolumnar junction moves out into ectocervix in young adult, then original squamous is restored in adulthood via metaplastic changes (transformation zone)

Front 21

HPV-mediated carcinogenesis

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HPV infects basal cells @transformation zone >> integrates into host DNA >> HPV viral oncogenes E6/7 overexpressed >> bind, destroy proteins encoded by p53 and Rb genes >> proliferating cells acquire additional genetic errors >> clonal selection leads to malignant phenotype.

Front 22

subclinical infection

Back 22

HPV DNA +
cytology -

Front 23

transient infection

Back 23

most common type
HPV DNA +
cytology + (LSIL)
clearing of DNA/dysplasia

Front 24

persistent infection

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HPV DNA +
persistent cytologic abnormalities (LSIL or HSIL)
possible progression

Front 25

pap smear effectiveness

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main issue is false negatives >> failure to sample dysplastic cells or to properly characterize them.

Front 26

clinically suspicious lesion

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must be investigated further regardless of negative Pap.

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Bethesda System 2001

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system for pap reporting:
-specimen type and adequacy
-general categorization (NILM)
-Interpretation/descriptive result

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specimen adequacy

Back 28

too few squamous cells is #1 reason for inadequacy

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candida

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spaghetti and meatballs
may see nuclear enlargement, light chromatin in cells near to pseudohyphae

Front 30

coccobacilli

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Clue cells covered in bacteria indicate a shift in normal flora (fewer lactobacilli) suggest bacterial vaginosis due to Gardnerella.

Front 31

HSV

Back 31

3 M's: multinucleation of nuclei, molding of nuclei, margination of chromatin
**call pt's dr if she is pregnant

Front 32

Trichomonas

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oval/pear nucleus (necessary for dx)
red cytoplasmic granules
infection may induce reactive atypia w/ cytoplsamic halos, background inflammation

Front 33

Actinomyces

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gram-pos long, filamentous bacteria
assoc w/ IUD use

Front 34

CIN/SIL histo characteristics

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characterized by morphologic changes like increased N:C ratio, nuclear hyperchromasia, apoptosis, mitotic figures above basal layer
1 (mild) = low-grade SIL
2(moderate) and 3 (severe) = high grade SIL

Front 35

CIN-1/LSIL

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cytology: perinuclear halo, peripheral dense cyto, enlarged/dark nucleus, low N:C ratio
histo: full-thickness abnormal nuclei, but upper layers retain maturation, abundant cyto

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CIN-2/HSIL

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cyto: enlarged, hyperchromatic, irregular nuclei, high N:C ratio
histo: loss of maturation in half/all epidermal layers

Front 37

types of cervical cancer

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squamous cell 75%+
adenocarcinoma is increasing

Front 38

SCC of the cervix

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cytology: Irregular nuclei, chromatin clumping, prominent nucleoli
histo: well/poor differentiation, +/- keratin pearls

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endocervical adenocarcinoma testing

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precursor is AIS; pap test is best screening test but has limited sens/spec.

Front 40

ACIS cyto and histo

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nuclear enlargement, increased N:C ratio, nuclear elongation, crowding, pseudostratification

Front 41

HPV testing

Back 41

DNA testing, always looks for 16, 18
very high NPV, false pos may occur

Front 42

cervical polyps

Back 42

Benign hyperplastic polyps arising in the Endocervix; may be associated with discharge or bleeding

Front 43

vagina anatomy and histo

Back 43

post to bladder, ant to rectum; stratified squamous epithelium

Front 44

vaginal tumors

Back 44

primary tumors rare, most are mets or from nearby organ

Front 45

DES exposure

Back 45

Drug used to prevent spontaneous abortion prior to 1980s; exposure in utero associated w/ changes in female genital tract - congenital anomalies, clear cell carcinoma of the vagina

Front 46

Embryonal rhabdomyosarcoma

Back 46

rare malignant vaginal tumor in childhood; bunch of grapes mass w/ small round blue cells on histo

Front 47

vulva

Back 47

keratinizing stratified sq epithelium; dermatologic conditions can affect it.

Front 48

lichen sclerosus

Back 48

painful, pale white plaques; cause not known.

Front 49

vulvar neoplasias

Back 49

HPV 6 and 11 can cause warts

Front 50

condylom acuminatum

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cauliflower lesions

Front 51

Paget Dz

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glandular tumor cells w/in epidermis; clear cyto, atypical nuclei. Positive intracytoplasmic staining for mucin distinguishes it from melanoma

Front 52

vulvar melanoma

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Cells are negative for intracytoplasmic mucin
Nests of large cells with enlarged atypical nuclei and prominent nucleoli. Melanin pigment

Front 53

Koilocyte

Back 53

cytologic and histologic changes seen in squamous cells infected with HPV ( “hollow cell”)
Nuclear enlargement and hyperchromasia, low N:C ratio, Perinuclear clearing/halo with sharp borders