Repro: Cervix Pathology

Front 1

Ectocervix vs Endocervix

Back 1

Ectocervix - visible from vagina - mature squamous epithelium, with dark cells arranged on basement membrane

Endocervix - entrance to uterine cavity, mucinous, columnar epithelium, longitudinally and in cross section with basally located nuclei and abundant cytoplasm

Separated by squamo-columnar junction

Junction location changes from birth to puberty to maturity and most common site for dysplasia

Front 2

Squamous metaplasia

Back 2

process by which endocervical glandular tissue becomes mature ectocervical squamous tissue

Progression from columnar to squamous epithelium is stimulated by mechanical or hormonal signals,

Front 3

HPV-Associated Lesions of Cervix

Back 3

Benign - Caused by Low-risk HPV (Types 6 and 11). Have KOIOCYTIC ATYPIA (nuclear enlargement and hyperchromasia and perinuclear halo. BINUCLEATED "RAISINOID" cells. CONDYLOMA ACUMINATUM - cauliflower like gross appearance. Branching papillae, epithelial koilocytes

Dysplasia in more high risk (Type 16 and 18) AND low risk types
CIN I - Dysplasia in lower 1/3 of mucosa - 2/3 regress
CIN II - Dysplasia in lower 2/3 of mucosa. Moderate, large irreggular, dark cells, may see mitotic figures. 2/3 PROGRESS
CIN III - Full thickness dysplasia. Severe dysplasia if have small pop normal cells at top. Carcinoma in situ if full thickness

Squamous Carcinoma - HIGH risk types (16,18,31,33)
a) Micro-invasive (Stage 1a) - Lesion which invades underlying cervical stroma to depth of 5.0mm (FIGO) or 3.0mm (SGO) or less. RARELY have lymph node metastasis. Node resection unnecessary. NOT visible on colposcopy or on hysterecopmy specimen without vinegar or Lugol's iodine

b) Invasive carcinoma (Stage 1b) - Invasive cervical SCC easily visible to naked wye and >5mm depth of invasion.

Front 4

Staging of Carcinoma of Cervix

Back 4

Stage 0 - Carcinoma in situ
Stage 1a - microinvasive carcinoma
Stage 1b - invasive carcinoma
Stage II - carcinoma extends beyond cervix (ex uterine fundus, upper 2/3 vagina) but not to pelvic sidewall or lower 1/3 vagina
Stage III - extends to pelvic sidewall or lower 1/3 of vagina
Stage IV - extends beyond true pelvis to urinary bladder or rectum; also any distant metastasis

Front 5

Carcinoma of Cervix Cause of Death

Back 5

MOST result from local extension of the disease in and around urinary bladder leading to:
Ureteral Obstruction
Pyelonephritis
Renal Failure
Uremia

MOST DEATHS NOT FROM DISTANT METASTASIS

Front 6

Histologic types of Cervical SCC

Back 6

Keratinizing SCC - "keratin pearls"; better differentiation

Large Cell Non-keratinizing SCC - eosinophilic cytoplasm with frequent mitotic figures (more common)

Small Cell Non-Keratinizing SCC - small, blue cell tumor; less common (LEAST COMMON, poorly differentiated, more extensive

Front 7

Excision, Hysterectomy, lymph node dissection, Radiotherapy/Chemotherapy indications

Back 7

Excision - high risk lesions, dysplasia (CIN 2 and above)

Hysterectomy - dysplasia (CIN 2 and above) and don't wish to have children. Microinvasive SCC needs Hysterectomy ONLY

Hysterectomy, lymph node, dissection, radiation and chemo - FOR INVASIVE SCC caused by High risk HPV subtypes

Front 8

Pap with high grade dysplasia, next steps

Back 8

Biopsy, if have CIN 2 or above can proceed loop excision with clear margin

Front 9

Endocervical Lesions

Back 9

Benign Endocervical Polyp - similar to endometrial polyp with fibrous stroma and vessels, remove

Endocervical adenocarcinoma in situ - Normal cells have small nucleus, abundant cytoplasm. Atypical cells have larger nuclei, less cytoplasm, Dark glands, mitotic figures, loss of polarity, NO STROMAL INVASION. Normally distributed glands with atypical epithelium

Endocervical Adenocarcinoma - Can be focal but shows invasion of the cervix into endometrium; enocervical more common, atypical glands with numerous nuclei and stromal invasion.

Can also get Adenosquamous, Endometroid, Clear cell (rare)