Pathology Of Cervix Flashcards
1
Q
Estrogen effect on cervical tissue
A
- Stimulates the maturation of cervical and vaginal squamous mucosa and formation of intracellular glycogen vacuoles in the squamous cells - As the cells shed the glycogen provides a substrate for endogenous vaginal aerobes and anaerobe - Normal cervical flora contains abundant lactobacilli which produces lactic acid
2
Q
Causes of Cervicitis
A
- Changes in vaginal pH - Decrease in lactobacilli - Infections - Gonococci, chlamydiae, mycoplasms and HSV - Cervical inflammation may alter the findings of a PAP smear
3
Q
Chronic endocervicitis Histology
A
4
Q
HSV of cervix Histology
A
- Intense non-specific inflammation
- Ulceration potentially
- Characteristic finding: Multinucleated Giant cells and intranuclear inclusions
5
Q
Multinucleated giant cells
A
- Histological finding for HSV infection
- Cells w/ large nuclei
6
Q
Endocervical polyps
A
- Non-neoplastic glandular lesion of the cervix
- Not true neoplasms; benign growths in women
- Result from Chronic inflammatory changes
- Range in size
- Dilated glands w/ an edematous, inflamed fibrotic stroma
- Surface epithelium but responds to the inflammation through squamous metaplasia
- May have a branching papillary structure
- May cause bleeding
- Composed of dense stroma covered by endocervical columnar epithelium
- Most are in the endocervical canal and may protrude from the cervical os
7
Q
Nabothian Cysts
A
- Non-neoplastic glandular lesion of the cervix
- Due to blockage of endocervical glands from inflammation
- Grossly appear as cystic spaces filled w/ mucoid
- Microscopicallly have cystically dilated glands lined by flattened epithelium
- May extend into the cervical wall which may mimic malignancy
8
Q
Tunnel Clusters
A
- Non-neoplastic glandular lesion of the cervix
- Localized proliferation of endocervical glands w/ side channels growing out
- Secretions may dilate the lumens
- Some have a florid glandular proliferation and a certain degree of atypia
9
Q
Microglandular hyperplasia
A
- Non-neoplastic glandular lesion of the cervix
- Involves the endocervical epithelium
- Complex proliferation of glands linded by flat epithelial cells w/ little or no atypia
- Squamous metaplasia may also be present
- Chronic inflammation is usually present in the stroma
10
Q
Diffuse laminar endocervical glandular hyperplasia
A
- Proliferation of medium sized, evenly spaced, well differentiated glands in the inner third of the cervical wall
- They are separated from the stroma
- Often has chronic inflammation
11
Q
Mesonephric duct rests
A
- Non-neoplastic glandular lesion of the cervix
- Undergo cystic dilation or have atypical hyperplastic changes
- May have a lobular, diffuse or ductal pattern
- Rarely malignant tumors can arise from these structures
- May be involved by CIN and other malignancies assoc. w/ it
12
Q
Cervical Carcinoma Risk Factors
A
- PAP smears have decreased deaths
- Multiple sex partners
- Male partner w/ multiple sex partners
- Young age at first intercourse
- Persistent infection of HPV 16 or 18
- Immunosuppression
- Certain HLA subtypes
- Use of OCP
- Use of nicotine
13
Q
Cervical Carcinoma Clinical Features
A
- Dysplasia early on is often asymptomatic
- Invasive cervcial carcinoma may present w/ irregular bleeding, postcoital spotting, pelvic pain, vaginal discharge and dysuria w/ renal failure in advanced cases (from closing the ureters)
14
Q
HPV Infection
A
- HPV infection is fairly common
- Most infections are transient and are eliminated by the immune response over several months
- Persistent infections increase the risk of precancerous and cancerous lesions
- HPVs infect the immature basal cells of the squamous epithelium in areas of epithelial breaks or immature metaplastic squamous cells at the squamocolumnar junction
- They do not infect mature superficial squamous cells covering the ectocervix, vagina or vulva
- Infection at these sites requires damage to surface epithelium, giving the virus access to the immature cells in the basal layer of the epithelium
- The cervix is susceptible due to a large amt of immature squamous metaplastic epithelium
- Replication occurs in the maturing squamous cells resulting in a cytopathic change-koilocytic atypia
- Prevents replicative senescence by up regulating telomerase
- Net result is an extension of the life span of epithelial cells which lead to tumor development
15
Q
Koilocytic atypia
A
- Seen on PAP smear of HPV infected individual
- When HPV virus gains access to immature squamous basal cells allowing for replication resulting in a morphologic change that is seen microscopically called koilocytosis
- Koilocytosis: shrinking of the nucleus w/ a perinuclear halo around it
- Telling of HPV infection
25
Q
Invasive squamous cell carcinoma
A
- Most common malignant tumor of the female genital tract in most countries
- Incidence in the US has decreased during the last several decades
- High risk types of HPV are implicated
- 3 Major categories: large cell nonkeratinizing, keratinizing and small cell carcinoma
- The better differentiated form of keratinizing squamous cell cancer lacks a strong relationship to HPV and CIN
- Spreads by direct extension to vagina, corpus, lower urinary tract and uterosacral ligaments
27
Q
Adenocarcinoma of the cervix
A
- No distinguishing gross characteristics
- HPV 16 and 18 found in most endocervical adenocarcinomas
- Overall prognosis is less favorable than for squamous cell carcinoma
28
Q
Adenoma malignum
A
- AKA minimal deviation adenocarcinoma
- Very well differentiated
- Distorted glands w/ irregular outlines deeply postitioned in the cervix and a portion of the tumor is assoc. w/ a stromal response
- Usually NOT assoc. w/ HPV
- May be seen w/ Peutz-Jeghers syndrome
30
Q
Neuroendocrine carcinoma of the cervix
A
- Similar to small cell carcinoma of the cervix
- May have trabecular, glandular, and spindle cell growth patterns
- May stain for chromogranin
- Mitoses and necrosis is common
