Cervix, Cervix Path

Question 1

HPV is necessary or sufficient to cause cervical cancer and dysplasia?

Answer 1

necessary

Question 2

HPV subtypes accounting for cancer

Answer 2

16, 18

Question 3

in addition to cervical cancers, high-risk HPV causes

Answer 3

• oropharyngeal cancer
• anal cancer
• vulvar and vaginal cancer

Question 4

HPV transmission

Answer 4

skin-skin contact

Question 5

HPV risk fx

Answer 5

STI risk fx
immunosuppression
smoking
young age

Question 6

HPV natural history

Answer 6

• vast majority of HPV infections are transient
• asymptomatic
• resolve spontaneously

Question 7

HPV persistent infection

Answer 7

• by same HPV type after 2 years

- leads to invasive cervical cancer through a stepwise sequence of progressive neoplasia

Question 8

It takes __ years form initial infection to develop invasive cancer

Answer 8

10-25

Question 9

cervical cancer screening guidelines

Answer 9

<21 y: none
21-29: pap q3yr
30-65: pap+HPV q 5 yr
>65 y or s/p hyst: no screening (no h/o CIN 2 or >20 in past 20 yr)

Question 10

colposcopy

Answer 10

-magnification and illumination to aid in cervix/vagina/anogenital area

Question 11

cervical cancer classification

Answer 11

CIN 1/2/3

Question 12

CIN 1 recommendation

Answer 12

co-test in 1 year

Question 13

CIN 2 recommendation

Answer 13

ev 6 mo colpo + pap, or treat

Question 14

CIN 3 recommendation

Answer 14

treat

Question 15

tx of CIN 2/3

Answer 15

excisional

• cold-knife cone biopsy
• LEEP

Question 16

cold-knife cone biopsy

Answer 16

large area of tissue around cervix is excised for examinatino

Question 17

LEEP

Answer 17

uses electrical current to excise the distal cervix including the transformation zone

Question 18

Invasive cervical cancer

Answer 18

• bleeding or brown discharge, often post-coital
• back pain, weight loss are late manifestations
• hx of inadequate screening
• dx established by biopsy

Question 19

Invasive cervical cancer natural hx

Answer 19

• once invasive, no regression
• spreads by direct extension/growth
• exophytic, cauliflower-like
• stage on physical exam

Question 20

Invasive cervical cancer - early stage disease

tx

Answer 20

radical hysterectomy

chemoradiation therapy

Question 21

Invasive cervical cancer - advanced stage disease

Answer 21

chemoradiation therapy

Question 22

5-yr survival of stage Ia cervical cancer

Answer 22

95%

Question 23

HPV vaccine

Answer 23

L1 capsid HPV viral protein

reduces risk up to 97% for 7 types of high-risk HPV including HPV 16/18 and 6/11 (genital warts)

Question 24

carcinoma of the cervix usually begins at the junction of the

Answer 24

ectocervix and endocervix

Question 25

transition zone

Answer 25

between the original squamocolunar junction and the new sqamocolumnar junction where cervical dysplasia occurs

Question 26

at puberty, cervix enlarges and ______ extends beyond the external os

Answer 26

endocervix

Question 27

HPV cytopathic effect

Answer 27

nuclear enlargement, hypERchromatism, membrane wrinkling multinucleation peri-nuclear cytoplasmic vacuolation ("halo") --> KOLIOCYTES

Question 28

koliocytes

Answer 28

seen in HPV due to E4 disrupting keratin matrix --> peri-nuclear cytoplasmic vacuolation

Question 29

invasive adenocarcinoma histo

Answer 29

malignant glands invading stroma pools of mucin from adenocarcinoma

Question 30

Bethesda system

Answer 30

describes pap findings LSIL (Low grade squamous intraepithelial lesion) or HSIL (High grade squamous intraepithelial lesion

Question 31

vulval neoplasia

Answer 31

condyloma acuminatum | -due to HPV 6 and 11

Question 32

vulval carcinoma histo

Answer 32

keratin pearl | invasive nests of squamous cell carcinoma

Question 33

clear cell adenocarcinoma

Answer 33

-assoc w/ DES (diethylstilbestrol) exposure of the patient's mother during pregnancy tumors in young (avg 19)

Question 34

clear cell adenocarcinoma histo

Answer 34

malignant clear cells with glycogen

Question 35

embryonal rhabdomyosarcoma

Answer 35

sarcoma botryoides a vaginal neoplasm children, <5 years small round blue cell tumor with rhabdomyoblasts

Question 36

grape-like tumor

Answer 36

embryonal rhabdomyosarcoma