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Vag/Cervix Patho

Diseases of Vagina, Cervix, and Vulva

**CERVIX** .
Premalignant Cervical Squamous Lesions = ? * New way = SIL (squamous intraepithelial lesion) ...... * Old Way = CIN
If Mild Dysplasia = ? * LSIL and CIN I
Mod/Severe = ? * CIN II-III and HSIL
HPV and human diseases ? * Cutaneous HPV = produce benign warts..... *Mucoutaneous HPV = 11 and 6 lead to warts and 16 and 18 lead to possibly developing invasive LSIL/HSIL cancer
How we get HPV = ? * Skin, Fomites, Sex... * it is very resistant to heat
HPV Genome Regions = ? * E = early region that encodes non-structural proteins..... * L = late region ..... * LCR = long control region which regulates gene expression
Causes E6 and E^ to be down regulated = ? * E2
Progression from a productive HPV infection to malignancy * if lack of immune response, can lead to cervical carcinoma
HPV E6 and E7 Oncoproteins = ? * E6 = promotes cell survival by binding to p53 and inhibits apoptosis...... * E7 = promotes cell prolif by inhibiting Rb
Episomal vs. Integrated HPV DNA ? * Episomal = high rate of Viral Load (LSIL)..... * Integrated = LOW viral load bc it is incorporated in to the DNA (HSIL)
Squamous Intraepithelial Lesions (SIL): Low vs. High Grade = ? * LSIL = associated with HPV infection, but no significant issue in host DNA, most regree, and DOES NOT go directly in to Invasive Carcinoma.... * HSIL = dereg. of cell cycle by HPV --> low viral load
Effect of HPV and its Detection = ? * Koliocytes/pink = LSIL... * brown cells packed together= HSIL for HPV
Cervical carcinoma types ? * Squamous cell carcinoma (80%) --- Cervical adenocarcinoma (15%) * --- Adenosquamous and neuroendocrine (5%) *.......* (*) ones that are found in advanced stage bc PAP doesn't screen for them well
Has the greatest risk of HPV infection and coincides with the greatest metaplastic activity ? * Squamocolumnar Junction
Squamous cell carcinoma of Cervix = ? * Composed of nests and tongues of malignant squamous epithelium ..... * see Keratin Pearls and it invades the Stroma
Adenocarcinoma of the Cervix = ? * proliferation of glandular epithelium ..... *Composed of malignant endocervical cells..... * see large, hyperchromatic nuclei
HPV and Clearance ? * Depends on strain type (low onco. are removed earlier and v/v)..... * Typically, 50% of HPV infections are cleared within 8 months and 90% are cleared within 2 years
Age we would want to screen for HPV infections ? * around 20ish (bc takes about 5 yrs to manifest itself)
Age we need to give immunizations against HPV ? * BEFORE 14-15, bc that is the sexual experimenting age, so nee to prevent the spread
Cervical Cancer Screening ? * 21-29 = PAP only, every 3 yrs..... * 30-65 = PAP and HPV tests done every 5 yrs
Cervical Cytology ( how to tell LSIL or HSIL) ? * LSIL = all have blue/pink in the slides.... * HSIL = have only blue, and the smaller/more compact the cells are, the higher the CIN grade
HPV vaccines are made of ? * virus like particles (VLP), which are empty viral capsids...* No cross protection of different VLP types, so a good shot has multiple/different VLP capsids in it
Common side effects of HPV vaccine ? * injection site pain..... * possible fever and muscle pain
**VULVA** .
Bartholin cyst = ? * From: blockage of the gland that lead can lead to Adenitis = infection of the gland.... * TMT: Excise
2 Non Neoplastic Epithelial Lesions ? * Lichen sclerosus and Squamous cell Hyperplasia
Lichen sclerosus = ? * smooth/white plaques that resemble cig. paper.... * Mostly in POSTmeno. women..... * Can have atrophic vagina and/or constricted orifice when entire vulva is affected..... * If lesion is symptomatic, risk increases for Sq. Cell Ca. development
Squamous cell hyperplasia = ? * aka. lichen simplex chronicus ..... * See Non specific condition resulting from rubbing or scratching of the skin to relieve pruritus ..... * Appears clinically as leukoplakia
2 Squamous Neoplastic Lesions = ? * Vulvar Intraepithelial Neoplasia (VIN) and Vulvar carcinoma
Classic VIN = ? * Related to HPV infection –Majority positive for HPV 16 .... * no cellular maturation
Differentiated VIN = ? * Non-HPV related.... * Chronic epithelial irritation in lichen sclerosus or squamous cell hyperplasia may contribute to a gradual evolution of malignant phenotype
Morphology of VIN = ? * Classic = no cell maturation and see squ. cell atypia, with increased mitosis....... * Differentiated = (Slide is BRIGHT Pink/Red) See Hyperkeratosis and Basal cell atypia
Classic VIN is the precursor lesion for ? * Basaloid vulvar carcinoma and Warty vulvar carcinoma
Differentiated VIN is the precursor lesion for ? * Keratinizing squamous cell carcinoma of vulva ( Histo: see nests and tongues and keratin)
Glandular Neoplastic Lesions basics ? * The vulva may contain tissue closely resembling breast (ectopic breast) and may develop two tumors: -- Benign- papillary hidradenoma -- and -- Malignant- extramammary Paget disease
Papillary Hidradenoma = ? * Vulva contains modified apocrine sweat glands .... * see a Sharp/well-circumscribed nodule (all dark purple)..... * It can ulcerate sometimes, so it can be confused with Carcinoma
Extramammary Paget Disease = ? * , 100% is associated with ductal breast carcinoma..... * Has a VERY high recurrence rate
Malignant Melanoma of the Vulva = ? * RARE !.... * May resemble Paget disease both grossly and histologically when confined to the epithelium, but this has a SUPER high mortality rate, so differentiate it !
**VAGINA** .
DES and clear cell adenocarcinoma = ? * DES (diethylstilbestrol) used to prevent threatened abortions .... * In those exposed to it, there is a high link to Clear Cell Adenocarcinoma
Vaginal Squ. Cell Carcinoma = ? * assoc. w/ high risk HPV types..... * if previous cervial squ. ca = increase vaginal incidence
Embryonal Rhabdomyosarcoma = ? * (Pic looks like a baby with a hemorrhoid pertruding out of the vagina)...... * found most in infants and children younger than 5y/o.... * Tmt: surgery and chemo
Created by: thamrick800