Diseases of Vagina, Cervix, and Vulva
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| **CERVIX** | .
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| Premalignant Cervical Squamous Lesions = ? | * New way = SIL (squamous intraepithelial lesion) ...... * Old Way = CIN
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| If Mild Dysplasia = ? | * LSIL and CIN I
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| Mod/Severe = ? | * CIN II-III and HSIL
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| 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
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| How we get HPV = ? | * Skin, Fomites, Sex... * it is very resistant to heat
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| HPV Genome Regions = ? | * E = early region that encodes non-structural proteins..... * L = late region ..... * LCR = long control region which regulates gene expression
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| Causes E6 and E^ to be down regulated = ? | * E2
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| Progression from a productive HPV infection to malignancy | * if lack of immune response, can lead to cervical carcinoma
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| HPV E6 and E7 Oncoproteins = ? | * E6 = promotes cell survival by binding to p53 and inhibits apoptosis...... * E7 = promotes cell prolif by inhibiting Rb
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| 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)
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| 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
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| Effect of HPV and its Detection = ? | * Koliocytes/pink = LSIL... * brown cells packed together= HSIL for HPV
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| 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
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| Has the greatest risk of HPV infection and coincides with the greatest metaplastic activity ? | * Squamocolumnar Junction
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| Squamous cell carcinoma of Cervix = ? | * Composed of nests and tongues of malignant squamous epithelium
..... * see Keratin Pearls and it invades the Stroma
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| Adenocarcinoma of the Cervix = ? | * proliferation of glandular epithelium ..... *Composed of malignant endocervical cells..... * see large, hyperchromatic nuclei
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| 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
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| Age we would want to screen for HPV infections ? | * around 20ish (bc takes about 5 yrs to manifest itself)
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| Age we need to give immunizations against HPV ? | * BEFORE 14-15, bc that is the sexual experimenting age, so nee to prevent the spread
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| Cervical Cancer Screening ? | * 21-29 = PAP only, every 3 yrs..... * 30-65 = PAP and HPV tests done every 5 yrs
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| 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
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| 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
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| Common side effects of HPV vaccine ? | * injection site pain..... * possible fever and muscle pain
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| **VULVA** | .
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| Bartholin cyst = ? | * From: blockage of the gland that lead can lead to Adenitis = infection of the gland.... * TMT: Excise
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| 2 Non Neoplastic Epithelial Lesions ? | * Lichen sclerosus and Squamous cell Hyperplasia
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| 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
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| 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
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| 2 Squamous Neoplastic Lesions = ? | * Vulvar Intraepithelial Neoplasia (VIN)
and Vulvar carcinoma
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| Classic VIN = ? | * Related to HPV infection –Majority positive for HPV 16
.... * no cellular maturation
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| Differentiated VIN = ? | * Non-HPV related.... * Chronic epithelial irritation in lichen sclerosus or squamous cell hyperplasia may contribute to a gradual evolution of malignant phenotype
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| 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
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| Classic VIN is the precursor lesion for ? | * Basaloid vulvar carcinoma and Warty vulvar carcinoma
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| Differentiated VIN is the precursor lesion for ? | * Keratinizing squamous cell carcinoma of vulva
( Histo: see nests and tongues and keratin)
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| 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
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| 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
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| Extramammary Paget Disease = ? | * , 100% is associated with ductal breast carcinoma..... * Has a VERY high recurrence rate
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| 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 !
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| **VAGINA** | .
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| 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
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| Vaginal Squ. Cell Carcinoma = ? | * assoc. w/ high risk HPV types..... * if previous cervial squ. ca = increase vaginal incidence
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| 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
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