Podcast
Questions and Answers
What histological feature predominates in Lichen Simplex Chronicus, differentiating it from other vulvar dermatoses?
What histological feature predominates in Lichen Simplex Chronicus, differentiating it from other vulvar dermatoses?
- Acanthosis with thickening of the prickle-cell layer (correct)
- Eosinophilic spongiosis with intraepidermal vesicles
- Mononuclear inflammatory infiltrate with plasma cells
- Subepithelial fibrosis with hyalinization
In the context of vulvar malignancies, which histologic subtype is most frequently associated with a poorer prognosis due to its propensity for deep invasion and lymphovascular involvement?
In the context of vulvar malignancies, which histologic subtype is most frequently associated with a poorer prognosis due to its propensity for deep invasion and lymphovascular involvement?
- Verrucous carcinoma
- Squamous cell carcinoma (correct)
- Adenoid cystic carcinoma
- Basal cell carcinoma
Which of the following histopathological features is LEAST likely to be associated with Condyloma Acuminatum?
Which of the following histopathological features is LEAST likely to be associated with Condyloma Acuminatum?
- Koilocytosis
- Parakeratosis
- Acanthosis
- Subepithelial fibrosis (correct)
Which of the following statements best differentiates differentiated vulvar intraepithelial neoplasia (dVIN) from usual vulvar intraepithelial neoplasia (uVIN)?
Which of the following statements best differentiates differentiated vulvar intraepithelial neoplasia (dVIN) from usual vulvar intraepithelial neoplasia (uVIN)?
Which of the following is the most critical factor determining the prognosis of Vulvar Squamous Cell Carcinoma?
Which of the following is the most critical factor determining the prognosis of Vulvar Squamous Cell Carcinoma?
Paget's disease of the vulva is characterized by intraepithelial adenocarcinoma; what is the origin of these malignant cells?
Paget's disease of the vulva is characterized by intraepithelial adenocarcinoma; what is the origin of these malignant cells?
Which of the following is the most common type of vaginal malignancy?
Which of the following is the most common type of vaginal malignancy?
Diethylstilbestrol (DES) exposure in-utero is a risk factor for which of the following vaginal neoplasms?
Diethylstilbestrol (DES) exposure in-utero is a risk factor for which of the following vaginal neoplasms?
Which of the following best describes the initial state of HPV during the pathogenesis of an HPV infection?
Which of the following best describes the initial state of HPV during the pathogenesis of an HPV infection?
What percentage of cervical carcinomas do Squamous cell carcinoma account for?
What percentage of cervical carcinomas do Squamous cell carcinoma account for?
According to FIGO staging for cervical cancer, microinvasion is defined as the early stage of squamous cell carcinoma with a depth of invasion less than:
According to FIGO staging for cervical cancer, microinvasion is defined as the early stage of squamous cell carcinoma with a depth of invasion less than:
What is the primary purpose of cervical cytology in cervical cancer prevention?
What is the primary purpose of cervical cytology in cervical cancer prevention?
What is the primary function of colposcopy in the evaluation of cervical abnormalities?
What is the primary function of colposcopy in the evaluation of cervical abnormalities?
Which of the following is a method used for lesion excision in the management of cervical dysplasia?
Which of the following is a method used for lesion excision in the management of cervical dysplasia?
A patient with Lichen Sclerosus is at an increased risk for developing:
A patient with Lichen Sclerosus is at an increased risk for developing:
Which of the following is the preferred management for Differentiated VIN due to high risk of invasion?
Which of the following is the preferred management for Differentiated VIN due to high risk of invasion?
Which of the following statements about HPV is false?
Which of the following statements about HPV is false?
Imiquimod stimulates the immune system by activating:
Imiquimod stimulates the immune system by activating:
Identify the INCORRECT statement regarding features associated with HPV infection?
Identify the INCORRECT statement regarding features associated with HPV infection?
Which of the following viral proteins is responsible for the integration of HPV DNA into the host cell genome?
Which of the following viral proteins is responsible for the integration of HPV DNA into the host cell genome?
Which of the following does NOT align with the key components of secondary prevention strategies for cervical cancer?
Which of the following does NOT align with the key components of secondary prevention strategies for cervical cancer?
Which biomarker, when positive, indicates the presence of cellular atypia, which may warrant further evaluation for cervical abnormalities?
Which biomarker, when positive, indicates the presence of cellular atypia, which may warrant further evaluation for cervical abnormalities?
What molecular mechanism is critically associated with the development of cervical cancer following persistent HPV infection?
What molecular mechanism is critically associated with the development of cervical cancer following persistent HPV infection?
What is a critical aspect of managing cervical cancer effectively, involving a combination of cytology, colposcopy, and lesion excision?
What is a critical aspect of managing cervical cancer effectively, involving a combination of cytology, colposcopy, and lesion excision?
Identify the most accurate explanation of how HPV vaccination contributes to global health advancements.
Identify the most accurate explanation of how HPV vaccination contributes to global health advancements.
What key feature distinguishes adenocarcinoma of the cervix from squamous cell carcinoma at the cellular level?
What key feature distinguishes adenocarcinoma of the cervix from squamous cell carcinoma at the cellular level?
What underlying genetic defect contributes substantially to the development of cervical cancer?
What underlying genetic defect contributes substantially to the development of cervical cancer?
Which of the following statements best explains the importance of desmoplasia patterns in staging cervical cancer?
Which of the following statements best explains the importance of desmoplasia patterns in staging cervical cancer?
Which of the following would NOT fall under the primary goal of an effective therapeutic strategy for cervical cancer?
Which of the following would NOT fall under the primary goal of an effective therapeutic strategy for cervical cancer?
Which of the following is a characteristic feature of Lichen Sclerosus?
Which of the following is a characteristic feature of Lichen Sclerosus?
A patient presents with vulvar itching and examination reveals areas of thickened skin. A biopsy shows acanthosis with hyperkeratosis. Which condition is most likely?
A patient presents with vulvar itching and examination reveals areas of thickened skin. A biopsy shows acanthosis with hyperkeratosis. Which condition is most likely?
Which of the following vulvar neoplasms is considered benign?
Which of the following vulvar neoplasms is considered benign?
What is the significance of Koilocytosis in the context of Condyloma Acuminatum?
What is the significance of Koilocytosis in the context of Condyloma Acuminatum?
Which of the following factors is associated with an increased risk of progression to invasive carcinoma in patients with vulvar intraepithelial neoplasia (VIN)?
Which of the following factors is associated with an increased risk of progression to invasive carcinoma in patients with vulvar intraepithelial neoplasia (VIN)?
Differentiated VIN (dVIN) is distinct from usual VIN (uVIN) in that dVIN is:
Differentiated VIN (dVIN) is distinct from usual VIN (uVIN) in that dVIN is:
What is the preferred management strategy for Differentiated VIN (dVIN) due to its high risk of invasion?
What is the preferred management strategy for Differentiated VIN (dVIN) due to its high risk of invasion?
Which factor indicates a poorer prognosis in vulvar squamous cell carcinoma?
Which factor indicates a poorer prognosis in vulvar squamous cell carcinoma?
Paget's disease of the vulva is characterized by which key feature?
Paget's disease of the vulva is characterized by which key feature?
What is the origin of Paget cells found in Paget's disease of the vulva?
What is the origin of Paget cells found in Paget's disease of the vulva?
Diethylstilbestrol (DES) exposure in utero is a risk factor for which type of vaginal neoplasm?
Diethylstilbestrol (DES) exposure in utero is a risk factor for which type of vaginal neoplasm?
In the context of cervical cancer development, what role does the integration of HPV DNA into the host cell genome play?
In the context of cervical cancer development, what role does the integration of HPV DNA into the host cell genome play?
Which of the following cell types is primarily assessed when evaluating a cervical cytology (Pap smear)?
Which of the following cell types is primarily assessed when evaluating a cervical cytology (Pap smear)?
What is the primary objective when performing a colposcopy?
What is the primary objective when performing a colposcopy?
Which of the following methods is used for lesion excision in the management of cervical dysplasia?
Which of the following methods is used for lesion excision in the management of cervical dysplasia?
Which of the following is the most common type of cervical carcinoma?
Which of the following is the most common type of cervical carcinoma?
According to the FIGO staging system for cervical cancer, what factor is crucial in determining the stage of the disease?
According to the FIGO staging system for cervical cancer, what factor is crucial in determining the stage of the disease?
How does HPV vaccination contribute to the prevention of cervical cancer?
How does HPV vaccination contribute to the prevention of cervical cancer?
Imiquimod is sometimes used in the treatment of vulvar lesions. How does Imiquimod work?
Imiquimod is sometimes used in the treatment of vulvar lesions. How does Imiquimod work?
Which statement accurately describes the relationship between HPV infection and cervical cancer?
Which statement accurately describes the relationship between HPV infection and cervical cancer?
Which of the following is the most likely age range for the highest incidence of cervical cancer?
Which of the following is the most likely age range for the highest incidence of cervical cancer?
What is a key feature that distinguishes adenocarcinoma of the cervix from squamous cell carcinoma?
What is a key feature that distinguishes adenocarcinoma of the cervix from squamous cell carcinoma?
Which of the following features is associated with condyloma acuminatum?
Which of the following features is associated with condyloma acuminatum?
What is the role of desmoplasia in the context of cervical cancer?
What is the role of desmoplasia in the context of cervical cancer?
What cellular process does cervical screening (cytology/HPV testing) primarily assess?
What cellular process does cervical screening (cytology/HPV testing) primarily assess?
A patient treated for cervical dysplasia with LLETZ (Large Loop Excision of the Transformation Zone) asks about the procedure. What is the best description of LLETZ?
A patient treated for cervical dysplasia with LLETZ (Large Loop Excision of the Transformation Zone) asks about the procedure. What is the best description of LLETZ?
In the context of HPV infection and cervical cancer, what is meant by the term 'episomal replication'?
In the context of HPV infection and cervical cancer, what is meant by the term 'episomal replication'?
Which of the following statements correctly describes the role of cytology in cervical cancer prevention?
Which of the following statements correctly describes the role of cytology in cervical cancer prevention?
How does persistent infection with high-risk subtypes of Human Papillomavirus (HPV) lead to the development of cervical cancer?
How does persistent infection with high-risk subtypes of Human Papillomavirus (HPV) lead to the development of cervical cancer?
Which of the following options best defines the term 'dyskaryosis' as it relates to cervical cytology?
Which of the following options best defines the term 'dyskaryosis' as it relates to cervical cytology?
Flashcards
Lichen Sclerosus
Lichen Sclerosus
A chronic vulvar condition that may present at any age, characterized by inflammation, subepithelial fibrosis, atrophy, and scarring, associated with a risk of subsequent malignancies.
Lichen Simplex Chronicus
Lichen Simplex Chronicus
A non-specific diagnosis characterized by microscopic features that develop as a response to chronic itch.
Papillary Hidradenoma
Papillary Hidradenoma
A benign vulvar tumor, histologically equivalent to intraduct papilloma of the breast.
Condyloma Acuminatum
Condyloma Acuminatum
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Age and VIN Progression
Age and VIN Progression
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Immunosuppression and VIN
Immunosuppression and VIN
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Usual VIN (uVIN)
Usual VIN (uVIN)
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Differentiated VIN (dVIN)
Differentiated VIN (dVIN)
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Vulvar Squamous Cell Carcinoma
Vulvar Squamous Cell Carcinoma
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Paget Disease (of Vulva)
Paget Disease (of Vulva)
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Diethylstilbestrol (DES)
Diethylstilbestrol (DES)
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Squamous Cell Carcinoma (Cervix)
Squamous Cell Carcinoma (Cervix)
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Adenocarcinoma (Cervix)
Adenocarcinoma (Cervix)
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HPV infection
HPV infection
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Cytology
Cytology
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Colposcopy
Colposcopy
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Cervical Screening
Cervical Screening
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High Risk HPV
High Risk HPV
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Vulvar Intraepithelial Neoplasia (VIN)
Vulvar Intraepithelial Neoplasia (VIN)
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Vulvar SCC
Vulvar SCC
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Paget Disease (of the vulva)
Paget Disease (of the vulva)
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Squamous Cell Carcinoma
Squamous Cell Carcinoma
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Adenocarcinoma
Adenocarcinoma
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Lesion Excision
Lesion Excision
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Excision of Lesion
Excision of Lesion
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Study Notes
- Study notes on the pathology of the female genital tract.
- Class of Year 2 Pathology, lectured by Professor Paul Murray in 2025
Learning Objectives
- Discuss vulval pathologies, list neoplasms of the vagina, and describe the anatomy of the cervix.
- Discuss cervical neoplasms, emphasizing HPV's role, HPV vaccination, and the natural history/progression of cervical neoplasms.
Vulvar Dystrophies
- Includes Lichen Sclerosus and Lichen Simplex.
Lichen Sclerosus (et Atrophicus)
- Can occur at any age; it is an inflammatory condition involving subepithelial fibrosis, atrophy, and scarring.
- Is associated with a risk of subsequent malignancies.
Lichen Simplex Chronicus
- It is a non-specific diagnosis with microscopic features responding to chronic itch.
- Features include acanthosis (benign thickening of the prickle-cell layer), hyperkeratosis, and variable inflammatory infiltrate in the dermis.
Vulval Neoplasms
- Benign types include Papillary Hidradenoma and Condyloma Acuminatum.
- Malignant types include Carcinoma (with VIN as a precursor to SCC, and Paget's disease) and Melanoma.
Benign Tumors
- Papillary hidradenoma is essentially the intraduct papilloma of the breast.
- Condyloma acuminatum includes acanthosis, parakeratosis, hyperkeratosis, and evidence of HPV infection like koilocytosis.
- Condyloma acuminatum is linked to HPV types 6 & 11, which are low-risk viruses.
- Parakeratosis means incomplete maturation of epidermal keratinocytes, leading to retained nuclei in the stratum corneum.
Vulval Intraepithelial Neoplasia (VIN)
- High-risk HPV leads to VIN, then carcinoma.
- Has similar pathogenesis and grading system as in the cervix.
- Risk of progression to invasive tumor rises with age and immunosuppression.
Usual VIN vs. Differentiated VIN
- Usual VIN is linked to high-risk HPV, especially HPV 16, and is more common in younger women (30-50 years).
- Risk factors for Usual VIN include smoking and immunosuppression, with a lower SCC progression risk if untreated (~10%).
- Management of Usual VIN: surveillance, excision, imiquimod, or laser ablation.
- Differentiated VIN is not HPV-related, found in older, postmenopausal women (>50 years.)
- A risk factor for differentiated VIN is Lichen sclerosus, with a higher risk of SCC progression if untreated (~30-50%).
- Management of differentiated VIN: surgical excision due to the heightened invasion risk.
- Imiquimod stimulates the immune system by activating Toll-like receptor 7 (TLR7), producing interferon-α and cytokines, boosting cytotoxic T-cell activity, and inducing apoptosis in HPV-infected cells.
Vulva: Squamous Cell Carcinoma
- Poor prognosis correlates with increased invasion depth and the presence of lymphovascular invasion.
Paget Disease (of Vulva)
- Presents as a red, crusted skin lesion with clusters or individual tumor cells in the epidermis and a clear halo around cells.
- Features granular cytoplasm and tests PAS positive.
- This intraepithelial adenocarcinoma has malignant glandular epithelial cells (Paget cells) within the epidermis, which originate from apocrine glands.
Vagina: Tumors
- Squamous cell carcinoma is related to HPV, and VaIN is a precursor (Vaginal Intraepithelial Neoplasia).
- Adenocarcinoma risks include DES exposure, especially clear cell carcinoma.
- Embryonal Rhabdomyosarcoma presents as Sarcoma botryoides.
- Diethylstilbestrol (DES) is a synthetic estrogen prescribed from 1940 to 1971 to prevent pregnancy complications.
Cervical Carcinoma
- Consists of 80% squamous cell carcinoma and 15% adenocarcinoma.
- Rarer tumors include neuroendocrine and adeno-squamous carcinoma.
HPV Life Cycle in the Cervix
- HPV pathogenesis begins with the virus latent in the epithelial cell, having a low proliferation rate.
- The proliferation rate increases as the virus enters the lytic cycle.
- Viruses assemble, leave the keratinocytes, and repeat the infection cycle.
Cervical Cancer Prevention
- Includes cervical screening: cytology/HPV testing, cervical examination (colposcopy), and lesion excision.
Cytology
- Assesses for dyskaryosis in squamous and glandular cells; identifies abnormalities.
Colposcopy
- Direct visualization of the cervix.
- Facilitates biopsy/treatment by removing lesions.
Excision of Lesion
- Includes large biopsy, LLETZ (Large Loop Excision of the Transformation Zone), cone biopsy, and hysterectomy.
Differentiated VIN
- Not HPV related, tumour suppressor genes are involved, notably p53.
- May develop quickly on the background of Lichen Sclerosus
Staging of Cervical Cancer
- FIGO and TNM staging systems are very similar.
- Microinvasion means early squamous cell carcinoma, with a depth of less than 3mm pose very low risk.
- Recent studies indicates the pattern of invasion, especially desmoplasia, is an important prognostic factor.
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