54 Questions
What is the critical event in the development of carcinoma from dysplasia?
Invasion through the basement membrane
Which type of HPV is the pre-invasive precursor of HPV associated cervical adenocarcinoma?
High Risk HPV 18
What percentage of cervical cancers are caused by HPV infection?
Over 95%
Which region has the highest incidence of cervical cancer?
Low & middle income countries
What is the most common cancer in North America and Europe presently?
Endometrial cancer
What strategy is used for population based screening to prevent cervical cancer?
Cervical sample HR HPV test
What has led to the reduction in incidence of cervical cancer in the UK, particularly since the early 1980s?
Introduction of the NHS cervical screening programme
What is the cause of the separate peaks in cervical cancer incidence?
Birth cohort effect
What has led to the increase in cervical cancer incidence and mortality in women reaching the age of sexual debut during WW1 and WW2?
Different exposure to HPV at the time of sexual debut
What has created new birth cohorts in relation to cervical cancer?
HPV vaccination
What type of virus are Human Papillomaviruses (HPVs)?
Double stranded DNA virus
What is the most common type of cervical cancer?
Squamous cell carcinoma
What is dysplasia characterized by?
Increased proliferation, atypia of nuclei, decreased differentiation
What is the term used for dysplasia in the UK for the squamous cervix?
Cervical intra-epithelial neoplasia (CIN)
Where does dysplasia often occur?
Sites with metaplasia
What is the term used for dysplasia in the US for the squamous cervix?
Squamous intra-epithelial lesion (SIL)
What are the characteristic features of dysplastic lesions?
Cells that look somewhat like malignant cells but do not invade the basement membrane
What may dysplasia progress to?
Invasive malignancy
What does CIN stand for?
Cervical intra-epithelial neoplasia
What is the main difference between dysplastic epithelium and normal epithelium?
Cells at the surface of dysplastic epithelium are different from those at the surface of normal epithelium
What does SIL stand for?
Squamous intra-epithelial lesion
What is the term used for dysplasia in the US for the squamous cervix?
Squamous intra-epithelial lesion (SIL)
What is the likelihood of CIN3 progressing to squamous cell carcinoma (SCC)?
40%
What is the likelihood of CIN1 progressing to CIN3?
1%
What is dysplasia being discussed as in this lecture?
A pre-malignant neoplastic event
What is the main focus of recognizing CIN using cytology cervical screening?
Identifying pre-cancerous changes
What is the key topic briefly touched on in the lecture?
Pathogenesis of cervical cancer
What is dysplasia characterized by in the context of the lecture?
Pre-malignant neoplastic changes
What are the features of S.I. under the microscope being discussed in the lecture?
Recognizing pre-malignant changes
What is the focus of the lecture in relation to dysplasia?
Pre-malignant neoplastic changes
What are the characteristics of abnormal nuclear features in dysplasia?
Irregular shape, irregularly distributed granular chromatin, and darker staining
What is used to sample cervical cells for testing for HPV infection?
A plastic broom
What is the critical event in the formation of invasive malignancy from dysplastic lesions?
Invasion through the basement membrane
What is the term used to describe changes in cytology specimens related to dysplasia?
Disk carrier SS
What is used to recognize abnormal cells in cytology specimens?
The ratio of nucleus size to cytoplasm volume
What is the main purpose of cervical screening?
Looking for abnormal cells in cytology specimens
Which microscopic feature is crucial in identifying dysplasia in epithelial neoplasms?
Presence of abnormal mitotic figures
What distinguishes dysplastic epithelium from normal epithelium under the microscope?
Irregular, atypical nuclei
Which characteristic is NOT associated with dysplastic epithelium?
Regular nuclear edges
What is a crucial clinical opportunity related to dysplastic lesions in epithelial neoplasms?
Recognizing dysplasia before invasive cancer develops
What is the main difference between dysplastic epithelium and normal epithelium?
Abnormal chromatin appearance
What is the primary characteristic of dysplasia in epithelial neoplasms?
Abnormal proliferation
What is the main cause of over 90% of cervical cancers?
Human papillomavirus (HPV) infection
Which HPV strains are considered high-risk for cervical malignancy?
HPV 16 and 18
What type of lesions are caused by HPV 6 and 11?
Genital warts
What is the main goal of the HPV elimination initiative?
Preventing most HPV-associated cervical cancers through vaccination and screening
Where does HPV infect proliferating cells in the cervix?
At the junction between squamous and columnar epithelium
What is the characteristic feature of invasive squamous cell carcinoma?
Irregular islands of cells invading through the basement membrane into the stroma
What is the term used in the US for cervical dysplasia?
Squamous intraepithelial lesion (SIL)
What is the risk of developing invasive cancer at ten years considered very high, necessitating treatment?
40%
Where does dysplasia often occur?
Transformation zone
What may contribute to the development of dysplasia and carcinoma?
Nature of the site and injurious stimuli
What can the degree of dysplasia in the squamous cervix predict?
Likelihood of developing invasive malignancy
Where else may dysplasia occur, with varying risks of developing invasive malignancy?
Bronchus and distal esophagus
Study Notes
Understanding Dysplasia and Its Clinical Implications
- Dysplasia is a generic term for the pathological process in the cervix.
- Different terminology is used for dysplasia, causing confusion due to attempts at clinically meaningful classification.
- In the US, cervical dysplasia is referred to as squamous intraepithelial lesion (SIL).
- Histologically, dysplasia in the squamous cervix can be recognized by different degrees and characteristics.
- The degree of dysplasia can predict the likelihood of developing invasive malignancy.
- The risk of progression to higher grade lesions and squamous cell carcinoma can be predicted based on the degree of dysplasia in the squamous cervix.
- Treatment is necessary because a 40% risk of developing invasive cancer at ten years is considered very high.
- Dysplasia often occurs in the transformation zone and is most commonly associated with smoking in the bronchial epithelium and esophagus.
- The transformation zone is where most dysplasia develops.
- Dysplasia may also occur in the bronchus and distal esophagus, with varying risks of developing invasive malignancy.
- The nature of the site and injurious stimuli might contribute to the development of dysplasia and carcinoma.
- The degree of dysplasia seen in the cervix is important in predicting expected clinical outcomes.
Test your knowledge of the pathology of the female reproductive tract with this quiz. Explore topics such as microscopic anatomy, neoplasia terminology, endometriosis, cervical intraepithelial neoplasia (CIN), and endometrial carcinoma. This quiz is designed for students and professionals in histopathology and gynecology.
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