02-22-2018, 03:39 PM
Growth Adaptations, Cellular Injury, and Cell Death
Growth Adaptations
Most cervical pathology stems from the effects of sexually transmitted infections.
Pap Smear: important screening test used for the detection of squamous dysplasia and cancer. It can also be used as a tool to evaluate hormone status.
In order to be considered an adequate sample, it must contain sampling from the squamocolumnar junction (transformation zone) cells. This would include both metaplastic squamous cells and mucus-secreting columnar cells.
Abnormal Pap smear findings include dysplasia or carcinoma in situ (CIS), both of which are characterized by the following findings on histology: •Koilocytic atypia
•Nuclear enlargement ("raisinoid" appearance)
•Nuclear hyperchromasia
•Coarse chromatin granules
•Perinuclear halo
Cervical Intraepithelial Neoplasia
Risk factors for cervical carcinoma are: •Early sexual intercourse
•Multiple sexual partners (#1 risk factor)
•Birth control pills
•Smoking
•Immunodeficiency (HIV infection)
Pathogenesis: •Strongly associated with "high-risk" HPV 16, 18, 31, & 33
•HPV infects immature basal cells of the squamous epithelium and immature metaplastic squamous cells at the squamocolumnar junction
•HPV viral proteins E6 and E7 inactivate cell cycle regulation by the p53 and Rb suppressor genes, respectively
A 9-valent vaccine (Gardasil 9) is the only HPV vaccine currently available in the United States. It targets HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58.
Classification of CIN (cervical intraepithelial neoplasia): •CIN 1: dysplasia involving lower 1/3 of the epithelium
•CIN 2: dysplasia involving lower 2/3 of the epithelium
•CIN 3: dysplasia involving slightly less than the entire thickness of the epithelium
•CIS (Carcinoma in situ): dysplasia involving the entire thickness of the epithelium.
Carcinoma in situ is characterized by atypical changes extending through the entire thickness of the epithelium. •As it has not yet invaded the basement membrane, it is considered a precancerous lesion.
Histopathology: cervical dysplasia is characterized by disordered epithelial growth and loss of cell polarity. •Koilocytes are seen beginning at the basal layer and extending outward. These are cells with a clear halo surrounding hyperchromatic, atypical nuclei.
Invasive Cervical Carcinoma
Cervical cancer is now the least common gynecologic cancer due to the success of the Pap smear screening tests. It typically presents with malodorous discharge and irregular bleeding, which is often postcoital.
The vast majority are squamous cell carcinoma; while adenocarcinoma accounts for 15-25% of cases.
Invasive cervical carcinoma evolves through the following progression: initial dysplasia, which then transforms into carcinoma in situ, and the final transformation is into invasive carcinoma.
Pap smear is the screening test of choice because it can discover cervical dysplasia before it progresses to invasive carcinoma. Dysplastic cells demonstrate koilocytosis (cellular changes in which cells appear to have halo nuclei on cytologic examination).
Spreads by direct invasion of nearby structures: can infiltrate bladder and/or ureters. Can also invade rectum, vagina or other adjacent structures.
Renal failure is the most common cause of death in patients with invasive cervical cancer. Invasion of bladder and ureters can lead to ureteral obstruction, and result in hydronephrosis and postrenal failure.
Cervicitis is a condition that involves inflammation of the cervix that typically occurs in the transformation zone. It is most commonly caused by ascending infections from chlamydia or gonorrhea.
Other common causes cervicitis include: •Trichomonas vaginalis: foul smelling, frothy, yellow/green discharge
•Candida albicans: white, chunky, cottage cheese discharge
•Gardnerella vaginalis (Bacterial vaginosis): foul smelling, fishy, grey discharge
•HSV-2
•HPV
Acute cervicitis •Presents with vaginal discharge, bleeding, pain, dyspareunia (pain with intercourse)
•If untreated it can progress to chronic cervicitis, which carries an increased risk for infertility
Follicular cervicitis •Subtype of cervicitis caused by Chlamydia trachomatis
•Common cause of neonatal conjunctivitis and pneumonia
•Histologically, it is characterized by lymphoid germinal centers and vacuoles containing reticulate bodies.
Growth Adaptations
Most cervical pathology stems from the effects of sexually transmitted infections.
Pap Smear: important screening test used for the detection of squamous dysplasia and cancer. It can also be used as a tool to evaluate hormone status.
In order to be considered an adequate sample, it must contain sampling from the squamocolumnar junction (transformation zone) cells. This would include both metaplastic squamous cells and mucus-secreting columnar cells.
Abnormal Pap smear findings include dysplasia or carcinoma in situ (CIS), both of which are characterized by the following findings on histology: •Koilocytic atypia
•Nuclear enlargement ("raisinoid" appearance)
•Nuclear hyperchromasia
•Coarse chromatin granules
•Perinuclear halo
Cervical Intraepithelial Neoplasia
Risk factors for cervical carcinoma are: •Early sexual intercourse
•Multiple sexual partners (#1 risk factor)
•Birth control pills
•Smoking
•Immunodeficiency (HIV infection)
Pathogenesis: •Strongly associated with "high-risk" HPV 16, 18, 31, & 33
•HPV infects immature basal cells of the squamous epithelium and immature metaplastic squamous cells at the squamocolumnar junction
•HPV viral proteins E6 and E7 inactivate cell cycle regulation by the p53 and Rb suppressor genes, respectively
A 9-valent vaccine (Gardasil 9) is the only HPV vaccine currently available in the United States. It targets HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58.
Classification of CIN (cervical intraepithelial neoplasia): •CIN 1: dysplasia involving lower 1/3 of the epithelium
•CIN 2: dysplasia involving lower 2/3 of the epithelium
•CIN 3: dysplasia involving slightly less than the entire thickness of the epithelium
•CIS (Carcinoma in situ): dysplasia involving the entire thickness of the epithelium.
Carcinoma in situ is characterized by atypical changes extending through the entire thickness of the epithelium. •As it has not yet invaded the basement membrane, it is considered a precancerous lesion.
Histopathology: cervical dysplasia is characterized by disordered epithelial growth and loss of cell polarity. •Koilocytes are seen beginning at the basal layer and extending outward. These are cells with a clear halo surrounding hyperchromatic, atypical nuclei.
Invasive Cervical Carcinoma
Cervical cancer is now the least common gynecologic cancer due to the success of the Pap smear screening tests. It typically presents with malodorous discharge and irregular bleeding, which is often postcoital.
The vast majority are squamous cell carcinoma; while adenocarcinoma accounts for 15-25% of cases.
Invasive cervical carcinoma evolves through the following progression: initial dysplasia, which then transforms into carcinoma in situ, and the final transformation is into invasive carcinoma.
Pap smear is the screening test of choice because it can discover cervical dysplasia before it progresses to invasive carcinoma. Dysplastic cells demonstrate koilocytosis (cellular changes in which cells appear to have halo nuclei on cytologic examination).
Spreads by direct invasion of nearby structures: can infiltrate bladder and/or ureters. Can also invade rectum, vagina or other adjacent structures.
Renal failure is the most common cause of death in patients with invasive cervical cancer. Invasion of bladder and ureters can lead to ureteral obstruction, and result in hydronephrosis and postrenal failure.
Cervicitis is a condition that involves inflammation of the cervix that typically occurs in the transformation zone. It is most commonly caused by ascending infections from chlamydia or gonorrhea.
Other common causes cervicitis include: •Trichomonas vaginalis: foul smelling, frothy, yellow/green discharge
•Candida albicans: white, chunky, cottage cheese discharge
•Gardnerella vaginalis (Bacterial vaginosis): foul smelling, fishy, grey discharge
•HSV-2
•HPV
Acute cervicitis •Presents with vaginal discharge, bleeding, pain, dyspareunia (pain with intercourse)
•If untreated it can progress to chronic cervicitis, which carries an increased risk for infertility
Follicular cervicitis •Subtype of cervicitis caused by Chlamydia trachomatis
•Common cause of neonatal conjunctivitis and pneumonia
•Histologically, it is characterized by lymphoid germinal centers and vacuoles containing reticulate bodies.