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Pathology of Cervix
- 1. Pathology of Cervix DR. USMAN SHAMS
- 4. CERVICAL DISEASES • INFLAMMATIONINFLAMMATION • METAPLASIAMETAPLASIA • POLYPSPOLYPS • CERVICAL EPITHELIAL ABNORMALITIESCERVICAL EPITHELIAL ABNORMALITIES
- 5. Acute and Chronic Cervicitis Lactobacilli = Normal Flora … protective ◦Acidic pH ◦H2O2 Some degree of cervical inflammation may be found in virtually all women … little clinical consequence. Infections by gonococci, chlamydia, mycoplasmas, and HSV … significant acute or chronic cervicitis … association with upper genital tract disease, complications during pregnancy, and sexual transmission.
- 9. Immature squamous metaplastic epithelial cells in the transformation zone are most susceptible to HPV infection, and as a result this is where cervical precursor lesions and cancers develop.
- 12. HPV Infection
- 14. The virus causes certain cytopathic changes including ◦Perinuclear vacuolation ◦Binuclaetion or multinucleation. ◦Rope like chromatin ◦Irregular nuclear membrane. These changes are called koilocytic atypia and cell is called koilocyte.
- 17. Koilocyte HPV (ISH) Ki-67 p16
- 18. Physical state of the virus is also IMPORTANT. ◦The viral DNA is integrated into the host cell genome in most cancers. ◦Viral DNA is extrachromosomal (episomal) in precursor lesions associated with high risk HPVs and in condylomata associated with low risk HPVs.
- 20. Nuclear atypia / Dysplasia ◦Nuclear enlargement ◦Hyperchromasia ◦Coarse chromatin granules ◦Variation in nuclear size and shape ◦Disturbed N/C ratio
- 21. If the immature squamous cells are confined to the lower one third of the epithelium, the lesion is graded as LSIL; if they expand to the upper two thirds of the epithelial thickness, it is graded as HSIL.
- 23. Cervical Cancer Worldwide, cervical carcinoma is ◦the third most common cancer in women ◦more than half are fatal.
- 24. Risk factors Early age at first intercourse Multiple sexual partners Increased parity Presence of high risk HPV Certain HLA and viral subtypes Exposure to oral contraceptives and nicotine Genital infections (chlamydia)
- 27. Gross
- 28. Histologic Types Squamous Cell Carcinoma Adenocarcinoma Adenosquamous Carcinoma Neuroendocrine Carcinoma All are related to HPV.
- 33. Treatment Cervical cone excision Hysterectomy with lymph node dissection Radiation and chemotherapy
- 35. No form of cancer better documents the remarkable benefits of effective screening, early diagnosis, and curative therapy than does cancer of the cervix.
- 36. Methods Pap smears Colposcopy Vaccination against HPV
- 37. Dr. George Papanicolaou (aka PAP)
- 39. Colposcopy
- 40. HPV Vaccination A new aspect of cervical cancer prevention is vaccination against high-risk oncogenic HPVs, which is now recommended for all girls and boys by age 11 to 12 years, as well as young men and women up to age 26 years.
- 41. THANK YOU
Editor's Notes
- HPVs infect immature basal cells of the squamous epithelium in areas of epithelial breaks, or immature metaplastic squamous cells present at the squamocolumnar junction (Fig. 22-11). HPVs cannot infect the mature superficial squamous cells that cover the ectocervix, vagina, or vulva.
- The nuclear changes are often accompanied by cytoplasmic “halos.” At an ultrastructural level, these “halos” consist of perinuclear vacuoles, a cytopathic change created in part by an HPV-encoded protein called E5 that localizes to the membranes of the endoplasmic reticulum. Nuclear alterations with an associated perinuclear halo are termed koilocytic atypia.
- Figure 22-15 A, Low-grade squamous intraepithelial lesion (LSIL)—Routine hematoxylin and eosin staining shows marked koilocytic change, seen as perinuclear “halos” in suprabasilar cells. B, In situ hybridization test for HPV DNA. The dark granular staining denotes HPV DNA, which is typically most abundant in the koilocytes. C, Diffuse positivity for the proliferation marker Ki-67 (seen as brown nuclear staining), illustrates abnormal expansion of the proliferating cells from the normal basal location to the superficial layers of the epithelium. D, Upregulation of the cyclin-dependent kinase inhibitor p16 (seen here as brown staining) characterizes high-risk HPV infections.
- Here lies the answer, why not all HPV infections lead to cervical cancer.
- Fifty years ago, carcinoma of the cervix was the leading cause of cancer deaths in women in the United States, but the death rate has declined by two thirds to its present rank as the thirteenth cause of cancer mortality.
- Using a spatula or brush, the transformation zone of the cervix is circumferentially scraped and the cells are smeared or spun down onto a slide. Following fixation and staining with the Papanicolaou method, the smears are screened microscopically