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What is the histology of the cervix?
stratisfied, squamous epithelium non-keratinizing
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How are the fallopian tubes, uterus, cervix and vagina made during embryogenesis?
the cranial unfused portion of the mullein ducts becomes the fallopian tubes and the caudal fused portion becomes the uterus, cervix, and the upper 2/3 of the vagina.
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transformation zone
the area in the endocervix in which he glandular epithelium is being replaced by the squamous epithelium and it changes in response to hormones
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squamocolumnar junction
junction between 2 types of epithelium (sq and muscinous and it is located in the transformation zone)
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Gross of endocervix
- cervix has endocervical canal lined by multiple infoldings of mucosa resulting in gland formation and at the microscopic level the mucosa is lined by a single layer of muscinous epithelium. Ciliated metaplastic epithemiulm can also be seen. Stroma that supports the endocervical mucosa consists of a mixture of fibrous connective tissue and smooth muscle .
- Mesophrenic duct remnants can also be id.
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What is the most important agent in cervical cerciniogenesis?
HPV es 16 and 18
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How is cervical neoplasia detected?
role of the pap smear
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What are some of the factors for cervical neoplasia?
- early age at first intercourse
- multiple sexual partners
- increased parity
- immunosuppresion
- oral contraceptives
- nicotine
- HPV 16 and 18
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How is HPV transmitted
sexually
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Where do the majority of cervical dysplasias occur?
transformation zone
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What are the very low oncogenic risk of HPV?
HPV 6 and 11
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What are HPV 6 and 11 most commonly make
vulvar, perianal, cervical viral lesions
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How does HPV infect?
- infect immature basal cells in areas of epithelial breaks or the squamocolumanr jxn. Doesn't affect mature cells but can replicate in them and induce changes.
- HPV induces synthesis of host cells bu reactivating the mitotic cycle extending the life-span of the cell
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What are the 3 types of classification systems for cervical pre cancers and how are they detected?
- Dysplasia/CIS: cervical biopsy and hysterectomy specimen
- Cervical CIN: cervical biopsy and hysterectomy specimen
- Sqaumous intra-epithelial lesion: Pap
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What are the different methods in which samples are obtained for cervical cancer
- pap
- colposcopy
- cervical biopsy
- cold cone biopsy
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How can you tell grossly if an HPV lesion is bad or not that bad?
- if it is raised then low risk
- flat high risk
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how can we see HPV lesions better?
acetic acid which makes the lesions white
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How do you treat cervical intra-epithelial neoplasia?
- CIN1: follow up pap-smear
- CIN2-3: cryotherapy, LEEP, cold knife core biopsy, and laser
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Squamous cell carcinoma of the cervix? what are the clinical manifestations?
- flank pain due to pelvic sidewall involvement
- leg pain due to sciatic nerve involvement
- vaginal bleeding
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What do most of the patients with squamous cell carcinoma of the cervix die of?
most die of renal failure due to involvement of the ureers by carcinoma causing hydronephrosis
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What is the therapy for the cancer of the cervix?
sx and lymph node dissection
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What are the adenocarcinoas of the cervix, where do they arise from?
- likely arise from the endocervical glandular epithelium
- often preceded by an intraepithelial glandular neoplasm (precancer), termed adenocarcinoma in situ (AIS), a lesion 1/5 as common as its squamous counterpart
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The adenosquamous carcinomas
- mixed glandular and squamous patterns
- likely arise from the reserve endocervical basal cells
- have a less favorable prognosis than SCC at the same stage
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