Pathology of HPV Infections (10/7)
What are the high risk HPV types? Which are the most common?
16,18 16,18 - 70% of cases
What percentage of penile, vulvar, oral/pharangeal, cervical cancers are HPV related?
50% 45% 90% about 100%
What are the low risk HPV types? What does it look like? What can it cause?
6,11 Warts - genital (condyloma accumulatum), other warts
Picture of Wart. What is a koilocyte? What characterizes it?
A epithelial cell that has undergone changes due to infection by HPV hyperchromatism clear area around nucleus (halo) nuclear enlargement irregularity of nuclear membrane
What is the Bethsesda system? What are the different grades of results?
ASCUS - atypical squamous cells of undetermined significance LSIL HSIL SqCCA
What is new as of 2014 in terms of screening guidelines?
FDA approved primary screening with molecular HPV testing
What are the options after HSIL detection?
LEEP - loop electrosurgical excision procedure CONE - a biopsy of the cervix, excising the transformed part Hysterectomy
Picture of precancer
The red, elongated thing
Picture of CIN-2. What characterizes this?
a little maturation at the surface
What is the sensitivity of cytology for HSIL? Even though it is low, why does it work?
about 50% (47%) the cancer is slow growing, so if there is a false negative one time, you will probably get it the next time, and its still ok
What are the screening guidelines for HPV/Cervical cancer?
age <21 - no screening age < 21-29 - cytologly alone every 3 years (only cytology, no molecular methods so you don't get all the cancers that are regressing) age 30-65 - HPV and cytology "cotesting" every 5 yrs, or cytology alone every 3 yrs. age >65 - no testing following negative prior screening after hysterectomy - no screening HPV vaccinated - screen as well
What are the different grades of squamous cell carcinoma as per the Bethesda system? What do they look like? What causes LSIL? How many of these regress? What distinguishes LSIL from HSIL? What distinguishes CIN-2 from CIN-3?
atypical squamous cells of undetermined significance low grade squamous intraepithelial lesion (LSIL) or CIN-1 (cervical intraepithelial neoplasia) - caused by high risk HPV types, most regress, some progress to HSIL and SqCCA, have koilocytes high grade squamous intraepithelial lesion (HSIL) or CIN-2 and CIN-3 - don't have koilocytes. CIN-2 maintains some maturation towards the towards the superficial layer, but in CIN-3 there is no more maturation and more mitotic figures. squamous cell carcinoma (SqCCA)
Picture of litigation cell. What grade of cervical cancer is this seen with?
in the center, you see a lone HSIL cells
Picture of CIN-3. What characterizes this?
no maturation at the surface more mitotic figures
Picture of LSIL. What characterizes this?
notice the nice koilocytes
Picture of normal pap smear. What characterizes it?
small nucleus, low N/C ratio
What are the common carcinomas associated with cervical cancers?
squamous cell carcinoma adenocarcinoma
