cervical pathology part 1 and 2

Cervical pathologies
learning objectives
squamocolumnar junction (SCJ)
cervical metaplasia
Transformation zone
Nabothian follicle
Polyp
CIN
cervical cancer :
risk factors, screening, types, clinical presentation, diagnosis and treatment principles

endocervical polyps is common and usually increases with age up to the menopause.
Occasionally these polyps will be symptomatic producing heavy vaginal discharge or bleeding upon coital contact.
Malignant change is most unusual, these polyps are removed by polypectomy.

PREMALIGNANT CONDITIONS OF THE CERVIX ( CIN)
cervical cancer is a common cancer affecting women.
the estimated prevalence of HPV in cervical cancers is 99.7 %.

CIN I, II , III correspond to
BETHESDA SYSTEM:
LSIL
Low-grade squamous intraepithelial lesion – Bethesda system grade equating to CIN1
HSIL
High-grade squamous intraepithelial lesion – Bethesda system grade equating to moderate and severe / CIN2 and CIN3

aetiology of CIN:
1- HPV is implicated in this process, although HPV infection alone does not appear to be sufficient to cause dysplasia,most of infections resolved spontaneously within 2 years.
2- Smoking?? Depressed local immunity
3- immune suppression appear to be additional factors which may act as co-agents, renal transplant and HIV.

PREVALENCE OF HUMAN PAPILLOMA VIRUS INFECTION :
Genital HPV infection is extremely common with up to 80 per cent of sexually active women being HPV positive at some point during their lifetime.
90 % of women will clear the infection within two years depend on the host immunity
With approximately 15 % prevalence of the oncogenic HPV types 16 and 18, 31, 33.
The majority of HPV infections result in CIN 1 and 60 % of these will regress without the need for treatment, while approximately 10 per cent will progress to high-grade lesions.
The estimated prevalence of HPV DNA in cervical cancers is 99.7 per cent.