Cervical cancer # Pathology@ Pap smear / Endocervical cell скачать в хорошем качестве

Cervical cancer # Pathology@ Pap smear / Endocervical cell

Cervical Cancer — Pathology Notes 1️⃣ Etiology & Pathogenesis • Persistent high-risk HPV infection is the main cause of cervical cancer. • High-risk types: HPV-16, 18 (most common), also 31, 33, 45, 52, 58 etc.  • HPV DNA integrates into host genome → overexpression of: • E6 → inhibits p53 • E7 → inhibits Rb → uncontrolled cell proliferation & dysplasia.  • Cancer develops in steps: 1. HPV infection of transformation zone 2. Persistent infection 3. Precancerous lesion (CIN) 4. Invasion through basement membrane.  ⸻ 2️⃣ Site of Origin (Important Viva Point) • Squamocolumnar junction / transformation zone • Area prone to metaplasia → dysplasia → carcinoma.  ⸻ 3️⃣ Precancerous Lesions Cervical Intraepithelial Neoplasia (CIN) CIN I (Mild dysplasia) • Lower 1/3 epithelium involved CIN II (Moderate) • Lower 2/3 involved CIN III (Severe dysplasia / carcinoma in situ) • Full thickness abnormal cells → CIN may progress to invasive cancer if untreated.  ⸻ 4️⃣ Cytologic Hallmark of HPV Infection 🔬 Koilocytosis • Enlarged hyperchromatic nucleus • Irregular nuclear membrane • Perinuclear halo → classic HPV cytopathic effect.  ⸻ 5️⃣ Histological Types of Cervical Cancer ✅ 1. Squamous Cell Carcinoma (MOST COMMON) • ~70% cases • Keratin pearls in well-differentiated tumors • Sheets/nests of malignant squamous cells ✅ 2. Adenocarcinoma • ~20–25% • Arises from endocervical glands • HPV-18 strongly associated ✅ 3. Rare Types • Clear cell carcinoma • Glassy cell carcinoma • Villoglandular adenocarcinoma (rare histologic variants described in pathology literature)  ⸻ 6️⃣ Gross Pathology Three classical patterns: 1. Exophytic/fungating mass 2. Ulcerative lesion 3. Infiltrative/endophytic growth Tumor may extend to: • vagina • uterus • parametrium • bladder / rectum ⸻ 7️⃣ Microscopic Features of Invasive Cancer Squamous carcinoma • Pleomorphic cells • High N:C ratio • Hyperchromatic nuclei • Keratin pearls (if well-differentiated) • Numerous mitoses Adenocarcinoma • Malignant gland formation • Mucin production ⸻ 8️⃣ Spread of Cervical Cancer Local spread • Parametrium • Vagina • Uterus Lymphatic spread • Parametrial nodes • Obturator nodes • Internal iliac → common iliac → para-aortic Hematogenous • Liver • Lung • Bone ⸻ 9️⃣ High-Yield Exam Points (NEET PG) ⭐ HPV infection = necessary cause ⭐ Koilocytes = early HPV sign ⭐ CIN III = carcinoma in situ ⭐ Most common histology → SCC ⭐ Origin → Transformation zone ⭐ E6 → p53, E7 → Rb