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BSMS203 Gynae (Theme 3) > 1 & 2. Pathology of the female reproductive tract > Flashcards

1 & 2. Pathology of the female reproductive tract Flashcards

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1
Q

Microscopic anatomy

A

Normal anatomy informs pathology

Microscopic changes in cells and tissues are translated into clinical disease

Neoplasms originate from cellular components of tissues

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2
Q

What kind of tissue are the vulva and vagins

A

Stratified squamous epithelium

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3
Q

Vagina at puberty

A

Oestrogen secreted by the ovary stimulates maturation of squamous epithelial cells
Glycogen is formed within mature squamous epithelial cells
Glycogen in cells shed from the surface is a substrate for vaginal anaerobic organisms (dominated by lactobacilli)
Lactobacilli produce lactic acid keeping vaginal pH below 4.5

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4
Q

Cervix parts

A

Ectocervix
Endocervix
Transformation zone

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5
Q

Ectocervix

A

stratified squamous epithelium

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6
Q

Endocervix

A

Single layer of tall, mucin producing columnar cells

The endocervix has a deceptively large surface area

Columnar epithelium lines tiny blind ending channels (‘clefts’)

These radiate out from the endocervical canal into the surrounding stroma

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7
Q

Squamo-columnar junction

A

The ectocervix is covered by stratified squamous epithelium
The endocervix is lined by columnar epithelium
The junction between the two is called the ‘squamo-columnar junction

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8
Q

Formation of the transformation zone

A

During puberty the cervix changes shape
The lips of the cervix grow
The distal end of the endocervix opens
Endocervical mucosa becomes exposed to the vaginal environment

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9
Q

Metaplasia in the vagina

A

The distal endocervical columnar epithelium is exposed to the acidic vaginal environment

It is not suited to this, so undergoes an adaptive change called metaplasia

Reserve cells in this area proliferate and mature to form squamous epithelium: This process is called squamous metaplasia

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10
Q

Metaplasia definition

A

a transformation of cell type from one kind of mature differentiated cell type to another kind of mature differentiated cell type

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11
Q

The transformation zone

A

Tissue from endocervical epithelium which has undergone metaplasia to become squamous like the ectocervix

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12
Q

What happens to the metaplastic squamous epithelium?

A

At first, the metaplastic squamous epithelium is thin and delicate (lots of proliferation & maturation is incomplete)

With time, the metaplastic epithelium comes to be as strong and well formed as that on the ectocervix

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13
Q

myometrium

A

bundles of smooth muscle, vasculature and nerves

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14
Q

Endometrium in proliferative phase

A
  1. Tubular glands
    1. Specialised stroma
    2. Blood vessels
      Mitoses in glands
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15
Q

Endometrium in secretory phase

A
  1. Cork screw glands
    1. Specialised stroma
    2. Blood vessels
      Secretions in glands
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16
Q

neoplasia

A

‘new growth’ – abnormal, uncoordinated and excessive cell growth.
persists following withdrawal of stimulus and associated with genetic alterations

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17
Q

Nomenclature of neoplasms

A

Different neoplasms have different behaviour
Accurate identification and naming therefore important for treating the patient

Neoplasms are classified according to their behaviour and histogenesis

Behaviour:  Benign or Malignant

Histogenesis: Recognising the cell of origin
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18
Q

behaviour of benign neoplasms

A

Benign:
Remains localised and doesn’t invade surrounding tissues
Generally grow slowly
Good resemblance of parent tissue

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19
Q

Consequences of benign neoplasms

A 
Pressure on adjacent tissue
Obstruction of lumen of a hollow organ
Hormone production
Transformation into a malignant neoplasm
Symptoms for the patient
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20
Q

Leiomyoma of the myometrium

A
  • A benign neoplasm of smooth muscle
    • Localised
    • Slow growing
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21
Q

benign neoplasms clinical problems

A 
Pressure on adjacent tissue
Bladder (frequency) Rectosigmoid (constipation)
Obstruction to lumen of a hollow organ
Adjacent (ureters) Blocking endocervix
Hormone production
? Erythropoietin producing polycythaemia
Transformation into a malignant neoplasm
Probably malignancy arises de novo

Abnormal uterine bleeding, pain

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22
Q

behaviour of malignant neoplasms

A

Invade into surrounding tissues
Spread via lymphatics to lymph nodes and blood vessels to other sites (metastasis)
Generally grow relatively quickly
Variable resemblance to parent tissue

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23
Q

How does malignant neoplastic tissue look different to normal tissue?

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A

loss of differentiation

loss of cellular cohesion

enlarged irregular dark nuclei

increased numbers of mitoses

24
Q

Consequences of malignant neoplasms

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A 
Destruction of adjacent tissue
Metastasis
Blood loss from ulcerated surfaces
Obstruction of a hollow viscera
Production of hormones
Weight loss and debility
Anxiety and pain
25
Histogenesis of neoplasms
Classification by cell of origin Determined by examining tissue under the microscope Resemblance to parent tissue correlates with clinical behaviour
26
Terminology of neoplasia
Neoplasms have the suffix – oma Malignant epithelial tumours are carcinomas Carcinomas are named for the epithelial cell type which they resemble Carcinomas of glandular epithelium are called adenocarcinomas Malignant stromal tumours are sarcomas
27
carcinoma
Malignant epithelial tumours are carcinomas | Carcinomas are named for the epithelial cell type which they resemble
28
Adenocarcinoma
Carcinomas of glandular epithelium
29
sarcomas
malignant stromal tumours
30
Squamous epithelium neoplasms
benign - squamous cell papilloma malignant - squamous cell carcinoma
31
Glandular epithilial neoplasms
benign - adenoma | malignant - adenocarcinoma
32
Mesenchymal (stromal) cancer types
smooth muscle, striated muscle, adipose tissue, blood vessel, bone, cartilage
33
smooth muscle cancers
leiomyoma (benign), leiomyosarcoma (malignant)
34
striated muscle cancers
rhabdyomyoma (benign) | rhabdomyosarcoma (malignant)
35
Adipose tissue cancers
lipoma (benign), liposarcoma (malignant)
36
Blood vessel cancers
angioma (benign), angiosarcoma (malignant)
37
Bone cancers
Osteoma (benign), osteosarcoma (malignant)
38
Cartilage cancers
chondroma (benign), chondrosarcoma (malignant)
39
malignant vulva tumours
squamous - squamous cell carcinoma
40
malignant vagina tumours
squamous - squamous cell carcinoma
41
malignant cervical tumour
squamous - squamous cell carcinoma | glandular - adenocarcinoma
42
malignant endometrium tumour
glandular adenocarcinoma | stroma stromal sarcoma
43
malignant myometrium tumour
sm muscle leiomyosarcoma
44
Dysplasia
For some malignant neoplasms a ‘pre-malignant’ state is identified This state is termed dysplasia There is an accumulation of cells which look somewhat like malignant cells but do not invade the basement membrane Dysplastic lesions may (but don’t always) progress to invasive malignancy Recognising dysplastic lesions allows early treatment before invasion occurs
45
Dysplasia definition
disordered growth and differentiation characterised by increased proliferation (more mitoses), atypia of cells and decreased differentiation
46
Dysplasia terminology
Eg for the cervix: Generic: Dysplasia UK: Cervical intra-epithelial neoplasia (CIN) US: Squamous intra-epithelial lesion (SIL)
47
How is degree of dysplasia relevant?
The degree of dysplasia may predict the likelihood of developing invasive malignancy Grade % progress to CIN3 % progress to SCC CIN1 11 1 CIN2 22 5 CIN3 - 40
48
Where does dysplasia often occur?
Dysplasia often occurs in sites where there is metaplasia squamous metaplasia of the cervical transformation zone squamous metaplasia of the bronchial epithelium glandular metaplasia of the distal oesophagus
49
Normal constituents of a smear test
Endocervical cells in endocervix Squamous cells in ectocervix metaplastic cells in transformation cells
50
Normal cells vs dysplastic cells
Normal cells have a small nucleus and lots of cytoplasm Dysplastic cells have a higher ratio of nuclear size to cytoplasmic volume, and the nuclei show the same features that we associate with malignancy
51
Difference between dysplasia and carcinoma
The difference between dysplasia and carcinoma is invasion through the basement membrane
52
What can cause CIN and cervical cancer?
human papillomavirus (HPV)
53
Human papillomavirus
Human Papillomaviruses (HPVs) infect epithelium Confined to local site of infection without viraemia Over 130 HPV types, some of which infect the anogenital mucosa Double stranded DNA virus 7.9Kbp
54
High risk vs low risk HPVs
High Risk HPV 16,18,31,33,35,39,45,51,52,56,58,59,68 Low Risk HPV 6,11,40,42,43,44,54,61,72,81
55
Strategies to prevent cervical cancer
``` HPV Vaccination Population based screening Cervical sample cytology Cervical sample HPV test Colposcopy Treatment of high grade dysplasia Large Loop Excision of the Transformation Zone ```
56
Endometrial cancer vs cervical cancer epidemiology
Cervical cancer is predominantly a disease of the developing world. The incidence of cervical cancer has been declining in Europe. The reduction in incidence of cervical cancer has been paralleled by reduced mortality Endometrial cancer is presently most common in North America and Europe
57
What do seperate peaks in cervical cancer incidence indicate?
The separate peaks in cervical cancer incidence reflect a birth cohort effect This happens when a group of people experience different circumstances to those born immediately before or after An increase in cervical cancer incidence and mortality was seen in women reaching the age of sexual debut during WW1 and again in WW2 The incidence and mortality of cervical cancer in the UK have decreased, particularly since the early 1980s In the UK this follows the introduction of the NHS cervical screening programme A birth cohort effect exists, believed to reflect the different exposure to HPV at the time women reached the age of sexual debut HPV vaccination is creating new birth cohorts

BSMS203 Gynae (Theme 3) (8 decks)

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