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Y5 Pathology > HistoPath - Gynae > Flashcards

HistoPath - Gynae Flashcards

1
Q

What are the congenital abnormalities of the uterus

A

Duplication (i.e. uterus didelphys)
Agenesis

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2
Q

Give examples of common infections of the genital tract

A

Infections that cause discomfort with NO serious complications
- Candida: more common in DM, OCP, pregnancy
- Trichomonas vaginalis: protozoan
- Gardenerella: Gram-negative bacillus causes vaginitis

Infections that cause SERIOUS complications
- Chlamydia: major cause of infertility
- Gonorrhoea: major cause of infertility
- Mycoplasma: causes spontaneous abortion and chorioamnionitis
- HPV: implicated in cancer

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3
Q

What are the common causes of PID

A
  1. Ascending from LGT: Chlamydia, Gonorrhoea
  2. Secondary to TOP: staph aureus, strep, clostridium perfringens (spread via lymphatics and blood vessels)
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4
Q

What are the complications of PID

A

Peritonitis
Bacteraemia and sepsis
Chronic PID
Adhesions → intestinal obstruction
Fitz-Hugh-Curtis syndrome

Salpingitis:
Tubo-ovarian abscess
Ectopic pregnancy
Infertility
Plical fusion
Hydrosalpinx (fallopian filled with fluid)

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5
Q

What is the most common site of ectopic pregnancy

A

Ampulla of fallopian tube

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6
Q

Define endometriosis

A

presence of endometrial tissue outside the uterus

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7
Q

What are the theories of endometriosis pathogenesis

A

Metaplasia of pelvic peritoneum (coelomic) → implantation
Retrograde menstruation

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8
Q

What are the symptoms and signs of endometriosis

A

Dysmenorrhoea
Pelvic pain
Dyspareunia
Subfertility

Nodules
Tenderness
Fixed retroverted uterus

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9
Q

What malignancies is endometriosis associated with

A

Strongly: clear cell (mesonephroid/epithelial) ovarian cancer
Less strongly: endometroid (epithelial) ovarian cancer

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10
Q

What would be found on histology for endometriosis

A

Laparoscopically: powder burns (red/blue vesicles) and endometriomas

Micro: endometrial glands and stroma

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11
Q

What is adenomyosis and what are the signs on examination

A

Ectopic endometrial tissue in the myometrium
O/E boggy uterus

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12
Q

What are leiomyomas and what are the types

A

Smooth muscle tumour of the myometrium
MOST COMMON (20% of >35yo) uterine tumour
Usually multiple
May be submucosal, intramural, or subserosal (outermost)

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13
Q

What is a malignant leiomyoma

A

leiomyosarcoma
RARE and usually solitary
Usually post-menopausal women
5-year survival of 20-30%
Local invasion and spread via the blood stream

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14
Q

What are the histological features of leiomyomas

A

Macro: sharp, circumscribed mass, discrete benign tumour
Micro: bundle of smooth muscle cells

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15
Q

What is endometrial hyperplasia and what are the causes

A

Increase in stroma and glands (usually driven by oestrogen)

Peri-menopausal
Persistent anovulation (because of persistently raised oestrogen levels)
PCOS can also cause persistently elevated levels of oestrogen giving rise to endometrial hyperplasia
Granuloma cell tumours of the ovary
Oestrogen therapy

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16
Q

What is the most common gynaecological malignancy in developed countries

A

Endometrial cancer

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17
Q

Describe type 1 endometrial cancers

A

Type 1 (85%): endometrioid (+mucinous and secretory adenocarcinoma)
- Younger (peri-menopausal)
- Oestrogen-dependent
- Associated with atypical endometrial hyperplasia
- Low grade tumours
- Associated with PTEN, K-Ras, FGFR2, p53 etc.

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18
Q

Describe type 2 endometrial cancers

A

15%: serous and clear cell
- Older patients
- Not oestrogen dependent
- Atrophic endometrium
- High grade, deeper invasion
- Associated with Her-2, p53, PTEN etc.

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19
Q

Describe is the staging for endometrial cancer

A

FIGO
I = limited to uterus
II = spread to cervix
III = spread adjacent (pelvis)
IV = distant spread

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20
Q

What are the prognostic factors of endometrial cancer

A

Type, grade (glands vs solid, degree of cytological aplasia), stage
Tumour ploidy - diploid have a better prognosis
Hormone receptor expression

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21
Q

What are the risk factors for endometrial cancer

A

Nulliparity
Obesity
Early menarche
Late menopause
COCP
HRT
Tamoxifen
Diabetes Mellitus

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22
Q

What is gestational trophoblastic disease and what are the types

A

spectrum of tumours characterised by proliferation of trophoblastic tissue
- Complete (2.5% malignancy; 10% invasive moles)
- Partial mole
- Invasive mole
- Choriocarcinoma

23
Q

What are complete and partial moles

A

Complete = empty egg fertilised by 2 sperm (or 1 which duplicates DNA)
46 XY or 46 XX (paternal origin only)

Partial = normal egg fertilised by 2 sperm (or 1 which duplicates DNA)
69 XXX or 69 XXY (1x maternal and 2x paternal origin)

24
Q

What is the prevalence of complete/partial moles and what are the clinical features

A

Prevalence: 1 in 1000 pregnancies

Features:
- Spontaneous abortion
- USS – snowstorm, cluster of grapes
- Very high hCG

25
Q

What are the features of choriocarcinoma (prevalence, origin, invasion, response to therapy)

A

Incidence: 1 in 20,000-30,000 pregnancies
50% arise in moles
25% arise in previous abortion
22% arise in normal pregnancy
Rapidly invasive, widely metastasising (lung, vagina, brain, liver, kidney)
Responds well to chemotherapy

26
Q

What are the types of ovarian cyst

A

Follicular (dominant follicle does not rupture)
Luteal cysts (CL does not break down → intraperitoneal cysts → “Ring of fire” on US
Endometriotic cyst

27
Q

What are the risk factors for ovarian tumours

A

Nulliparity
Early menarche
Late menopause
Genetic predisposition
Infertility
Endometriosis
HRT
Inflammation (PID)
FHx ovarian/breast cancer

28
Q

What are the types of ovarian tumours

A

Epithelial, germ cell, sex chord (Stromal)

Epithelial
Type 1: endometrioma, clear cell, mucinous, low-grade serous
Type 2: serous

Germ cell
Teratoma
Dysgerminoma
Choriocarcinoma
Endodermal sinus tumour

Sex chord/stromal
Fibroma
Granulosa cell tumour
Sertoli-Leydig cells
Thecoma

29
Q

Describe serous cystadenomas

A

Epithelial tumours - most common
Mostly benign
30-50% are bilateral
Ciliated cells, Psamomma body seen
If malignant = cystadenocarcinoma
NOT associated with KRAS, BRAF

30
Q

Describe mucinous cystadenoma

A

Mostly benign
Mucin secreting cells (epithelium resemble gastrointestinal or endocervical epithelium)
Pseudomyoxoma peritonei
Associated with KRAS mutations

31
Q

Describe endometriomas

A

Epithelial
Mostly malignant
Associated with Endometriosis and Endometrioid carcinoma
Chocolate cysts

32
Q

Describe clear cell tumours

A

Epithelial
Mostly malignant
Strong association with endometriosis
Clear cells (cytoplasm is clear due to the presence of a lot of glycogen)
Hobnail appearance

33
Q

Describe teratomas

A

Germ cell tumour
<20yo
Arise from all 3 germ cell layers
Mature (most common): benign, tissues mature to adult-type tissue e.g. teeth, hair - “Dermoid cyst”
Immature: embryonic elements present (most commonly neural tissue), malignant
Mature cystic with malignant transformation: SCC

34
Q

Describe dysgerminoma

A

Germ cell tumour
Female testicular seminoma

35
Q

Describe choriocarcinoma

A

Germ cell tumour
Malignancy of the trophoblastic cells of placenta
Raised HCG

36
Q

Describe endodermal sinus tumours

A

Germ cell tumours
From extra-embryonic tissue e.g. amniotic sac

37
Q

Describe fibromas

A

Sex cord stromal tumour
Arises from fibroblasts
No endocrine production

38
Q

What is Meig’s syndrome

A
  1. Fibroma
  2. Ascites
  3. Pleural effusion
39
Q

Describe granulosa cell tumours

A

Sex cord stromal tumour
Variable behaviour
May produce oestrogen → precocious puberty
Cal exner bodies

40
Q

Describe sertoli-Leydig cells

A

Sex cord stromal tumour
Secrete testosterone (androgenic) → virilisation, defeminisation
Associated with Peutz-Jegher Syndrome

41
Q

Describe thecomas

A

Sex cord stromal tumour
Arises from thecal cells
Secretes oestrogen

42
Q

Describe Krukenberg tumours

A

Bilateral metastases composed of mucin-producing signet ring cells
Most often from gastric or breast cancer

43
Q

Which familial syndrome give rise to ovarian cancer

A

BRCA1: Familial breast-ovarian cancer syndrome
BRCA1: Site-specific ovarian cancer
Cancer family syndrome (Lynch type II)
BRCA: serous tumours
HNPCC: mucinous and endometrioid carcinomas

44
Q

What is lichen sclerosus

A

Thinning epithelium with a layer of hyalinisation underneath
Sometimes associated with epithelial dysplasia and development of malignancy

45
Q

What are the types of vulval cancer

A

Type 1: usual type
RF: HPV, smoking
35-55
Warts

Type 2: Differentiated
Keratinated SqCC (most common)
RF: lichen sclerosus
Older females

45
Q

What are the types of vulval cancer

A

Type 1: usual type
RF: HPV, smoking
35-55
Warts

Type 2: Differentiated
Keratinated SqCC (most common)
RF: lichen sclerosus
Older females

46
Q

What are the risk factors for cervical cancer

A

45-50 years
HPV 16 and 18 (6 and 11 for warts)
Many sexual partners
Sexually active early
Smoking
Immunosuppression (i.e. HIV)

47
Q

What is the pathogenesis of HPV infection

A

In most people, the immune system eliminates HPV → undetectable within 2 years
HPV 16 and 18 → encodes for proteins E6 and E7 which binds and inactivates TSGs
- E6: p53
- E7: retinoblastoma

48
Q

What is the difference between latent and productive HPV infection

A

Latent = HPV resides in cell and only replicates when the cell divides
- Complete viral particles not produced
- Cellular changes of HPV not seen

Productive = HPV replicates independently of cell cycle
- Cellular changes of HPV are seen
- Halo around the nucleus (koilocyte)

49
Q

What are the stages of CIN

A

CIN I: lower 1/3
CIN II: lower 2/3
CIN III: entire epithelium

Invasion through BM → invasive malignancy (most commonly SqCC)

50
Q

Describe the staging for Cervical cancer

A

FIGO
0: CIN
1: Cervix
2: upper 1/3 vagina
3. Lower 2/3 vagina + pelvic side wall
4. Mets

51
Q

What are the screening approaches to cervical cancer

A

Cervical cytology
Hybrid Capture II (HC2) HPV DNA Test

52
Q

Which HPV vaccines are available

A

Bivalent (16 + 18)
Quadrivalent (6, 11, 16, 18)
National vaccination programme for girls aged 12 + boys aged 13

Y5 Pathology (71 decks)

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