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YR5 Histopathology > Crash Course: gynae and breast > Flashcards

Crash Course: gynae and breast Flashcards

1
Q

Hyperplasia

A

Increased no. cells
e.g. parathyroid hyperplasia

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2
Q

Hypertrophy

A

Increased size of cells
e.g. HOCM, LVH

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3
Q

Metaplasia

A

Reversible change from 1 cell type to another
e.g. Barrett’s oesophagus

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4
Q

Dysplasia

A

Reduced differentiation of cells
Decreased grading of cells i.e. replacement of norma cells with abnormal cells
Basement membrane intact
e.g. CIN

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5
Q

Neoplasia

A

Uncontrolled abnormal growth of cells + tissues
Benign or malignant (if invades BM)

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6
Q

What is the vulva composed of?

A

vaginal opening
labia majora
labia minora
clitoris

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7
Q

What are the 3 grades of VIN?

A
  1. Bottom 1/3
  2. Bottom 2/3
  3. Full thickness
    Through basement membrane = cancer
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8
Q

What are the 2 types of VIN? Which patient group is more commonly affected by each?

A

Usual: Young
Differentiated: Older

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9
Q

Give 3 risk factors for usual VIN

A

HPV 16 + 18
Smoking
Immunosuppression

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10
Q

What is a risk factor for differentiated VIN?

A

Lichen sclerosis

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11
Q

Which type of VIN is more likely to progress to squamous cell carcinoma of the vulva?

A

Differentiated VIN

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12
Q

What is the predominate type of vulval carcinoma? In which patients is this more common? What risk factor may be in their history?

A

Primary vulval carcinoma (95%)
(Squamous cell carcinoma)

Older
Lichen sclerosis/ HPV

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13
Q

What is the less common type of vulval carcinoma?
In which patients is this more common?

A

Clear cell (5%)
(Adenocarcinoma)
Teenagers

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14
Q

Give 5 signs and symptoms of vulval carcinoma

A

Visible painless lesion
Ulcerated
Difficulty urinating
Itching, irritation
FLAWS

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15
Q

Describe the anatomy/ histology of the cervix

A

Ectocervix: Squamous
Transition zone- lower part of cervical canal
Endocervix: Columnar

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16
Q

In which part of the cervix is there a high degree of replication and thus increased susceptibility to infection + cancer?

A

Transformation zone

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17
Q

What are the 3 grades of CIN?

A
  1. Bottom 1/3
  2. Bottom 2/3
  3. Full thickness
    Through basement membrane = cancer
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18
Q

What cellular change characterises both CIN and VIN?

A

Dysplasia
Proliferation of poorly differentiated cells
Hasn’t invaded BM

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19
Q

Cervical cancer predominantly is which cell type?

A

SCC: 80%
Adenocarcinoma: 20%

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20
Q

Give 5 risk factors for CIN

A

HPV
Smoking
Immunosuppression
COCP
High parity

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21
Q

What happens for most people infected with HPV?

A

Nothing.
Immune system eliminates HPV
HPV undetectable within 2y in 90%

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22
Q

Which proteins encoded by HPV lead to proliferation of epithelium?

A

E6 + E7 bind to + inactivate 2 tumour suppressor genes:

E6 inactivates P53
E7 inactivates Retinoblastoma gene (Rb)

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23
Q

In those who do not clear HPV infection what occurs?

A

HPV remains latent within cells
At time of immunosuppression/ stress, can become activated
Viral DNA replication
Resulting in cytological + histological changes of cancer

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24
Q

What are the screening intervals for cervical cancer?

A

25: 1st invitation

25-49: Every 3y

50-64: Every 5y

65+: Only if 1 of last 3 was abnormal

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25
Q

What are the 2 types of proliferation in the endometrium?

A

Benign: Leiomyomas (fibroids)
Malignant: Adenocarcinomas 80% (SCC 20%)

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26
Q

What are 2 types of adenocarcinoma in the endometrium?

A

Endometrioid: 80%
Non-endometrioid: 20%

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27
Q

What are Leiomyomas?

A

Smooth muscle tumour of myometrium.

Commonest uterine tumour

40% of women >40y

AKA fibroid

Usually multiple

May be intramural, submucosal or subserosal

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28
Q

What is the pathophysiology of leiomyomas?

A

Oestrogen dependent growth
Enlarge during pregnancy
Regress during menopause

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29
Q

Describe leiomyomas macroscopic appearance

A

Large white well circumscribed bundles

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30
Q

Describe microscopic appearance of leiomyomas

A

Purple bundles of smooth muscle cells

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31
Q

What is endometriosis?

A

Presence of endometrial tissue outside the endometrium

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32
Q

What is endometriosis caused by?

A

vascular or lymphatic dissemination of endometrial cells

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33
Q

What is the name for endometrial tissue occuring within the myometrium?

A

Adenomyosis

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34
Q

Give 2 macroscopic features of endometriosis

A

Powder burns: red-blue/ brown vesicles
Chocolate cysts: endometriomas on ovaries

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35
Q

Describe endometriosis microscopically

A

Endometrial tissue is darker hence appearance of “powder burns”

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36
Q

In which women is each type of endometrial adenocarcinoma more common?

A

Endometriod: Peri-menopausal + Increased lifetime oestrogen exposure

Non-endometriod: Post-menopausal

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37
Q

What are the 3 types of endometriod cancer of the endometrium?

A

Secretory
Endometriod
Mucinous

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38
Q

What are the 3 non-endometroid types of cancer of the endometrium?

A

Papillary
Clear cell
Serous

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39
Q

What is the pathophysiology of each type of endometrial adenocarcinoma?

A

E: Related to oestrogen excess
NE: Unrelated to oestrogen excess

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40
Q

Which mutations are related to each type of endometrial adenocarcinoma?

A

E: PTEN (TSG in >50%)
NE: PTEN, P53, HER-2

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41
Q

Give 3 key features of Pelvic inflammatory disease

A
  1. Ascending infection ascending from vagina + cervix to uterus, Fallopian tubes + ovaries
  2. Inflammation (e.g. endometritis, salpingitis)
  3. Formation of adhesions
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42
Q

What is Fits-Hugh Curtis syndrome? What buzzwords are associated with this? What symptom?

A

Complication of PID in which adhesions form around liver
“Violin strings” + “Peri-hepatic lesions”
RUQ pain due to peri-hepatitis

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43
Q

Give 3 classes of causes of PID

A

Ascending e.g. STI
External contamination e.g. TOP, abortion
Other

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44
Q

Name 2 ascending causes of PID

A

N. gonorrhoea
C. trachomatis

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45
Q

Name 1 external contamination causes of PID

A

S. aureus

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46
Q

Give 2 ‘other’ causes of PID

A

TB
Schistosomiasis

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47
Q

What are the 2 main types of physiological ovarian cyst?

A

Follicular (most common)
Corpus luteum (in early pregnancy)

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48
Q

Give 2 features of follicular ovarian cysts

A

Due to non-rupture of dominant follicle or failure of atresia in a non-dominant follicle
Commonly regress after several menstrual cycles

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49
Q

What causes formation of a corpus luteum cyst?

A

During menstrual cycle if a pregnancy doesn’t occur the corpus luteum breaks down + disappears.
If this doesn’t happen the corpus luteum may become filled with blood or fluid become a corpus luteal cyst

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50
Q

How do corpus luteal cysts most commonly present?

A

Intraperitoneal bleeds

51
Q

What is the most common benign ovarian tumour in under 30s?

A

Dermoid cyst (germ cell)

52
Q

Give 3 features of dermoid cysts

A

a.k.a mature cystic teratomas
Usually lined with epithelial tissue: contain skin, hair + teeth
A/w torsion

53
Q

What densely echogenic nodule arises in mature cystic teratomas?

A

Rokitansky’s protuberance
Solid protuberance projecting from a dermoid cyst

54
Q

What is the most common malignant ovarian cancer in younger women? What management is used?

A

Dysgerminoma (germ cell)

Sensitive to radiotherapy

55
Q

What is the most common benign ovarian epithelial tumour?

A

Serous cystadenoma

56
Q

Give 2 histological features of serous cystadenomas

A

Columnar epithelium
Psammoma bodies

57
Q

Give 3 features of ovarian mucinous cystadenomas

A

2nd most common benign epithelial tumour
Typically very large + become massive
May cause pseudomyxoma peritonei

58
Q

What is seen on histology in ovarian mutinous cystadenomas?

A

mucin secreting cells

59
Q

Name 2 malignant epithelial ovarian tumours

A

Endometriod carcinoma
Clear cell carcinoma

60
Q

Give 3 features of endometriod ovarian tumours

A

Co-exist with endometrial cancer + endometriosis
Histology: tubular glands
Raised CA125

61
Q

Give 2 features of ovarian clear cell carcinoma

A

A/w endometrioma
Histology: clear cells, hobnail appearance

62
Q

What are the sex cord tumours in the ovary?

A

Granulosa/ theca cell tumours

Sertoli/ Leydig cell tumours

63
Q

Give 5 manifestations of granulosa/ theca cell tumours in the ovary

A

Secrete oestrogen:
PMB
IMB
Breast enlargement
Endometrial cancer
Breast cancer

64
Q

What histological feature are granulosa/ theca cell tumours characterised by?

A

Call-exner bodies

65
Q

Give 4 manifestations of sertoli/ leydig cell tumours

A

Secrete androgens:
Virilisation
Defeminisation
Breast atrophy
Hirsuitism
Enlarged clitoris

66
Q

Which is the most common ovarian malignancy in the general population?

A

Serous carcinoma

67
Q

What occurs in breast lobules?

A

Milk is produced + stored during pregnancy + breastfeeding

68
Q

What is the function of breast ducts?

A

Carry milk from lobules to the nipple where it exits the body
(lymph flows in opposite direction)

69
Q

What is involved in a triple assessment?

A
  1. Clinical: Hx + Examination
  2. Imaging: USS (<35y) or Mammography (>35y)
  3. Pathology: FNA or core biopsy
70
Q

What is the difference between fine needle aspiration cytology and core biopsy?

A

FNA: Collects sample of cells. Use when suspect content to be liquid e.g. cyst

Core biopsy: Collects core of tissue. Use when contents appears more solid

Both used for grading

71
Q

What coding is used for FNA cytology?

A

C1: Inadequate sample
C2: Benign
C3: Atypia
C4: Suspicious of malignancy
C5: Malignant

72
Q

What coding is used for core biopsy?

A

B1: Normal
B2: Benign
B3: Uncertain
B4: Suspicious
B5a: DCIS
B5b: Invasive carcinoma

73
Q

Give 3 signs of mastitis

A

Erythematous +/- discharge from nipple
Tender breast
Fevers

74
Q

Name 2 inflammatory causes of breast lump

A

Mastitis
Fat necrosis

75
Q

Name 2 types of mastitis

A

Lactational: within 6w postpartum due to milk stasis, may have CRACKED nipple
Non-lactational: >6w postpartum or not currently breastfeeding

76
Q

What is seen microscopically in mastitis?

A

Abundance of neutrophils

77
Q

What is the management of mastitis?

A

Conservative:
warm compresses,
analgesia,
elevation,
continue breastfeeding bilaterally

If unresolved after 12-24h

Medical: oral abx (usually Fluclox as S. aureus most common organism)

78
Q

What indicates breast abscess rather than mastitis? How is this treated?

A

Fluctuant swelling
Extreme pain
Swinging fevers

Tx: IV Abx + Incision + drainage

79
Q

What is fat necrosis?

A

Inflammatory reaction to damaged adipose tissue

80
Q

Give 3 buzzwords/ phrases associated with fat necrosis

A

Breast trauma (e.g. RTA)
Previous radiotherapy
Unilateral underlying mass, changing acutely

81
Q

How does fat necrosis appear microscopically?

A

Large damaged fat lobules
Irregular in breast tissue

82
Q

List 3 causes of benign breast lump

A

Fibroadenoma
Fibrocystic disease
Duct ectasia

83
Q

What are the 2 types of fibroadenoma?

A

Fibro– (stomal)
Glandular (epithelial)

84
Q

What is the most common breast lump in women aged 20-40? What is this caused by?

A

Fibroadenoma

Oestrogen driven: causes cyclical pain + thus regress during menopause

85
Q

What 7 buzzwords/ phrases are associated with fibroadenoma?

A

Single 1-5cm
Unilateral
Spherical
Well demarcated
Firm/ rubbery
Painless
Mobile a.k.a. “breast mouse”

86
Q

What is the management for fibroadenoma?

A

< 3 cm → conservative
> 3 cm → surgical excision

87
Q

What is a phyllodes tumour?

A

Aggressive malignant fibroepithelial neoplasms arising from breast stroma

i.e. malignant version of fibroadenomas

88
Q

Give 3 features of phyllodes tumours

A

EXTREMELY rare
>50s
Structurally similar to fibroadenoma

89
Q

Give 3 buzzwords associated with phyllodes tumours

A

Artichoke appearance
Frond-like
Branching

90
Q

What is fibrocystic disease?

A

Fluid filled sacs in breast
Common ~7%
Pre/ peri-menopausal women

91
Q

Give 7 buzzwords associated with fibrocystic disease

A

Single or multiple “LUMPINESS”
Unilateral or bilateral
Cyclical pain
Well demarcated
Fluctuant
Transilluminable
Clear nipple discharge

92
Q

Give 2 red flags on biopsy of initially suspected fibrocystic disease

A

FNA is blood-stained
Core biopsy reveals complex cystic contents

93
Q

What is duct ectasia?

A

When mammary duct gets blocked, usually by milk stasis
Leads to dilatation, lump formation + localised infection

94
Q

How may duct ectasia present on clinical examination?

A

Sub/ peri-areolar mass
Firm, thick yellow, green, brown discharge

95
Q

On microscopy what can be seen in duct ectasia?

A

Proteinaceous material inside duct
Nipple discharge contains macrophages + proteinaceous material

96
Q

In which patient group is duct ectasia more common?

A

Smokers

97
Q

Name 2 proliferative causes of breast lumps

A

Intraductal papilloma
Radial scar

98
Q

What is intraductal papilloma?

A

Benign neoplasms growing within the ducts of breast: “well defined nodule within a duct”

Presents similarly to malignancy but does NOT invade the basement membrane

99
Q

In which patient groups is intraductal papilloma seen?

A

Peri and post menopausal women

100
Q

What are the 2 types of intraductal papilloma? How do they present?

A
  1. Peripheral: small ductules affected- clinically silent with subareolar mass
  2. Central: large ductules affected- blood or clear nipple discharge
101
Q

Describe the histological appearance of intraductal papilloma

A

Dilated ductule with papillary mass
(not covering entire duct)

102
Q

What is a radial scar?

A

Benign sclerosing lesion caused by impaired healing post-injury e.g. radiotherapy
Can present as a lump

103
Q

What 3 buzzwords are associated with radial scars?

A

Central
Fibrous (a/w scar formation)
Stellate area (a/w scar formation)

104
Q

What are proliferative pre-malignant breast conditions?

A

Intraductal proliferative lesions a/w increased risk of developing subsequent invasive breast carcinoma

Usually ASYMPTOMATIC

105
Q

What are the 3 proliferative pre-malignant breast lumps? List in order of increasing risk of cancer

A

Usual epithelial hyperplasia
Flat epithelial atypia
In situ lobular neoplasia

106
Q

Give 4 epidemiological facts about breast cancer

A

Commonest cause of cancer in the UK
1/7 females
Rare in <35s
Increases with age

107
Q

List 3 genetic risk factors for breast cancer

A

BRCA 1/2 (autosomal dominant)

FH +ve

Li Fraumeni syndrome

108
Q

List 5 lifetime oestrogen exposure related risk factors for breast cancer

A

Early menarche
Late menopause
Nulliparity
Late first child
COCP

109
Q

List 3 lifestyle risk factors for breast cancer

A

Alcohol
Smoking
Poor diet

110
Q

What are the 2 types of non-invasive breast cancer?

A

Ductal carcinoma in situ (3-5%)
Lobular carcinoma in situ (1%)

Limited to ducts/ lobules by basement membrane

111
Q

How does non-invasive breast cancer usually present?

A

DCIS: Microcalcifications in asymptomatic

LCIS: Incidental finding

112
Q

Describe histology of DCIS

A

ducts filled with atypical epithelial cells (not invading surrounding tissue)

113
Q

What are the 3 types of invasive breast cancer?

A

Invasive ductal carcinoma (85%)
Invasive lobular carcinoma (10%)
Paget’s disease (2%)

114
Q

What are invasive breast cancers?

A

Malignant epithelial tumours which infiltrate breast, + have capacity to metastasize

115
Q

What is the most common breast cancer in women?

A

Invasive ductal carcinoma

116
Q

Describe histological features of ductal and invasive lobular carcinoma

A

Ductal: big, pleomorphic cells
Invasive: cells in chains/ single file

117
Q

What are the histological features of tubular and mucinous breast cancer?

A

Tubular: Well-formed tubules
Mucinous: Extracellular mucin

118
Q

What grading system is used for breast cancer?

A

Nottingham Grading system

119
Q

Which 3 features are scored in the Nottingham grading system?

A

Nuclear pleomorphisms
Tubule formation
Mitotic activity

120
Q

What are the 3 grades of breast cancer?

A

Grade 1 = well differentiated (<5)
Grade 2 = moderately differentiated (6-7)
Grade 3 = poorly differentiated (8-9)

121
Q

What are all breast cancers assessed for?

A

ER, PR + HER-2 status

122
Q

Name 2 targeted treatments of breast cancer

A

Tamoxifen: anti-ER in breast
Herceptin: monoclonal Ab to HER-2

123
Q

What is the most important prognostic indicator in breast cancer?

A

Axillary lymph node status

YR5 Histopathology (27 decks)

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