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Clinical Pathology > 47 - Diseases of the female genital tract 2 > Flashcards

47 - Diseases of the female genital tract 2 Flashcards

1
Q

Endometriosis - what is it?

A

Ectopic endometrium -> bleeding into tissues -> fibrosis

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2
Q

Endometriosis - who?

A

6-10% of women

30-40 yo

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3
Q

Endometriosis - hx

A 
25% asymptomatic
Dysmenorrhoea
Dyspareunia
Pelvic pain
Subfertility
Pain on passing stool
Dysuria
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4
Q

Endometriosis - Ix

A

Laparoscopy

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5
Q

Endometriosis - Rx

A

Medical (COCP, GnRH agonists/antagonists, progesterone antagonists)

Surgical

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6
Q

Endometritis - what is it?

A

Inflammation of the endometrium?

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7
Q

Endometritis - types

A

Acute - retained placenta, prolonged rupture of membranes, complicated labour

Chronic - pelvic inflam disease, retained gestational tissue, endometrial TB, IUCD (intrauterine contraceptive device) infection

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8
Q

Endometritis - history

A 
ab/pelvic pain
pyrexia
discharge
dysuria
abnormal vaginal bleeding
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9
Q

Endometritis - investigations

A

biochem/microbiology, USS

Histology shows lymphocytes and plasma cells

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10
Q

Endometritis - Rx

A

Analgesia, antibiotics (ABX), remove cause

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11
Q

Endometrial polyps - who

A
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12
Q

Endometrial polyps - history

A 
Often asymptomatic
Intermenstrual bleeding
Post menopausal bleeding
Menorrhagia
Dysmenorrhoea
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13
Q

Endometrial polyps - investigations

A

USS

Hysteroscopy

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14
Q

Endometrial polyps - treatment

A

Expectant, medical or surgical

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15
Q

Endometrial polyps - prognosis

A

1% are malignant

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16
Q

Leiomyomata (uterine fibroids) - who?

A

20% women 30-50s

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17
Q

Leiomyomata (uterine fibroids) - Risk factors

A 
Genetics 
Nulliparity
Obesity
PCOS
HTN
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18
Q

Leiomyomata (uterine fibroids) - history

A

Often asymptomatic
Menometrorrhagia (Fe def anaemia)
Subfertility
Pressure

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19
Q

Leiomyomata (uterine fibroids) - Investigations

A

Bimanual examination

USS

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20
Q

Leiomyomata (uterine fibroids) - treatment

A

Medical

Non-medical - art. emboli, ablation, TAH)

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21
Q

Leiomyomata (uterine fibroids) - prognosis

A

menopausal regression, malignancy risk (0.01%)

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22
Q

Endometrial hyperplasia - risk factors

A 
Obesity
Exogenous E2
PCOS
E2 - producing tumours
Tamoxifen
HNPCC
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23
Q

Endometrial hyperplasia - History

A

Abnormal bleeding

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24
Q

Endometrial hyperplasia - investigations

A

USS

Hysteroscopy +/- biopsy

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25
Q

Endometrial hyperplasia - treatment

A

Medical

Surgical (TAH)

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26
Q

Endometrial hyperplasia - prognosis

A

Endometrial adenocarcinoma

Regression

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27
Q

Endometrial carcinoma - history

A

PMB/IMB pain if late

28
Q

Endometrial carcinoma- investigations

A

USS
Biopsy
Hysteroscopy

29
Q

Endometrial carcinoma - staging

A

FIGO (1-4)

30
Q

Endometrial carcinoma - treatment

A

Medical
Surgery - TAH
Chemo+radio

31
Q

Endometrial carcinoma - prognosis

A

Stage one of figo - 90% 5 yr survival

Stage 2-3 -

32
Q

Polycystic ovary syndrome - summary

A

Complex endocrine disorder
Hyperandrogenism
Menstrual abnormalities
Polycystic ovaries

33
Q

Polycystic ovary syndrome - who?

A

6-10% of women

34
Q

Polycystic ovary syndrome - investigation

A

USS

Fasting biochemical screen (low FSH, high LH, high test. high DHEAS), OGTT

35
Q

Polycystic ovary syndrome - diagnosis

A 
Rotterdam criteria (2/3 polycystic ovaries)
Hyperandrogenism
Irregular periods (>35 days)
36
Q

Polycystic ovary syndrome - treatment

A

weight loss, medical, surgical

37
Q

Gonadal failure - primary causes

A

Congenital - Turner’s, Klinefelter’s

Acquired - infection, surgery, chemo-radiotherapy, toxins/drugs

38
Q

Gonadal failure - secondary causes

A

Hypogonadatrophic hypogonadism (pit/hypothalamus failure)

39
Q

Gonadal failure - clinical presentation

A

Amenorrhoea
Delayed puberty
Low sex hormone levels, high LD, high FSH

40
Q

Gonadal failure - investgations

A

hormonal profiling, karyotyping

41
Q

Gonadal failure - prognosis

A

difficult - address cause

HRT

42
Q

Origins of ovarian neoplasms

A

Sex-cord stromal tumours

Surface epithelial stromal tumours

Germ cell tumours

43
Q

Epithelial tumours - prevalence

A

90% of ovarian neoplasms

44
Q

Epithelial tumours - histological types

A

Serous (tubal)
Mucinous (endocervical)
Endometroid (endometrium)

45
Q

Epithelial tumours - benign tumours subclassification

A

Cystic (cystadenomas)
Fibrous (adenofibromas)
Cystic and fibrous (cystadenofibromas)

46
Q

Epithelial tumours - malignant types

A

Cystadenocarcinomas

47
Q

Germ cell tumours - types

A

15-20% of all ovarian tumours

Germinomatous - dysgerminomas

Non-germinomatous - teratomas (mature, immature (malignant), yolk sac tumours, choriocarcinomas)

48
Q

Germ cell tumours - treatment

A

Surgical +/- chemo/radio

49
Q

Sex cord stromal tumours -

A

Rare, from ovarian stroma

Can generate cells of opposite sex

50
Q

Sex cord stromal tumours - types

A

Thecoma/fibrothecoma/fibroma - benign, produce E2, fibromas hormonally inactive. Comprised of spindle cells. Meig’s syndrome

Granulosa cell - low grade malignant, produces E2

Sertoli-Leydig - produces androgens, 10-25% malignant

51
Q

Ovarian cancer -

A

2nd commonest gynae cancer

52
Q

Ovarian cancer - risk factors

A 
FH
Elderly
PMH breast cancer
Smoking
E2-only HRT
Lynch II syndrome
Obesity
Nulliparity
53
Q

Ovarian cancer - protective factors

A

OCP
Breast feeding
Hysterectomy

54
Q

Ovarian cancer - history

A 
Non-specific
Pain
Bloating
Weight loss
PV bleeding
Urinary freq.
Anorexia
55
Q

Ovarian cancer - staging

A

FIGO

56
Q

Ovarian cancer - treatment

A

Stage TAH/BSO
Omentectomy, appendectomy, lymphadenectomy & adjuvant chemo
Chemo is only done in sensitive germ tumours

57
Q

Ovarian cancer - prognosis

A

5 years 43% survival

58
Q

Ovarian cancer - metastatic tumour types

A

Mullerian tumours (most common): uterus, fallopian, pelvic peritoneum, contralateral ovary

Extra-mullerian tumours: lymph/haem spread - GI, breast, melanoma, less commonly kidney and lung. Direct extension: bladder, rectal

59
Q

Endometriosis summary

A

Spread of endometrium into the pelvis

60
Q

Endometritis summary

A

Acute/chronic inflammation (usually due to infection)

61
Q

Endometrial polyps summary

A

Local endometrial overgrowth

62
Q

Leiomyomata summary

A

Benign smooth muscle tumours of the myometrium

63
Q

Endometrial hyperplasia summary

A

Oestrogenic stimulation of endometrial proliferation; continuous stimulation may lead to atypical hyperplasia and carcinoma

64
Q

Endometrial cancer summary

A

Commonest gynae cancer with increasing incidence; two types

65
Q

PCOS summary

A

Common, multiple follicular cysts, hyperandogenism, menstrual irregularity

66
Q

Gonadal failure summary

A

Primary (ovarian) and secondary (hypothalamus/pituitary)

67
Q

Ovarian neoplasms summary

A

90% epithelial and based on cell type; benign cystadenoma -> borderline -> malignant cystadenocarcinoma progression; germ cell tumours; sex cord stromal tumours

Clinical Pathology (65 decks)

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