B Histopathology 13 and 14: Gynaecological Pathology

Question 1

What is salpingitis?

Answer 1

Infection of fallopian tubes

Question 2

What are the possible complications of untreated salpingitis?

Answer 2

AdhesionsAbscessesPeritonitisEctopic pregnancy

Question 3

What are the high risk forms of HPV for cervical cancer?

Answer 3

16 and 18

Question 4

Recall the stages of progression from normal cervical cells to cervical carcinoma

Answer 4

NormalT positive HPV (abnormal cells) CIN 1 (lower 1/3 of cells neoplastic)CIN 2 (2/3 of cells neoplastic) CIN 3 (full thickness neoplastic) Carcinoma

Question 5

What do CIN and CGIN stand for, and what is the main difference between them?

Answer 5

CIN = cervical intraepithelial neoplasiaCGIN = cervical glandular intraepithelial neoplasiaCIN progresses to squamous cell carcinomaCGIN progresses to adenocarcinoma

Question 6

How does HPV lead to neoplatic transformation of cervical cells?

Answer 6

E6 and E7 viral proteins deactivate p53 and Retinoblastoma (tumour suppressor genes)

Question 7

What age range is invited to cervical screening?

Answer 7

25-64

Question 8

Which HPV strains are included in the quadrivalent vaccine?

Answer 8

6,11,16,18

Question 9

What is leiomyoma of the uterus?

Answer 9

Smooth muscle cell tumour of the uterus

Question 10

What is a fibroid?

Answer 10

Leiomyoma

Question 11

How are fibroids classified?

Answer 11

As either intramural, submucosal or subserosal

Question 12

What is the biggest risk factor for endometrial hyperplasia?

Answer 12

Persistent oestrogen

Question 13

What is the difference between type 1 and 2 endometrial carcinomas?

Answer 13

Type 1: adenocarcinomasType 2: Serous/ clear cell carcinoma

Question 14

What is the relative prevelance of type 1 vs type 2 endometrial carcinoma?

Answer 14

Type 1 = 80-85%Type 2 = 10-15%

Question 15

Recall the genetic associations of serous and clear cell endometrial carcinomas

Answer 15

Serous: p53 mutationClear cell: PTEN mutation

Question 16

Which type of endometrial carcinoma is high grade and which is low grade?

Answer 16

Type 1 = low gradeType 2 = high grade

Question 17

Which type of endometrial carcinoma is most likely to arise in atrophic endometrium?

Answer 17

Type 2

Question 18

Recall the FIGO stages of endometrial cancer

Answer 18

Stage 1: Confined to uterusStage 2: Spread to cervixStage 3: Spread to adnexa, vagina, local lymph nodes (pelvic/ para-aortic) Stage 4: Distant metastases

Question 19

Recall the different types of gestational trophoblastic disease

Answer 19

Partial/ complete moleInvasive moleChoriocarcinoma

Question 20

How does gestational trophoblastic disease usually present?

Answer 20

As spontaneous abortion

Question 21

What is the cause of gestational trophoblastic disease?

Answer 21

Fertilisation of one egg by 2 sperm

Question 22

Describe the prognosis of choriocarcinoma

Answer 22

Very aggressive but also very responsive to treatment

Question 23

What is endometriosis?

Answer 23

Presence of endometrial glands and stroma outside of the uterus - bleeding of ectopic material is painful

Question 24

What is adenomyosis?

Answer 24

Ectopic endometrial tissue within the myometrium

Question 25

What is the main symptom of adenomyosis?

Answer 25

Dysmennorhoea

Question 26

What type of tumour are 95% of ovarian neoplasms?

Answer 26

Epithelial tumours

Question 27

Describe the 2 different types of ovarian carcinoma

Answer 27

Type 1 (low grade, has precursors) Type 2 (high grade, associated with p53 mutations)

Question 28

What type of epithelium are most ovarian carcinomas derived from?

Answer 28

Serous

Question 29

Which types of ovarian carcinoma are associated with endometriosis?

Answer 29

Endometrioid and clear cell carcinoma

Question 30

Recall the 4 types of sex cord stromal tumours, and the malignant potential of each

Answer 30

Fibromas (from fibroblasts) = benignGranulosa cell tumours = variable behaviourThecoma (thecal cells) = benignSertoli-Leydig cell tumours = variable behaviour

Question 31

In what age group of women are germ cell tumours seen?

Answer 31

<20s

Question 32

Recall the different types of germ cell tumour in women

Answer 32

Undifferentiated germ cells: dysgermiomaTumour of extra-embryonic tissue: endodermal sinus tumourTrophoblast tumour: choriocarcinomaCancer of embryonic tissue: teratoma

Question 33

Recall 2 types of cancer that commonly metastasise to the ovary

Answer 33

Krokenburg tumoursColon cancer