Cervical screening and pathology Flashcards Preview

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Flashcards in Cervical screening and pathology Deck (31):
1

Metaplasia

replacement of one differentiated cell type with another, mature differentiated cell type

2

Dysplasia

abnormality of development or an epithelial anomaly of growth and differentiation

not invasive!

3

Neoplasia

New and abnormal development of cells that may be benign or malignant

Intraepithelial neoplasia = dysplasia (not invasive)

Invasiveneoplasia (neoplasm) = cancer

4

What could cause this mass in the myometrium

  1. Benign Leiomioma  see pic*
    -benign SM tumours
    -common
    -Hormone receptive; regress following menopause
     
  2. Leimyosarcoma (invasive SM cancer)
    -Malignant smooth muscle tumour

5

How can a benign leiomioma cause menorrhagia

If you get a sub-endometrial leiomioma you increase the surface area of the uterine cavity → increased bleeding and shedding.

Pain as uterus contracts around large fibroids

 

6

Whats the macroscopic difference between a leiomyosarcoma and a leiomyoma/fibroid

Leiomyoma: ovoid/round, circumscribed, solid creamy

Leiomyosarcoma: necrotic core/area, haemorragic areas, larger. It is heterogenous

7

Whats the microscopic description of a leiomyoma 

Leiomyoma : collection of smooth muscle cells, arranged in a new growth formation (different to SM of uterus). Cigar shaped nuclei, and pink elongated cytoplasms.

 

8

cyclical abdominal pain indicates issues with?

Her period

9

Potential causes of painful heavy periods

Leimyoma (fibroids)

Endometriosis

Primary endometrial pathology

 

Leimyosarcoma unlikely

10

A chocolate (haemorrhagic) cyst of the ovary

11

What is endometriosis? What does it cause?

Endometrial tissue outside the lining of the uterus.

It responds to menstrual cycle hormones, leading to:

-pain
-cysts
-Tissue inflammation
-fibrosis
-infertility/ectopic pregnancy
-POTENTIALLY malignancy
 

12

What are the 3 things that need to be seen microscopically in order to diagnose endometriosis

  1. Endometrial glands
  2. Endmetrial stroma
  3. Changes in the surrounding tissue: fibrosis and/or haemocytic macrophages

13

What are you looking for macroscopically to diagnose Endometriosis

Cyst formation, many that are 'chocolatey' due to haemorrhage.

Changes the structure/function of normal tissues

14

What do we suspect from this?

-polycystic ovarian syndrome: underlying endocrine disorder cause her to be obese/infertile. Ovaries/follicule never ovulate so continued production of oestrogen. 

This can cause excessive proliferation and shedding of the endometrium → heavy and irregular periods. (the irregularity makes you think she is not ovulating cyclically)

-leiomyoma

15

Age variation in a thickened endometrium?

-Postmenopausal: no oestrogen production so there shouldn't be proliferating/shedding at all.

If there is this is a BAD SIGN,

16

How do you do a biopsy of the endometrium? What are the issues?

Pipelle Biopsy: little tube in uterus, suck out some endometrium. Not done under direct vision so can be incredibly difficult in obese patients.

D and C 'Dilation and Curettage': under direct vision in theatre under anaesthetic. Endometrium viewed and abnormal tissue scraped out.

17

What is this and what would it look like microscopically

Endometrial adenocarcinoma.

Shaggy, thickened, heterogenic, invading into the myometrium.

 

Glands proliferate and become increasingly crowded and complex

18

What can lead to too much eostrogen

-Obesity
-Exogenous oestrogen (HRT)
-Polycystic ovarian syndrome (PCOS)
-Hormone secreting tumours
-Early menarche, late menopause
-Nulliparity (pregnancy is a progestogenic state)

19

cervical/PAP smear

  1. Conventional smear: scraping spatula
  2. Cytobrush (liquid based cytology): brush, send to lab, do liquid based tests

20

What is cytology? Issues?

Diagnosis by examining the structure of individual or groups of cells.

Issue: Usually no architecture present, looking at cytologic features!!

Cytology specimens obtained via: cervical smear/brushings, fine needle aspirations

21

Steps of Cytology

  1. Cervical PAP smear
  2. Slide screened by a cytology technologist, if abnormal → reviewed by a pathologist (looks for dysplasia)

22

What sort of things is the cytologist looking for in the cervical smear specimen

  • Nuclei:cytoplasm ratio
  • Nuclei enlargement
  • Nuclei variation

Is it normal, low grade dysplasia or high grade dysplasia

23

What happens if you have a smear, and see high-grade dysplastic lesion??

  1. Abnormal smears are refered to gynaecologist for colposcopy (examination of cervix with a specialised microscope).
  2. Cervix can be 'painted' with acetic acid to highlight abnoral areas 
  3. A biopsy is taken of the suspicious areas and sent to the lab

24

What happens to the biopsy of the high-grade dysplastic region?

It is looked at microscopically (histology) and it is decided/confrimed what CIN stage the tissue is at.

CIN I: some cytoplasm still present, most of the issue down further below.

CIN III: Full thickness abnormality, lots of cytoplasm lost, darker nuclei

25

Whats the treatment for the abnormal area? Follow up?

Area is surgically removed (Iletz or cone biopsy)

 

Followup: regular or annual cervical smears

26

What is this? why is this so bad?

Cervical Cancer. Because of its anatomical location it can easily invade into important surrounding structures (rectum, bladder etc)

27

What are the important risk factors asosociated with developing cervical cancer

  • Not have cervical smear tests regularly (3years)
  • Smoking can increase risk of persistant HPV

28

Mature Dermoid Cyst. Tries to recapitulate a human in the ovary.

29

What is a Mucinous Cystdenoa

Epithelial tumours of the ovaries

30

How can we classify Ovarian Epithelial Tumours

  • Mucinous vs Serous
    -Serous = tubal type epithlium (pseudostratified ciliated)
    -Mucinous = mucinous epithelium
  • Benign
  • Borderline
  • Malignant

31

Serous Carcinoma