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

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

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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

 

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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

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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.

 

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8

cyclical abdominal pain indicates issues with?

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Her period

9

Potential causes of painful heavy periods

Leimyoma (fibroids)

Endometriosis

Primary endometrial pathology

 

Leimyosarcoma unlikely

10

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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
 

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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

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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

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14

What do we suspect from this?

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-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

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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.

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17

What is this and what would it look like microscopically

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Endometrial adenocarcinoma.

Shaggy, thickened, heterogenic, invading into the myometrium.

 

Glands proliferate and become increasingly crowded and complex

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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)

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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

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23

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

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  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

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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

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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?

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

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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

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

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29

What is a Mucinous Cystdenoa

Epithelial tumours of the ovaries

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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

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