Flashcards in Diseases of the female genital system 2 Deck (67):
What is endometriosis?
What is the epidiemiology of endometriosis?
6-10% of women, 30 – 40yo
What are the clinical features of endometriosis?
- 25% asymptomatic
- pelvic pain
- pain on passing stool
What is the treatment for endometriosis?
Medical (COCP - GnRH agonists/antagonists, progesterone antagonists)
surgical (ablation/ TAH-BSO)
What other diseases is endometriosis linked to?
- Ectopic pregnancy
- ovarian cancer
What is endometritis?
Inflammation of the endometrium
What are the acute causes of endometritis?
- Retained POC/placenta
- prolonged ROM
- complicated labour
What are the chronic causes of endometritis?
- retained gestational tissue
- endometrial TB
- IUCD infection
What is the difference in histology between acute and chronic endometritis?
Acute - neutrophils
Chronic - lymphocytes/plasma cells
What are the clinical features of endometritis?
- Abdominal/pelvic pain
- abnormal vaginal bleeding
What is the treatment of endometritis?
- remove cause
What are endometrial polyps?
Sessile/polypoid E2-dependent uterine overgrowths
What are the clinical features of endometrial polyps?
- Often asymptomatic
- intermenstrual bleeding
- post menopausal bleeding
- menorrhagia, dysmenorrhoea
What is the treatment for endometrial polyps?
- medical (P4/GnRH agonists)
- surgical (curettage)
What is leiomyomata?
Uterine fibroids - benign myometrial tumours with E2/P4-dependent growth
What is the epidemiology of leiomyomata?
~20% women 30-50’s
What are the risk factors for leiomyomata?
What are the clinical features of leiomyomata?
- Often asymptomatic
- menometrorrhagia (Fe def. anaemia)
- subfertility/ pregnancy problems
- pressure sx
What are the treatments for leiomyomata.
- Medical (IUS/NSAIDs/OCP/P4/Fe2+);
- non-medical (artery embolization, ablation, TAH)
What is the prognosis for leiomyomata?
- menopausal regression
- malignancy risk 0.01%
What is endometrial hyperplasia?
Excessive endometrial proliferation (increased E2, decreased P4)
What are the risk factors for endometrial hyperplasia?
- exogenous E2
- E2-producing tumours
- HNPCC (PTEN mutations)
How is endometrial hyperplasia classified?
- non-atypical hyperplasia (1-3% progress)
- atypical hyperplasia (23-48% are carcinoma on hysterectomy)
What are the symptoms of endometrial hyperplasia?
Abnormal bleeding - IMB/PCB/PMB
What is the treatment for endometrial hyperplasia?
- medical (IUS, P4),
- surgical (TAH)
What is the prognosis for endometrial hyperplasia?
- endometrial adenocarcinoma
What is the most common cancer of the female genital tract?
What are the two types of endometrial carcinoma?
- Type 1 - endometroid
- Type 2- serous
What is the difference in epidemiology between serous and endometroid carcinoma?
- endometroid - 75% of cases
- serous - 25% of cases
- endometroid - Pre/perimenopausal
- serous - postmenopausal
What mutations are found in endometroid carcinoma?
What mutations are found in serous carcinoma?
What is the E2 status of endometroid cancer?
What is the E2 status of serous cancer?
What are the grades of endometroid cancer?
What are the grades of serous cancer?
How is endometrial carcinoma staged?
FIGO (1 - 4)
What are the treatments for endometrial cancer?
- medical (P4), surgery (TAH-BSO), adjuvant therapy (chemo-/radiotherapy)
What is the prognosis for endometrial cancer?
- Stage 1 = 90% 5yr survival
- Stage 2-3 =
What is polycystic ovary syndrome?
Complex endocrine disorder; hyperandrogenism, menstrual abnormalities and polycystic ovaries
What is the epidemiology of polycystic ovary syndrome?
6-10% women (20-30% have polycystic ovaries)
What investigations are performed for PCOS?
- fasting biochemical screen (↓FSH, ↑LH, ↑testosterone, ↑DHEAS )
How is PCOS diagnosed?
Rotterdam criteria 2/3 of:
- polycystic ovaries
- hyperandrogenism (hirsuitism/ biochemical)
- irregular periods (>35 days)
What are the treatments for polycystic ovary syndrome?
- lifestyle (weight loss)
- medical (metformin, OCP, clomiphene)
- surgical (ovarian drilling)
What other conditions are linked to PCOS?
- endometrial hyperplasia/ adenocarcinoma
What is hypergonadotrophic hypogonadism?
Primary failure of gonads
What are the congenital causes of hypergonadotrophic hypogonadism?
- Turner syndrome (XO)
- Klinefelter’s syndrome (XXY)
What are the acquired causes of hypergonadotrophic hypogonadism?
What is hypogonadothrophic hypogonadism?
Hypothalamic/ pituitary failure -> secondary failure of gonads
What are the causes of hypogonadothrophic hypogonadism?
- Sheehan’s syndrome
- pituitary tumours
- brain injury
- empty sella syndrome
What is the presentation of hypogonadothrophic hypogonadism?
- amenorrhoea/absent menarche; delayed puberty
- decreased sex hormone levels +/-
- increased LH and FSH levels
What investigations are used in suspected hypogonadothrophic hypogonadism?
- Hormonal profiling
What is the treatment for hypogonadothrophic hypogonadism?
- Difficult - address cause
What are the origins of ovarian neoplasms?
Sex-cord stromal tumours
- Granulosa cell thecomas
- Sertoli-Leydig cell tumours
Surface epithelial stromal tumours
- Transitional cell
- Clear cell
Germ cell tumours
- Yolk sac tumours
What is the most common group of epithelial neoplasms?
What are the three major histological types of epithelial ovarian tumours?
- Serous (tubal)
- Mucinous (endocervical)
- Endometroid (endometrium)
What are sex cord stromal tumours?
- Rare; arise from ovarian stroma, which was derived from sex cord of embryonic gonad
- Can generate cells from the opposite sex
What are thecoma/ fibrothecoma/ fibromas?
- Benign, thecomas and fibrothecomas produce E2 (also rarely androgens)
- Fibromas hormonally inactive
- Comprised of spindle cells (plump spindle cells with lipid droplets = thecoma appearance)
What are granulosa cell tunours?
Low grade malignant, produces E2
What are Sertoli-Leydig cell tumours?
Produces androgens; 10-25% malignant
What is the 2nd commonest gynae cancer?
What are the risk factors for ovarian cancer?
- breast cancer
- E2-only HRT
- Lynch II syndrome
- obesity (weak)
- nulliparity (weak)
What are the protective factors for ovarian cancer?
What is the typical history for ovarian cancer?
- non-specific symptoms
- weight loss
- PV bleeding
- urinary frequency
What is the treatment for ovarian cancer?
What is the prognosis for ovarian cancer?
Overall 5 years 43% survival
What is the most common type of metastatic ovarian tumour and where do they spread from?
- Fallopian tube
- Pelvic peritoneum
- Contralateral ovary