Disorders of the female genital tract 2 Uterus and ovaries Flashcards Preview

Clinical Pathology > Disorders of the female genital tract 2 Uterus and ovaries > Flashcards

Flashcards in Disorders of the female genital tract 2 Uterus and ovaries Deck (55):
1

What is endometriosis?

Ectopic presence of endometrium stroma/glands in other sites (mostly fallopian tubes/ovaries)

2

What are the clinical characteristics of endometriosis?

Stroma/glands are subject to hormone induced haemorrhagic breakdown -

- dysmenorrhea
-pain with sex (fibrosis), -pelvic pain
-infertility
-pain passing stool
-dysuria

3

What is the pathogenesis of endometriosis?

Ectopic endometrium (regurgitation of menses through fallopian tube and to other places) -> haemorrhage (subject to same hormone-induced changes in endometrium -> fibrosis

4

How is endometriosis investigated?

Laparoscopy

5

What is the treatment of endometriosis?

- Oral contraceptive pill
- GnRH agonist/antagonist
- Progesterone antagonist
- Surgery (Want to be fertile - remove ectopic sites; hysterectomy if not)

6

What are the usual causes for acute endometritis?

Retained contraceptive products/ instrumentation

Complicated labour

7

What is the associated histological findings of acute endometritis?

Neutrophils in the stroma/manifestations of acute inflammation

8

What are the main causes of chronic endometritis?

-Pelvic inflammatory disease
-TB/Chlamydia
- Inter uterine contraceptive device infection

9

What are the histological findings of chronic endometritis?

Lymphocytes/plasma cels

10

What are the symptoms/signs associated with endometritis?

-Abdominal pain
-Dysuria
-Vaginal discharge
-Abnormal vaginal bleeds
-Pyrexia

11

What is the treatment for endometritis?

Analgesia
Antibiotics
Remove cause

12

What are endometrial polyps?

Sessile/polypoidal uterine overgrowths that are oestrogen dependent

Occur in 10% women (40-50s)

13

What are the symptoms of endometrial polyps

-Can be asymptomatic
- Inter-menstrual bleeding
- postmenopausal bleeding
- Dysmenorrhoea
- Menorrhagia

14

How are endometrial polyps diagnosed?

Ultrasound
Hysteroscopy

15

What is the treatment for endometrial polyps?

GnRH agonist/progesterone
Surgical

16

What are leiomyomata (uterine fibroids)?

Benign myometrial tumours with oestrogen and progesterone dependent growth

Usually gone after menopause

17

What are the main risk factors for leiyomata (uterine fibroids)?

Anything that increase oestrogen production!
Genetic
Nulliparity (not having kids)
PCOS
Obesity

18

What are the main symptoms for leiomyomata? (uterine fibroids)

-Asymptomatic (can be)
-Menometrorrhagia (painful, heavy bleeds - result in anaemia)
-Infertility
-Problems with pregnancy

19

What is the treatment for leiomyomata (uterine fibroids)?

Dependent on age (regress post menopause)

-IUS
-NSAIDs
-Oral combined contraceptive pill/progesterone

Surgical - artery embolization, ablation, hysterectomy

20

What is endometrial hyperplasia and whats it caused by?

Excess proliferation of endometrium

Caused by increased oestrogen and reduced progesterone

21

What are the risk factors for endometrial hyperplasia?

Obesity
PCOS
Oestrogen producing tumours
Exogenous oestrogen

22

How are endometrial hyperplasia categorised?

Non-atypical hyperplasia (low risk of turning malignant)

Atypical hyperplasia (high risk)

23

What are the signs of endometrial hyperplasia?

Abnormal bleeding (inter menstrual bleeds, post coital bleeds, post menopausal bleeds)

24

What are the investigations that should be performed for endometrial hyperplasia?

Ultrasound
Biopsy

25

What is the treatment for endometrial hyperplasia?

Medical (ICU, progesterone)
Surgical - hysterectomy

26

What can endometrial hyperplasia progress to?

Endometrial carcinoma (adenocarcinoma) - histological seen as increased gland to storm ratio

27

What are the two types of endometrial carcinoma?

Type I (endometroid) and type II (serous)

28

What are the characteristics of type I endometrial carcinoma?
Incidence
Age
Pre-existing state
Mutations
Oestrogen status
Grades

Most common
Younger (pre menopause)
Endometrial hyperplasia
PTEN mutation
Oestrogen positive
Grade I - 3

29

What are the characteristics of type II endometrial carcinoma?
Incidence
Age
Pre-existing state
Mutations
Oestrogen status
Grades

Rarer
Older post menopausal
Endometrial atrophy
P53 mutation
Oestrogen negative
Grade 3

30

What symptoms are associated with endometrial carcinoma?

Post menopausal bleeding
Intermenstrual bleeding

31

How are endometrial carcinomas staged?

FIGO staging (1-4)

32

What is the treatment for endometrial carcinoma?

Progesterone
Hysterectomy
Chemotherapy

33

What are the 3 cardinal signs of polycystic ovary syndrome? (aka ROTTERDAM CRITERIA)

Hyerandrogenim
Menstrual abnormalities
Polycystic ovaries

Need 2 out of 3 for POS to be diagnosed!

34

What biochemical markers is POS associated with?

Increased testosterone DHEAS and LH

Reduced FSH

35

How is POS treated?

-Weight loss (ass with obesity)
-Combined oral contraceptive pill
-Metformin (diabetes meds)
-Ovarian drilling

36

What is primary gonadal failure? What is it characterised by?

Hypergonadotrophic hypogonadism (PRIMARY FAILURE)

Increased LH and FSH (failure of ovaries despite increased stimulation)

37

What are the causes of primary gonadal failure?

Congenital - Turners and Klinefelters syndorme

Acquired - infection, surgery, chemotherapy

38

What are the characteristics of secondary of the gonads? What is it characterised by?

Hypogonadotrophic hypogonadism

- Failure of pit gland/hypothalamus (low LH/FSH)

39

What are the causes go secondary gonadal failure (hypogonadatrophic hypogonadism)

- Sheeran's syndrome
- Pit tumours
- Brain injury
- PCOS

40

What are the presentations of gonadal failure (primary and secondary)

Amenorrhea/absent menarche
- reduced sex hormones
- Delayed puberty
- +/- FSH/LH levels

41

What is the treatment for gonadal failure?

HRT

42

What are the three types of ovarian neoplasms?

-Surface epithelium stromal tumours **

- Germ cell tumours

- Sex-cord stromal tumour

43

What are the three types of epithelial stromal tumours (ovarian neoplasms)?

Mucionous
Serous
Endometrial

Can be benign, borderline or malignant

44

How are beinign endometrial stromal tumours in the ovary classified if they are more..
- Cystic
- Fibrous
- Both cystic and fibrous

-Cystadenomas

-Adenofribroma

-Cystadenofibromas

45

What are malignant epithelial tumours known as?

Cystoadenocarcinomas

46

What are the two types of germs cell tumours?

Germinous e.g. dysgerminomas - oogonia, malignant, responsive to chemo

Non-germinous e.g. teratomas,yolk sac tumours, choriocarcinomas

47

What are the two types of teratomas?

Mature - multiple structure e.g. hair, teeth (multiple germs layers) - BENIGN

Immature - MALIGNANT - abnormal foetal/embryological tissue

48

What are yolk sac tumours?

Differentiate into extra embryological yolk sac - malignant, responsive to chemo

49

What are choricoadenomas

Differentiate toward placenta - malignant but NOT responsive to chemo

50

What are the sex chord stromal tumours comprised of?

Thecomas/fibromas/fibrothecoma - produce oestrogen, spindle appearance

Granuloma cell tumours - low grade, produces oestrogen

Sertoli (sperm, FSH) -leydig (testosterone, LH) tumours - produces androgens

51

What are the risk factors of ovarian cancer?

Family history
Age
Smoking
Breast cancer (PMH)
Oestrogen only HRT
Obesity
Pull parity

52

What are the symptoms of ovarian cancer?

Very non-specific - pain, bloating, weight loss

53

How is ovarian cancer staged?

FIGO

54

What is the treatment for ovarian cancer?

Chemo
Omentectomy
Appendectomy
Lympadenectomy
Hysterectomy

55

What are the most common places where mullein metastatic tumours occur?

GI tract
Breast
Melanoma
Kidney/lung (less common)

Decks in Clinical Pathology Class (50):