Female Pathology Flashcards

Question

Is congenital adrenal hyperplasia associated with breast hypoplasia?

Answer 1

Nipple inversion from birth is a benign congenital anomaly. A new nipple inversion in someone who has never had an inverted nipple may be a sign of cancer.

Answer 2

- acute mastitis - granulomatous conditions - peuidcutal mastitis - fat necrosis

Answer 3

This is acute inflammation of the breast and is associated with redness, swelling, pain and tenderness. This is often associated with breast feeding. It is usually a bacterial infection and the bacteria are able to invade trough small erosion and fissuring skin. The stagnant milk allow growth. Symptoms include redness, tenderness, cellulitis and risk of abscess.

Answer 4

This is often associated with breast feeding. It is usually a bacterial infection and the bacteria are able to invade trough small erosion and fissuring skin. The stagnant milk allow growth.

Answer 5

This is characterised by formation of granulomas. Causes include systemic granulomatous disease (for example tuberculosis and sarcoidosis), idiopathic granulomatous mastitis (when infection has been clinically excluded and treatment is steroids) and reactions to ruptured implants can be granulomatous (breast implants have a risk of bursting).

Answer 6

Causes include systemic granulomatous disease (for example tuberculosis and sarcoidosis), idiopathic granulomatous mastitis (when infection has been clinically excluded and treatment is steroids) and reactions to ruptured implants can be granulomatous (breast implants have a risk of bursting).

Answer 7

The central ducts become inflamed, blocked and dilated. This is associated with chronic inflammation and scarring. There is a known relationship to smoking. Symptoms include: - Redness, swelling, tenderness around the nipple - Sometimes a mass underneath the nipple - Sometimes nipple retraction - Sometimes nipple discharge This is one of the causes of breast abscess – along with acute lactational mastitis.

Answer 8

This is an inflammatory reaction caused by damage to the breast fat. Any sort trauma may cause it, including external trauma, previous surgery and other inflammatory condition.

Answer 9

Inflammatory cancer is not a type of cancer, but it is where lots of lymphatics are blocker by a tumour. The breast is diffusely oedematous red and tender. It mimic inflammatory conditions. This is where the inflamed breast is actually cancer. It is where lots of lymphatic get blocked and there is unilateral breast tenderness.

Answer 10

- fibrocystic change | - racial scar

Answer 11

This is very common and has many microscopic appearances. The pathology is most likely due to an aberrant response of normal breast tissue to fluctuations in cyclical hormones. Clinically, there is a lumpy/bumpy appearance, breast pain, breast cysts and symptoms being worst before menstruation. Microscopically, there can be: - Small and large cysts - Adenosis: more glands/lobular tissue (or sclerosing adenosis where the many glands are small and squashed) - Epithelial hyperplasia: duct or lobular epithelial gets thicker and forms unusual shapes - Apocrine metaplasia: where the epithelial cells of cysts change to look like apocrine sweat glands

Answer 12

Aberrant response of normal breast tissue to fluctuations in cyclical hormones

Answer 13

This is where there are more glands and lobular tissue

Answer 14

This is where the increased number of glands becomes small and squashed

Answer 15

- Apocrine metaplasia: where the epithelial cells of cysts change to look like apocrine sweat glands

Answer 16

Clinically, there is a lumpy/bumpy appearance, breast pain, breast cysts and symptoms being worst before menstruation.

Answer 17

Before mensuration

Answer 18

A racial scar is a growth that looks like a scar when the tissue is viewed under a microscope. This is important form of proliferate breast disease larger become mammographically they look like small cancers. The features are: - Fibrosis and elastic material at the centre - ‘star shaped’ or ‘flower head’ appearance - Trapped glands only ‘pseduo-infiltrative’ - Myoepithelial cells present in a way that is not seen in cancer

Answer 19

The features are: - Fibrosis and elastic material at the centre - ‘star shaped’ or ‘flower head’ appearance - Trapped glands only ‘pseduo-infiltrative’ - Myoepithelial cells present in a way that is not seen in cancer

Answer 20

Yes: this is significant as myoepithelial cells are not seen in cancer

Answer 21

- fibroadenoma - phyllodes tumour - intraduit papilloma

Answer 22

This is the commonest benign neoplasm and is commoner in young patients. It is often asymptomatic but can cause a lump. Fibroadenoma is the most common type of benign breast tumor, and most don't increase your risk of breast cancer. It is a tumour of the fibrous tissue and the gland tissue. The lump is firm but not hard and is mobile -hence called a ‘breast mouse’. Breast cancer is rock hard, fixed and tethered. Microscopically: - Giant lobule: all the tissue expanded and distorted - Ducts, glands and lots of variability cellular fibrous tissue Rare fibroadenomas in adolescent girls may become very large (100mm+ - giant fibroadenoma). Juvenile fibroadenoma is a related entity in girls <18 years of age and often large.

Answer 23

Breast cancer is rock hard, fixed and tethered.

Answer 24

The lump is firm but not hard and is mobile -hence called a ‘breast mouse’.

Answer 25

Phyllodes tumour is very similar to fibroadenoma but is commoner in older patients. They are more cellular, more mitotic and more atypical than fibroadenoma. They are fast growing masses that form from the periductal stromal cells. They are also often larger. While ALL fibroadenomas are benign only MOST Phyllodes behave in a benign fashion. SOME phyllodes are frankly malignant.

Answer 26

This is another relatively common benign neoplasm. It is a frond like growth usually in large ducts below the nipple. Patients will often present with nipple discharge. It benign but is often removed to ensure nothing worse lurking. Papillomatosis is different. This is multiple papilloma’s in small ducts at the periphery of the breast. This is not dysplasia as such but does slightly increase cancer risk for the patient

Answer 27

Papillomatosis is different. This is multiple papilloma’s in small ducts at the periphery of the breast. This is not dysplasia as such but does slightly increase cancer risk for the patient

Answer 28

This is where there are cysts alongside the nipple and can be mistake for cancer.

Answer 29

Phyllodes tumour is common more in older patients. They are more cellular, more mitotic and more atypical. There is a higher chance of Phyllodes tumour turning malignant.

Answer 30

Breast cancer is the most commonly diagnosed cancer in women in the UK (but not the cancer with the highest mortality which is lung cancer).

Answer 31

Breast cancer is rare in women in their 20s and uncommon in the 30s. Incidence rises steadily from the later 30s to about 60, after which it does not change much.

Answer 32

Median age for breast cancer diagnosis is mid-60s.

Answer 33

- Reproductive: early menarche, late menopause, late 1st pregnancy - Hormonal: HRT therapy, oral contraceptive use - Anatomical/physiological: dense breast on mammography - Behavioural: alcohol, smoking - Genetic: positive family history, some rare genetic conditions (BRCA 1 and 2, Li Fraumeni)

Answer 34

Early menarche, late menopause and late 1st pregnancy (<30 years)

Answer 35

HRT and oral contraceptive therapy

Answer 36

Dense breast on mammography

Answer 37

Alcohol and Smoking and obesity

Answer 38

Positive family history. | Some rare genetic (BRCA and Li Fraumeni and Cowden syndrome)

Answer 39

In the breast: - Lump - Thickening - Skin changes: ‘peu d’organe’ (rare), redness At the nipple: - skin changes: rash, redness - new inversion - discharge: occurs when the tumour invades the duct In the axilla: - as a lump: the local lymph nodes for the breast are in the axilla.

Answer 40

Peu d’Orange is where the skin over the lump gets dimples and resembles a orange. It will appear red and swollen.

Answer 41

Breast cancer can be discovered at breast screening. The Scottish Breast Screening Programme invites women aged between 50 and 70 years old for screening every three years. Women over 70 years old are able to attend through self-referral. Tumours discovered at screening are often: - asymptomatic - small - lower grade and stage than symptomatic tumours

Answer 42

Every three years

Answer 43

- asymptomatic - small - lower grade and stage than symptomatic tumours

Answer 44

Core biopsy

Answer 45

A triple assessment is for breast cancer where pathology, radiology and examination are carried out at the same time and diagnosis can be given

Answer 46

Wide local excision: the aim is to take just the tumour with a rim of normal tissue in order to preserve the remaining breast. It usually combined with radiotherapy in order to minimise the risk of recurrence. Pathological assessment of the margins is important.

Answer 47

Mastectomy (removal of the whole breast) usually takes places when tumours are large, multiple or extensive. Neo-adjuvant chemotherapy can shrink some of these large tumours to make wide local excision possible. Other tumours size, extent or location may mean that mastectomy is clinically safest. Multiple tumours and smaller breasts, have a better outcome with mastectomy.

Answer 48

Axillary surgery is involved when the breast cancer spread to local lymph nodes via lymphatics (the ones for the breast are the axilla). Formerly the only option was to excise all of the nodes in the axilla to ensure that all the nodes with cancer were removed. This “Axillary clearance” sometimes caused poor post op arm function or gross arm oedema. The modern alternative is Sentinel node biopsy. Sentinel node biopsy. The sentinel node is the node that cancer will likely spread to first before it involves any other axillary nodes. Identifying and removing the sentinel node allows pathologists to assess whether or not there is tumour in the sentinel node

Answer 49

The removal of a sentinel node involves injecting blue ink into the breast and operating. During the operation, the surgeons will trace the dye from the breast into the first node that turns blue.

Answer 50

If sentinel node is negative, no further treatment is required

Answer 51

If it is positive, then further surgery and clearance is required. Axillary radiotherapy can be done. Treatment is stopped when oncological treatments in play mop up any residual carcinoma

Answer 52

Radiotherapy: this is given to the breast following a WLE to reduce risk of recurrence. It is always given to the axilla if the positive nodes have been found.

Answer 53

Hormonal therapy: In tumours with high levels of residual hormone receptors (oestrogen receptor/progesterone receptor +) the use of drugs which block hormone function such as tamoxifen may be used. These are often used after surgery for ER, PR + tumours. In post-menopausal women there is no endogenous oestrogen from the ovaries but oestrogen can be produced in soft tissue (fat etc). Aromatase inhibitors such as Letrozole can inhibit this process in post-menopausal women and reduce recurrence after surgery.

Answer 54

Block hormones. | - hormone positive breast cancer

Answer 55

Soft tissue for example fat

Answer 56

Aromatase inhibitor

Answer 57

- Before surgery to reduce the size of a tumour

Answer 58

- After surgery to reduce the risk of metastasis at a distant site. Not all patients will benefit and stratification of risk is important using various prognostic factors (grade, stage etc) to identify “high risk” tumours. - Particularly useful in “triple negative” breast carcinoma which lack targets for the usual hormonal therapies (ER, PR, HER 2 –Negative) and are thus difficult to treat.

Answer 59

- Ductal carcinoma in-situ (DCIS) - Lobular carcinoma in-situ (LCIS) Both of these come from TDLU.

Answer 60

Dysplastic represents the stage before invasive malignancy. There is malignant looking proliferation of epithelial cells within the basement membrane. There is no extension into the breast stroma, no communication with blood vessels or lymphatics and no possibility of metastases.

Answer 61

Lobular carcinoma in situ (LCIS) is an area (or areas) of abnormal cell growth that increases a person’s risk of developing invasive breast cancer later on in life. Lobular means that the abnormal cells start growing in the lobules, the milk-producing glands at the end of breast ducts. Carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs — such as breast tissue. In situ or “in its original place” means that the abnormal growth remains inside the lobule and does not spread to surrounding tissues. LCIS of less clinical concern than DCIS. It is more of a risk factor for malignancy. The person will be at a higher risk of breast cancer. LCIS usually does not cause any signs or symptoms, such as a lump or other visual change to the breast. Doctors usually find LCIS through an abnormal mammogram.

Answer 62

Ductal carcinoma in situ (DCIS) is non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts. DCIS is more significant and usually requires treatment. Up to between 14 -50 % of patients with DCIS will develop invasive cancer if left untreated DCIS can be extensive and form a significant mass or lesion without progressing to invasive cancer. It can co-exist with invasive malignancy. It is usually treated with surgery but without axillary surgery. DCIS generally has no signs or symptoms. It's not common, but some women will feel a lump or have nipple discharge; but typically, DCIS is found on a mammogram.

Answer 63

* Around 70-80% of all breast cancer * Also called invasive carcinoma NST – “No Special Type” * Classic histological features of malignancy: variation in size, necrosis

Answer 64

Ductal carcinoma (accounting for around 70-80%)

Answer 65

* Around 10 -15% of all breast cancer * More likely to be Bilateral and Multifocal * Does not have the classical features of malignancy * Small * Bland: the cells look the same * Discohesive cells – loss of cell adhesion molecule E-Cadherin

Answer 66

- small cells - bland cells - discohesive cells (loss of E-cadherin)

Answer 67

E-cadherin

Answer 68

- Papillary / micropapillary - Tubular - Medullary - Mucinous

Answer 69

- Sarcoma - Lymphoma - Malignant phyllodes

Answer 70

ER + • “Luminal A” – Better prognosis • “Luminal B” – Less good prognosis

Answer 71

Triple negative” – Her2, PR, ER all negative • Basal Type – aggressive – includes some BRAC cancers • Normal breast type

Answer 72

Some breast and stomach cancers have large amounts of human epidermal growth factor receptor 2 (HER2). They are called HER2 positive cancers. HER2 makes the cancer cells grow and divide. Trastuzumab (Herceptin) is a type of targeted cancer drug called a monoclonal antibody. It works by attaching to HER2 so it stops the cancer cells from growing and dividing.

Answer 73

* Grade 1 – slow growing * Grade 2 – intermediate growing * Grade 3 – fast growing

Answer 74

Slow growing

Answer 75

Intermediate growing

Answer 76

Fast growing

Answer 77

Devised by Ellis and Elston in Nottingham the Nottingham Prognostic Index (“NPI”) is a way of combining grade and stage together into a single number that can be used as a shorthand to stratify prognosis. NPI = [0.2 x S] + N + G • Where: • S is the size of the index lesion in centimetres • N is the node status: 0 nodes = 1, 1-3 nodes = 2, >3 nodes = 3 • G is the grade of tumour: Grade I =1, Grade II =2, Grade III =3

Answer 78

Size of lesion in cm

Answer 79

Node staus

Answer 80

Grade of tumour

Answer 81

This is the lower part of the vagina. It is around 2-3cm and is roughly cylindrical in shape.

Answer 82

Prior to puberty, the ectocervix is covered by non-keratinizing stratified squamous epithelium

Answer 83

the endocervix is lined by columnar (glandular) epithelium.

Answer 84

With growth of the cervix after puberty the squamo-columnar junction is everted into the vagina and the squamous epithelium adapts to the vaginal environment by squamous metaplasia in the 'transformation zone'. Columnar cells are constantly changing into squamous cells in an area of the cervix called the transformation (transitional) zone.

Answer 85

The transformation zone, a zone of unstable differentiations.

Answer 86

Human papillomavirus infection (HPV infection) is an infection caused by the human papillomavirus(HPV).

Answer 87

Cancer of the oropharynx, larynx, vulva, vagina, cervix, penis, and anus

Answer 88

Sexually transmitted infection of HPV to the stratified epithelial tissue.

Answer 89

Persisting infection with an oncogenic strain of HPV is thought to be a necessary cause of cervical cancer and precancer. This means that persistent and repeated infections of HPV are likely to give cancer rather than just one case.

Answer 90

CIN: cervical intraepithelial neoplasia

Answer 91

Nuclear abnormalities

Answer 92

The CIN 1 grade is used to describe mild dyskaryosis, which signifies mild changes to the cervical cells. This affects only one-third of the cervical surface area. These changes definitely do not signify cancer and in the majority of cases will not cause cancer in the future. CIN1 usually corresponds to infection with Human Papilloma Virus (HPV) and will often resolve by itself within six months.

Answer 93

All (more than 2/3)

Answer 94

A CIN 2 grade refers to two-thirds of the thickness of the surface layer of the cervix showing cell changes. It is used to describe moderate dyskaryosis and again, does not mean cancer.

Answer 95

CIN 3 refers to severe dyskaryosis and affects the full thickness of the cervix surface. Even with this result, it is unlikely that a woman already has cervical cancer. However, it is important to treat severe dyskaryosis as soon as the changes are detected.

Answer 96

5-6 times clockwise

Answer 97

The current policy in Scotland is that women aged 25 -65 are invited. That is inclusive of those that have been vaccinated. • Age 25 to 50 three yearly • Age 50 to 65 five yearly

Answer 98

Every 3 years

Answer 99

Every 5 years

Answer 100

Routine screening

Answer 101

Repeat in 6 months

Answer 102

Refer to colposcopy

Answer 103

Colposcopy

Answer 104

Colposocpy

Answer 105

Squamous carcinoma

Answer 106

Adenocarcinoma

Answer 107

2008 | - catch up programme for older girls

Answer 108

Scotland is now using a quadrivalent vaccine to cover against HPV 6, 11, 16 and 18. Is it mostly delivered in the schools in S1. HPV 6 and 11 are for genital warts. HPV 16 and 18 are for cancer.

Answer 109

12/13 year olds

Answer 110

1. Cervix visualised 2. Washed with acetic acid 3. Application of iodine 4. Green light filter 5. Abnormal area can be biopsied or treatment performed at the time or at further appointment

Answer 111

Acetic acid

Answer 112

Green light

Answer 113

Early genes E1 to E7 interact with intracellular molecules to interfere with cell proliferation machinery to replicate the virus.

Answer 114

Late genes L1, L2 encode capsid proteins. Disruption of cell cycle checkpoints may contribute to accumulation of oncogenic mutations and carcinogenesis

Answer 115

Whitsh appearance. | This is will get more dense as the grade increases.

Answer 116

Mosaic pattern

Answer 117

The most common treatment is large loop excision of the transformation. Zone. This involves removing the abnormal cells through a thin wire loop that is heated with electrical current.

Answer 118

``` Immediate – Pain – Haemorrhage Delayed – Secondary haemorrhage (1-2%) – Infection – Cervical stenosis (~1%) – No good evidence of impact on fertility ```

Answer 119

Endocervical glandular epithelium also undergoes premalignant change-Cervical Glandular Intraepithelial Neoplasia (cGIN ). The malignant change from glandular epithelium is Adenocarcinoma. Signs include pseuostratification, abnormal Rosette, smaller cells and darker nuclei

Answer 120

* Post coital bleeding (after sexual intercourse) * Intermenstrual bleeding. * Irregular vaginal bleeding. * Pain. * None.

Answer 121

Low oestrogen after the menopause may lead to atrophic vaginitis with discomfort, dyspareunia, and bleeding. Polyps and cysts are not uncommon.

Answer 122

VAIN and squamous carcinoma of the vagina are uncommon, but primary cancers of the cervix or vulva can involve the vagina. Infections including bacterial vaginosis, thrush, and trichomonas vaginalis are sometimes identified in smears.

Answer 123

Infections including bacterial vaginosis, thrush, and trichomonas vaginalis are sometimes identified in smears.

Answer 124

Threads appearing. Thrush is a fungal infection and it will cause the discharge to have a cottage cheese appearance. No smell will be present.

Answer 125

Actinomyces: this is a bacteria infection and cells appear star shaped. There is a link with this infection and the coil.

Answer 126

* Occurs almost exclusively in females less than 60 years old. * Associated with high incidence of lower genital tract neoplasia particularly CIN and invasive cervical cancer. * Usually related to high risk type HPV 16/18. * Warty or basaloid cancers.

Answer 127

* Occurs in an older age group – most over 60, many over 70. * Most of the cancers are well differentiated and keratinising. * Not associated with HPV infection or VIN. * Adjacent squamous hyperplasia and/or lichen sclerosus common.

Answer 128

Lichen sclerosus is a skin condition that causes itchy white patches on the genitals or other parts of the body.

Answer 129

Salpingitis

Answer 130

Inflammation of the fallopian tube

Answer 131

Bacterial infection. | - chlamydia, gonorrhoea

Answer 132

Tuberculous salpingitis uncommon, usually associated with tuberculosis of the endometrium.

Answer 133

- fever - lower abdominal pain - pelvic pain - pelvic masses will occur if they are distended with exudate or secretions

Answer 134

 Adherence of tube to ovary; tubo-ovarian abscess  Adhesions involving tubal plicae increase risk of tubal ectopic pregnancy  Damage or obstruction of tube lumen may produce infertility with may not be easy to treat

Answer 135

There is increased risk of ectopic pregnancy. This is because the lumen is different and this can interfere with the transport of the oocyte.

Answer 136

BRCA1 mutations

Answer 137

• STIC: serous tubal intraepithelial carcinoma. This is a lesion limited to the fallopian tube epithelium that is a precursor to extrauterine (pelvic) high grade serous carcinoma. It is confined the epithelium. Common mutations for the type of cancer are ones related to p53.

Answer 138

This is where the follicles are

Answer 139

This is where there are vessels and connective tissue

Answer 140

A non-neoplastic disorder that usually affects postmenopausal women. It is characterized by proliferation of ovarian stromal cells without evidence of atypia. There is usually bilateral ovarian involvement. The ovaries may or may not be enlarged

Answer 141

Inclusion, Follicular and Luteal cysts

Answer 142

A follicular cyst occurs when follicle fails to rupture and contains to grow

Answer 143

A luteal cyst will form when the corpus lutuem fails to involute and continues to grow.

Answer 144

• Over-production of androgens by multiple cystic follicles in the ovaries (reasons unclear); LH high, FSH low.

Answer 145

- enlarged ovaries - multiple subcortical cysts - thickened, fibrotic outer surface - cysts lined by hypertrophic. and hyper plastic luteinized theca interna - absence of corpora luted and corpora albicans (due to ovulation not occurring)

Answer 146

Ovarian Adnexal Torsion: this is where the ovary is twisted around its ligamentous support. Risk factors include ovarian neoplasm and cysts. Symptoms include abdominal pain, nausea, vomiting and tenderness.

Answer 147

Tubal pregnancy: this is where the pregnancy is located in the fallopian tube.

Answer 148

5th most common cancer in women | - fifth leading cause of death in women

Answer 149

* 1- surface (coelomic) epithelium * 2- germ cells * 3- sex cord/stromal cells.

Answer 150

Nulliparous is the medical term for a woman who has never given birth either by choice or for any other reason.

Answer 151

Reduces risk

Answer 152

Mostly related to BRCA1 and BRCA2 gene mutations. | Lifetime risk of ovarian cancer is ~30% in BRCA1 carriers; lower in BRCA2 carriers.

Answer 153

Poor | • HER2 overexpressed in 35% of ovarian cancers

Answer 154

Mucinous cystadenocarcinomas.

Answer 155

High grade serous cancers

Answer 156

60% - 25% malignant - 15% borderline

Answer 157

This is the presence of endometrial tissue outside the uterus

Answer 158

This is the present of endometrial tissue within the myometrium

Answer 159

Adenomyosis

Answer 160

``` Ovaries Peritoneal surfaces (uterine ligaments and rectovaginal septum) Large and small bowel Appendix Mucosal of the cervix ```

Answer 161

This is painful menstruation

Answer 162

Dysmenorrhoea

Answer 163

Clinical symptoms include dysmenorrhoea (painful menstruation), pelvic pain and infertility.

Answer 164

- The metastatic theory: retrograde menstruation or surgical procedures introduce endometrium to site out with the uterine cavity

Answer 165

- The metaplastic theory: endometrium arises directly from the coelomic epithelium (i.e. peritoneum) of the pelvis, as this is where the endometrium originates from during embryological development

Answer 166

In the myometrium

Answer 167

These are exophytic masses of variable size which project into the endometrial cavity. They are benign.

Answer 168

Yes. This is a drug for breast cancer.

Answer 169

Abnormal bleeding

Answer 170

haphazardly arranged glands with preservation of low gland to stormal ratio

Answer 171

A hysteroscopy is a procedure used to examine the inside of the womb (uterus).

Answer 172

Thick walled

Answer 173

Become fibrous

Answer 174

The glands are usually inactive, but can also show proliferation, secretory changes or metaplasia.

Answer 175

Prolonged oestrogen stimulation of the endometrium

Answer 176

Prolonged oestrogen stimulation of the endometrium and this usually follows endometrial hyperplasia

Answer 177

Endometrial Hyperplasia and Adenocarcinoma

Answer 178

The possible underlying causes: - Anovulatory cycles (absence of ovulation) - Endogenous sources of oestrogen: obesity, PCOS, oestrogen secreting ovarian tumours - Exogenous sources of oestrogen such as oestrogen only HRT

Answer 179

- Endogenous sources of oestrogen: obesity, PCOS, oestrogen secreting ovarian tumours

Answer 180

- Exogenous sources of oestrogen such as oestrogen only HRT

Answer 181

Atypical endometrial hyperplasia is a known precursor of endometrioid adenocarcinoma, and 5-10% of those with this diagnosis will also have endometrioid adenocarcinoma in subsequent hysterectomy specimens.

Answer 182

• Hyperplasia – progesterone therapy such as Mirena, IUS, or hysterectomy

Answer 183

• Endometrial adenocarcinoma – hysterectomy, with subsequent management depending on tumour grade and stage

Answer 184

The nuclei will be darker and irregular. There will be areas of necrosis. There is invasion of the myometrium.

Answer 185

``` This is a benign smooth muscle tumour of the myometrium. It is very common, at least 25% of women, mostly of reproductive age and the incidence is over 70% by the age of 50. It may be single or multiple. Symptoms: - Asymptomatic - Abnormal bleeding - Urinary frequency if large - Impaired fertility ```

Answer 186

- Asymptomatic - Abnormal bleeding - Urinary frequency if large - Impaired fertility

Answer 187

Management: - Varies depending on number, size and symptom - Medical: progesterone secreting IUS, hormonals therapies, tranexamic acid GnRH agonists

Answer 188

This is an uncommon malignant smooth muscle tumour of the myometrium (1-2% of uterine malignancies and is the commented uterine sarcoma). The peak incidence is age 40-60 years and can be pre- or post- menopausal. The symptoms include - Initially none - Bleeding or pain Pathology: - Macro: bulky invasive masses or polypod necrosis, haemorrhage and variable cut surface - Micro: overt cytological atypia, necrosis, mitotic activity, infiltrative margin Prognosis: - Spread to lungs, liver and brain, 40% 5 year survival.

Answer 189

The peak incidence is age 40-60 years and can be pre- or post- menopausal.

Answer 190

Endometrial stromal sarcoma is a rare form of cancer that occurs due to abnormal and uncontrolled cell growth in the uterus. Endometrial stromal sarcoma, specifically, develops in the supporting connective tissue (stroma) of the uterus. This is a group of tumours of the endometrial stroma. It is rare (0.2-1.5% of uterine malignancies and <10% of uterine sarcomas). It can be low grade (more common) or high grade (rare). Both have a diffusely infiltrative ‘worm like’ growth pattern macroscopically and microscopically. Microscopically there is also low-grade tumour cells resembling cells of proliferating endometrial stroma, with mitoses.

Answer 191

Both have a diffusely infiltrative ‘worm like’ growth pattern macroscopically and microscopically.

Answer 192

Molar pregnancy is an abnormal form of pregnancy in which a non-viable fertilized egg implants in the uterus and will fail to come to term. A molar pregnancy is a gestational trophoblastic disease which grows into a mass in the uterus that has swollen chorionic villi. These villi grow in clusters that resemble grapes.

Answer 193

Gestational trophoblastic disease

Answer 194

Hydatidiform mole (HM) is a rare mass or growth that forms inside the womb (uterus) at the beginning of a pregnancy. It is a type of gestational trophoblastic disease (GTD). First a fertilised egg implants into the uterus, but some cells around the fetus (the chorionic villi) do not develop properly. The pregnancy is not viable, and the normal pregnancy process turns into a benign tumour. Hydatidiform moles present with either spontaneous miscarriage or abnormalities detected on ultrasound.

Answer 195

Partial mole: fertilisation of one egg by two sperm, resulting in a triploid karyotype. Microscopy shows oedematous villi and subtle trophoblast proliferation. There is a risk of invasive mole, which invades and destroys the uterus

Answer 196

Fertilisation of an egg with no genetic material, usually by one sperm which duplicates its chromosomal material. 10% occur when an egg with no genetic material is fertilised by two sperm. Diploid karyotype, usually 46 XX. Microscopy shows markedly enlarged oedematous villi with central cisterns and circumferential trophoblast proliferation. Carries a 10% risk of invasive mole and a 2.5% risk of choriocarcinoma (which is frankly malignant, rapidly invasive and metastastises widely, but is treatable with chemotherapy).

Answer 197

Grape like

Answer 198

* 1- surface (coelomic) epithelium * 2- germ cells * 3- sex cord/stromal cells

Answer 199

- reduces risk

Answer 200

. Epithelial ovarian cancers can be subdivided into four types: serous, mucinous, endometrioid and transitional.

Answer 201

Serous and mucinous tumors arise emerge from epithelial cells that line the outside of ovaries,

Answer 202

The endometrioid and transitional cell tumors arise from other cell types.

Answer 203

Most women with ovarian cancer present late and in many the prognosis is poor. Successful early diagnosis has not been achieved in ovarian cancer.

Answer 204

Benign serous tumours are called serous cystadenomas, are most common, and often develop on both ovaries, and typically affect premenopausal women.

Answer 205

The malignant type of serous tumors are called serous cystadenocarcinomas.

Answer 206

HGSC account for about 70% of all ovarian cancers; mutations in p53 and BRCA1 are atypical

Answer 207

Mutations in BRAF and K-RAS are common in borderline tumours and LGSC.

Answer 208

Benign serous tumours: large, cystic, (up to 30 - 40 cm). May be bilateral. Smooth shiny serosal covering. Cysts filled with a clear serous fluid, lined by a single layer of tall columnar epithelium. Some of the cells ciliated.

Answer 209

Serous carcinoma: Anaplasia of cells, obvious stromal invasion. and psammoma bodes

Answer 210

Psammoma bodies (concentrically laminated calcified concretions) common in the papillae of serous tumours in general.

Answer 211

Serous tumours of the ovary

Answer 212

Benign mucinous tumors are called mucinous cystadenomas, and often develop on one ovary.

Answer 213

Malignant mucinous tumors are called mucinous cystadenocarcinomas.

Answer 214

'Krukenberg tumours'

Answer 215

Morphology: large, multilocular, no psammoma bodies. Cysts lined by cells with abundant mucinous cytoplasm

Answer 216

Next are endometrioid tumors which come from endometrium-like cells which is ectopic, meaning out of place, because those sorts of cells are usually found in the endometrium. Benign endometrioid tumors often have cysts filled with dark blood, so although these are called endometriomas, they are sometimes referred to as chocolate cysts. Rarely, endometrioid tumors can be malignant, and the endometrial-like cells can spread out to other areas including the fallopian tubes and the peritoneal cavity.

Answer 217

Ovarian clear cell carcinoma is also associated with endometrioses.

Answer 218

95% ovarian germ cell tumours are mature cystic teratomas: ('dermoid cysts'). Totipotent germ cells differentiate into mature tissues of all 3 germ cell layers: ectoderm (skin, hair, teeth), endoderm (GI, respiratory epithelium), mesoderm (fat, muscle). Most found in young women as ovarian masses or are found incidentally on abdominal scans. May contain foci of calcification associated with bone or teeth. ~10% bilateral. Grossly: smooth capsule, often filled with sebaceous secretion and matted hair. Sometimes, foci of bone and cartilage, nests of bronchial or gastrointestinal epithelium, teeth and other recognizable lines of development also present, e.g. thyroid.

Answer 219

Dermoid cyst

Answer 220

About 5% of ovarian teratomas in adults are immature cystic teratomas with immature neuroectodermal elements, associated with more aggressive behaviour. Immature ovarian cystic teratomas (IMCT) are a less common subtype of ovarian teratomas with malignant clinical behaviour; they are histologically distinguished by the presence of immature or embryonic tissues, particularly neuroectodermal elements Teratomas in children are rare but much more often immature than in adults In ~1% there is malignant transformation of one of the tissue elements (squamous carcinoma, adenocarcinoma, sarcomas etc).

Answer 221

About 5% of ovarian teratomas in adults are immature cystic teratomas with immature neuroectodermal elements, associated with more aggressive behaviour. Immature ovarian cystic teratomas (IMCT) are a less common subtype of ovarian teratomas with malignant clinical behaviour; they are histologically distinguished by the presence of immature or embryonic tissues, particularly neuroectodermal elements

Answer 222

These include granulosa and theca cell tumours, which often secrete oestrogen, and (uncommonly) Sertoli-Leydig cell tumours, which may secrete androgens. Granulosa cell tumours usually occur in postmenopausal women and are not rare. Oestrogen over-production may lead to endometrial hyperplasia or endometrial carcinoma.

Answer 223

Hormone over-production

Answer 224

Transitional

Answer 225

These are uncommon mixed surface epithelial-stromal tumours. Usually benign, unilateral, size very variable, solid, circumscribed, yellowish. Often found incidentally. These tumors are made of transitional cells which can usually found in the lining of the bladder. They're quite rare and usually solid, as opposed to cystic like the others. Histologically, nests of transitional epithelial cells with longitudinal nuclear grooves (coffee bean nuclei) and abundant fibrous stroma.

Answer 226

Challenging because often asymptomatic until well advanced. Clinical presentations often similar despite biological diversity: local pressure symptoms (e.g., pain, gastrointestinal complaints, urinary frequency). Sometimes they become twisted on their pedicles (torsion), producing severe abdominal pain (acute abdomen). Functioning ovarian tumours often come to attention because of the hormones they produce. Abdominal swelling due to ascites is a common presentation of ovarian malignancy but ascites is also seen with benign tumours.

Answer 227

Pelvic inflammatory disease, also known as pelvic inflammatory disorder (PID), is an infection of the upper part of the female reproductive system, namely the uterus, fallopian tubes, and ovaries, and inside of the pelvis.[ Often, there may be no symptoms. Signs and symptoms, when present, may include lower abdominal pain, vaginal discharge, fever, burning with urination, pain with sex, bleeding after sex, or irregular menstruation. Untreated PID can result in long-term complications including infertility, ectopic pregnancy, chronic pelvic pain, and cancer. The disease is caused by bacteria that spread from the vagina and cervix. Infections by Neisseria gonorrhoeae or Chlamydia trachomatis are present in 75 to 90 percent of cases Tubo-ovarian abscesses are one of the late complications of pelvic inflammatory disease (PID) and can be life-threatening if the abscess ruptures and results in sepsis. It consists of an encapsulated or confined 'pocket of pus' with defined boundaries that forms during an infection of a fallopian tube and ovary.

Answer 228

Tubo-ovarian abscesses are one of the late complications of pelvic inflammatory disease (PID) and can be life-threatening if the abscess ruptures and results in sepsis. It consists of an encapsulated or confined 'pocket of pus' with defined boundaries that forms during an infection of a fallopian tube and ovary.

Answer 229

Choriocarcinoma is a fast-growing cancer that occurs in a woman's uterus (womb). The abnormal cells start in the tissue that would normally become the placenta. This is the organ that develops during pregnancy to feed the fetus. Choriocarcinoma is a type of gestational trophoblastic disease.

Answer 230

- Uncontrolled proliferation - Loss of original function (anaplasia) - Invasiveness - Metastasis (malignant cells)

Answer 231

Only sold tumours. For example blood cancer is not acceptable. It can also not be performed when there is metastases.

Answer 232

Irradiation can be used if the tumour is localised and non-metastasised.

Answer 233

A single cell, after 30 doublings, gives a cell mass of 109 cells – 2cm in diameter. This is detectable in skin and breast but would be non-detectable in organs like the liver.

Answer 234

Cancer is uncontrolled growth. The immune system is unbale to recognized this as it is the body’s own cells.

Answer 235

Apoptosis is the best anticancer process in the body. The cells will fail at certain check points and go through programmed cell death. For example, sitting in the sun damages the skin and cause DNA damage. The cells damaged will go through apoptosis. However, when one cell does not due to damage of a tumour suppressor gene from radiation, uncontrolled division will occur.

Answer 236

- Diving cells: progressing through the cell cycle (sensate to cell cycle specific drugs) - Resting cells: these are not diving but are able so (insensitive to many drugs and are at risk of relapses) - Cells which can no longer divide by contribute to tumour size (not a problem).

Answer 237

G1, S and G2 | - there is also G0

Answer 238

DNA synthesis

Answer 239

Non-diving stage

Answer 240

If there is a mutation in the tumour suppressor genes, damaged cells will be able to pass through the checkpoints.

Answer 241

Cell division. These dogs target rapidly diving cells.

Answer 242

- Bone marrow suppression (generation of blood cells diminished): anaemia, immune depression, prone to infection, impaired wound healing (less platelets) - Loss of hair - Damage to gastro-intestinal epithelium - Liver, heart and kidney damage - In children: depression of growth - Sterility - Teratogenicity (damage to embryo)

Answer 243

- bone marrow suppression. This can lead to less blood cell generation, leading to anaemia, immune depression, prone to infection and impaired wound healing.

Answer 244

- bone marrow suppression. This can lead to less blood cell generation, leading to anaemia, immune depression, prone to infection and impaired wound healing.

Answer 245

Depression

Answer 246

Actively dividing cells are sensitive to many anticancer drugs. Drugs that are only active on dividing cells are known as cell-cycle specific drugs.

Answer 247

Resting phase cells are less sensitive to anticancer drugs. Drugs that work on resting cells are known as cell cycle-non specific.

Answer 248

- Alkylating agents - Antimetabolites - Cytotoxic antibiotics - Microtubule inhibitors - Steroid hormones and antagonists

Answer 249

The drugs form covalent bonds with DNA. This interferes with both transcription and replication due to interfering with polymerases. Most alkylating agent have two reactive groups, allowing the drug to cross-link. The drug cross links either within on strand of DNA or across the two strands of DNA.

Answer 250

They form covalent bonds with DNA. They are able to interfere with both transcription and replication. They have two reactive groups which form cross-links.

Answer 251

Melphalan is a type of nitrogen mustard gas. This is a combination of mechlorethamine ad phenylalanine (precursor for melanin). It is a much more stable drug and absorption and distribution is possible without extensive alkylation. It is an oral drug and can be used to multiple myeloma, ovarian and breast cancer.

Answer 252

It is an oral drug and can be used to multiple myeloma, ovarian and breast cancer.

Answer 253

Cyclophosphamide is a prodrug that requires activation of phosphoramidase. There is high phosphoramidase activity in some tumours. However, the drug is activated in other areas like the liver. The liver has Aldehyde dehydrogenase (ALDH) which protects the liver against the toxicity of the drug. ALDHs are present in large concentrations in bone marrow cells, hepatocytes and intestinal epithelium. It used to treat many cancers, but no liver or bone marrow.

Answer 254

The liver produces a protective enzyme ALDH.

Answer 255

Phosphoramidase. | There is high phosphoramidase activity in some tumours. However, the drug is activated in other areas like the liver.

Answer 256

ALDHs are present in large concentrations in bone marrow cells

Answer 257

Cisplatin was formed when platinum from electrodes reacted with ammonia. It targets the N7 region of Purine nucleotides and forms cross links. It interferes with the nucleotide excision repair mechanisms and may affect the efflux transporters for copper

Answer 258

N7 region of prune nucleotides and forms cross links

Answer 259

These work by depriving the cell with a nucleotide they need, hence the cell will be unable to proliferate.

Answer 260

Alkylating Agents

Answer 261

Alkylating Agents

Answer 262

Alkylating Agents

Answer 263

Antimetabolites

Answer 264

Antimetabolites

Answer 265

Antimetabolites

Answer 266

Methotrexate. this is able to inhibit folic acid as it has a higher affinity for dihydrofolate reductase. This will decrease the formation of dihydrofolate, which is needed for the synthesis of pyrimidine nucleotides. Hence, this will halt DNA and RNA synthesis.

Answer 267

Dihydrofolate. This is because it has a high affinity for dihydrofolate reductase.

Answer 268

Dihydrofolate. This is because it has a high affinity for dihydrofolate reductase.

Answer 269

5-fluorouracil prevents thymidine formation (makes a molecule mimics thymine so the enzyme is inhibited) and stops DNA synthesis.

Answer 270

Purine analogues: Mercaptopurines. These are converted into false nucleotides and this disrupts purine nucleotide synthesis. This may be incorporated into DNA, disrupting the helix.

Answer 271

Arabinosine - due the change in one hydroxyl group

Answer 272

Cytarabine is an arabinosine as there is a change in one hydroxyl group. This is isolated from the sponge Cryptothethya crypta. This is S-phase cell cycle specific and it get falsely built into DNA, inhibiting DNA polymerases.

Answer 273

Cytotoxic Antibiotics

Answer 274

Cytotoxic Antibiotics

Answer 275

Cytotoxic Antibiotics

Answer 276

Dactinomycin is isolated from streptomyces and inserts itself into the minor groove in the DNA helix. This disrupts RNA polymerase function.

Answer 277

Minor groove in double DNA helix

Answer 278

Doxorubicin is also from a Streptomyces. This inserts itself between base pairs. It binds to the sugar-phosphate DNA backbone, causing local uncoiling. There is impaired DNA and RNA synthesis. It is an aromatic structure, meaning it is a flat structure and it able to slide between base pairs.

Answer 279

Sugar phosphate backbones

Answer 280

``` Vinca Alkaloids (Vincristine) is isolated from Madagascar periwinkles. This has no oral absorption and the following is the mechanism of action: • bind to microtubular protein • block tubulin polymerisation • block normal spindle formation • disrupt cell division ```

Answer 281

Prednisone is a synthetic adrenocortical steroid hormone. It is converted into its active form, prednisolone, in the body and this suppresses lymphocytes growth.

Answer 282

Prednisolone

Answer 283

Lymphoycte growth

Answer 284

Hormone Antagonists

Answer 285

Tamoxifen is an antagonist for the oestrogen receptor. Some breast cancers are oestrogen dependent and oestrogen stimulates their growth. Tamoxifen is also an ovulatory infertility treatment

Answer 286

Testosterone

Answer 287

Most prostate cancers are dependent on testosterone. Treatment can therefore use testosterone receptor antagonists. Examples include flutamide (Drogenil) or Bicalutimade (Casodex). The latter is now used. In addition, pituitary downregulators can also be used to stop the synthesis of the hormone is stopped: – LHRH agonists (e.g. Prostap) – Inhibit release of Luteinising Hormone (LH) – LH normally stimulates testes to produce testosterone

Answer 288

(Testosterone receptor antagonist)

Answer 289

Colposcopy

Answer 290

'Dyskaryosis' implies definitely abnormal nuclei and the most likely reason for their presence is significant cervical intraepithelial neoplasia or CIN.

Answer 291

No but has the potential to become malignant

Answer 292

Koilocytes are a sign of a viral infection in the epithelial cells of the squamous cervical mucosa. The likely infection is Human papilloma virus.

Answer 293

cold sores

Answer 294

Genital herpes

Answer 295

type one herpes simplex virus

Answer 296

two herpes simplex virus

Answer 297

Radical hysterectomy and radiotherapy are used for malignant cases.

Answer 298

Loop excision of the transformation zone (LETZ) treats the abnormal epithelium and allows full assessment of the lesion by histopathology, confirmation of CIN, assessment of excision, and making sure there is no invasive cancer.

Answer 299

Liquid Based Cytology (LBC) is a new technique for collecting cytological samples in order to detect cervical cancer. With conventional cytology a smear taker takes a sample that is applied directly to a slide for microscopic investigation.

Answer 300

The koilocyte is characterised by a ‘clearing’ of the cytoplasm around the nucleus of the cell, which is quite recognizable on cytology and histology, and is a reliable sign of HPV infection.

Answer 301

Inflammation and necrosis are sometimes a clue on cervical cytology to the presence of invasive squamous carcinoma, but the diagnosis can be very difficult on cytology and colposcopy and biopsy are required for definitive diagnosis. This ‘dirty looking’ smear reflects necrosis and inflammation which can be a clue to the presence of an invasive carcinoma.

Answer 302

Like vagina, ectocervix (up to the transformation zone) is lined by this kind of epithelium. As cells migrate and mature (differentiate) towards epithelial surface they accumulate glycogen which gives them characteristic 'basket weave' appearance.

Answer 303

Mitosis in the cervical stratified squamous epithelium is seen just above the basal layer. Mitoses (dividing cells) are most likely to be seen in the proliferative zona just above the basal layer of cells in normal cervical stratified squamous epithelium. The basal layer itself includes stem cells and does not proliferate very rapidly.

Answer 304

Increases in size

Answer 305

Towards the middle and surface of the surface of the epithelium, the cells develop more cytoplasm and their nuclei are relatively smaller. The cells flatten out towards the surface.

Answer 306

The endocervix is lined by a glandular, columnar mucosa.

Answer 307

Yes. This is not an invasion.

Answer 308

1, 2, 4 and 63

Answer 309

Its well-developed blood supply may have contributed to its tendency to bleed.

Answer 310

Leiomyomas

Answer 311

Fibroids are non-cancerous growths that develop in or around the womb (uterus). The growths are made up of muscle and fibrous tissue and vary in size. They're sometimes known as uterine myomas or leiomyomas. Many women are unaware they have fibroids because they don't have any symptoms. The kind a tumour a fibroid is a Leiomyoma.

Answer 312

A leiomyoma is a benign smooth muscle tumour. Histologically the normal and neoplastic smooth muscle are very similar.

Answer 313

There are clonal cytogenic abnormalities in about 40% of leiomyomas for example trisomy 12 or translocation 12:14. These would support a neoplastic character.

Answer 314

Leiomysarcoma

Answer 315

As the ectocervix grows, it tends evert itself and the mucosa of the endocervix becomes more exposed to the vaginal environment. Hence, the columnar mucous undergoes squamous metaplasia.

Answer 316

This works on a sonar. The beam gets reflected by fat. However, this means that less beam is present to penetrate deeper structure. Therefore, there is less information on deeper structure.

Answer 317

Transabdominal and Tranvaginal

Answer 318

The transabdominal technique refers to insonation of the pelvis through a partially distended urinary bladder to minimize the acoustic impedance of interposed bowel gas. In transabdominal, An ultrasound transducer (probe) is pressed firmly against the skin of the abdomen. Transabdominal can either be transverse of longitudinal.

Answer 319

The transabdominal technique refers to insonation of the pelvis through a partially distended urinary bladder to minimize the acoustic impedance of interposed bowel gas.

Answer 320

Side to side

Answer 321

Up and down

Answer 322

A transvaginal scan is where a probe is inserted into the Vagina.

Answer 323

Soft tissue detail

Answer 324

The rectum and the bladder

Answer 325

Sometimes the dominant follicle can become too large. This is very common and is a benign condition. This is asymptomatic and nothing is usually done about it. On ultrasound scan, it may look like a cyst, but most don’t need follow up. This can be known as a functional cyst. If it is <3cm in premenopausal women, it does not need mentioned. If it is between 5-7cm, there may be a need for an annual follow up. In postmenopausal women, >3cm, a follow up scan is needed and the Ca125 level should be checked. An abnormal level may show a sing of cancer.

Answer 326

When it is >3cm | - Ca125 should be checked

Answer 327

This is where the there is a haemorrhage into a dominant/functional cyst. This is usually asymptomatic or present with pain. ON Ultrasound, there will be cysts with haemorrhage debris. A follow-up is required in 6 weeks.

Answer 328

This is also known as a chocolate cyst. They are a localized form of endometriosis and are usually within the ovary. The ultrasound will show a cyst with haemorrhagic debris and , unlike haemorrhagic cyst, it will not go away after 6 weeks. A MRI will show haemorrhagic material in the cyst.

Answer 329

On CT, it looks characteristic. It will show fat, fluid, calcification and soft tissue. Most of the stuff is dark and looks the same density as the subcutaneous pelvis fat.

Answer 330

On ultrasound, it will look variable due to the high amount of material. There will be some solids bits, cystic parts and fat. It is a heterogenous mass.

Answer 331

Calcification

Answer 332

Multiple follicles and no obvious dominant follicle

Answer 333

This is where the ovary twist on its vascular pedicle. This usually affects young women. It will present with Abdo/pelvic pain, nausea and vomiting. Half of the time it is associated with an ovarian mass (e.g. dermoid cyst). On ultrasound, there is an enlarged ovary, free fluid in the pelvis and the ovary show absent vascularity.

Answer 334

Dermoid cyst

Answer 335

On ultrasound, there is an enlarged ovary, free fluid in the pelvis and the ovary show absent vascularity.

Answer 336

It will present with Abdo/pelvic pain, nausea and vomiting.

Answer 337

- Abdominal distension - Pelvic or abdominal pain - Feeling full and loss of appetite - Increasing urinary urgency or frequency - Irritable bowel disease > 50

Answer 338

The risk of malignant index: RMI = Ultrasound score x menopausal score x CA 125 Menopausal score • premenopausal – 1 • postmenopausal – 3 Ultrasound score • 0 = none • 1 = one abnormality • 3 = two or more abnormalities RMI > 200 is concerning for malignancy.

Answer 339

Menopausal score • premenopausal – 1 • postmenopausal – 3

Answer 340

Ultrasound score • 0 = none • 1 = one abnormality • 3 = two or more abnormalities

Answer 341

* Irregular solid or multi-loculated cystic mass * Solid components on cyst wall * Bilateral ovarian lesions * Ascites, peritoneal nodules, or other evidence of metastases

Answer 342

Malignant features will show thick septations and solid components. There may be ascites, peritoneal metastases, lymphadenopathy and distant metastases.

Answer 343

Serous tumours are mostly benign, but can be malignant, especially in older women. On imaging, there is a large cystic mass. The tumour all looks the same consistency and colour.

Answer 344

Disease confined to ovary

Answer 345

Disease confided to pelvis

Answer 346

Diseases extant to upper abdomen including serousal metastases to the liver and bowlel

Answer 347

Distant metastases including the liver parenchyma

Answer 348

Krunkenberg tumours.

Answer 349

Fibroids are the most common benign uterine lesion. Usually found incidentally in premenopausal women and it may cause pain, infertility, menorrhagia. Imaging features are variable:  Hypoechoic mass on ultrasound  Often make the uterus look bulky/lobulated on CT

Answer 350

In post-menopausal women, over 5mm. | MRI will show local invasion and CT may show distant metastases.

Answer 351

Carcinoma in uterus

Answer 352

Outside the uterus with the lesser (true) pelvis

Answer 353

Spread to the cervix

Answer 354

Beyond the pelvic

Answer 355

Parametrium is a fibrous band that separates the cervix from the bladder. o If this is NOT invaded – Surgery o If this is invaded – Chemotherapy/radiation

Answer 356

Parametrium is a fibrous band that separates the cervix from the bladder.

Answer 357

Chemotherapy/.radiation

Answer 358

Bleeding, lump or itch that won’t go away

Answer 359

- HPV virus | - Cervix cancer metastasis

Answer 360

Enlarged vagina

Answer 361

They are associated with endometriosis but can also occur in women without this.

Answer 362

SurgeryIt is resistant to platinum-based chemotherapy. It is resistant to platinum-based chemotherapy.

Answer 363

Can be difficult to differentiate from high grade serous carcinoma but do not have mutations in p53.

Answer 364

This is a combindation of ovarian fibroma, ascites and pleural effusion.

Answer 365

CIN: Cervical intraepithelial neoplasia. CIN1 is equivalent to low grade dysplasia. CIN II and CIN III are regarded as equivalent to high grade dysplasia.

Answer 366

A benign cystic neoplasm of epithelial origin.

Answer 367

A malignant cystic neoplasm of epithelial origin.

Answer 368

Epithelial hyperplasia with features overlapping with ductal carcinoma in situ, but not bad enough to call DCIS.

Answer 369

Epithelial hyperplasia with features overlapping with lobular carcinoma in situ, but not bad enough to call LCIS.

Answer 370

Invasive duct carcinoma

Answer 371

Invasive lobular carcinoma.

Answer 372

Invasive lobular carcinoma.

Answer 373

E-cadherin

Answer 374

Salpingo-oophorectomy is the surgery to remove the ovaries and fallopian tubes.

Answer 375

She is peri-menopausal. This means that after years of ovulation, the supply of oocytes is exhausted.

Answer 376

A blood breakdown product composed of a storage complex containing iron, often found where there has been a previous haemorrhage

Answer 377

it will regress

Answer 378

Transcription factor associated with the GI tract

Answer 379

Keratin expressed commonly in colonic epithelium.

Answer 380

Granulosa cell tumour is the commonest type of sex cord stromal tumour and usually presents in middle aged and older women

Answer 381

A common presentation is post-menopausal bleeding as the tumour produces oestrogens which can stimulate the endometrium and result in hyperplasia or carcinoma.

Answer 382

During lactation

Answer 383

Prolactin producing tumours of the pituitary may give rise to unexpected milky discharge in non-lactating individuals.

Answer 384

Duct estasia may give rise to greenish nipple discharge but without any acute inflammation or fever and the nipple discharge typically contains foamy macrophages and chronic inflammation cells, no neutrophils.

Answer 385

nipple discharge typically contains foamy Macrophages and chronic inflammation cells, no neutrophils.

Answer 386

Gynaecomastia is associated with hormonal alterations and with some drug treatments, including spironolactone and therapies used in prostatic carcinoma.

Answer 387

A lipoma is typically soft to palate, less mobile than a fibroadenoma and only mature fat cells seen on FNA.

Answer 388

Macrophages

Answer 389

Extramammary Paget’s disease is a rare disorder of apocrine origin which can be confused with eczema clinically. Paget’s can be primary or secondary a result of cutaneous spread from a bladder, anal or rectal tumour. It is identical to an histological of Paget’s on the nipple.

Answer 390

- Apocrine metaplasia - Cyst formation - Stromal fibrosis - Adenosis

Answer 391

- ulnar-mammory syndrome - Poland's syndrome - Turners syndrome - congenital ardrenal hygerpalsia

Answer 392

Aberrant response to flucntations in cyclical hormones.

Answer 393

Staph aureus

Answer 394

Yes. There will also be breast pain and symptoms will worsen before menstruation.

Answer 395

There is fibrosis and elastic material at the centre and there is a star shaped appearance. The trapped glands are only pseudo-infiltrative. There are myoeptithelial cells present.

Answer 396

Yes: but this is rare

Answer 397

After a wide local incision

Answer 398

Microcalcification

Answer 399

- melphalan - cyclophosphamide - cisplatin

Answer 400

Anti-metabolite

Answer 401

- dactinomycin | - doxorubicin

Answer 402

A cough lasting 4 weeks requires a chest x-ray

Answer 403

They can lower sodium. Therefore, H2 receptor antagonists can be used.

Answer 404

Age 12: pregnant women will be offered it

Answer 405

Noral squamous cells will have large amounts of cytoplasm whereas Koilocytes will have decreased cytoplasm and enlarged nuclei

Answer 406

Genital warts

Answer 407

Common warts

Answer 408

This is secondary to a primary lesion

Answer 409

- abscess - increased risk of tubers ectopic pregnancy - infertility

Answer 410

Symptoms of salpingitis include: - Abnormal vaginal discharge - Spotting between periods - Painful periods - Pain during ovulation - Abdominal pain - Pain during sexual intercourse

Answer 411

- mucinous - serous - transitional - endometrial

Answer 412

Yes: plaques of calcium and cellular debris

Answer 413

This is an ovary tumour (mutinous) that has metastases to the ovary from the GI

Answer 414

- cervix washed - washed with acetic acid - application of iodine - green light filter - abnormal area can be biopsied

Answer 415

- post coital bleeding - intermenstrual bleeding - irregular vaginal bleeding - pain

Answer 416

There will be a cottage cheese appearance of the discharge and there is not typically a smell. It will be itchy. it is caused by a fungal infection.

Answer 417

This is caused by an anaerobic bacteria. There is a fishy smell and there is a watery consistency. The treatment is metronidazole (you should not drink alcohol on this medication).

Answer 418

Obesity, PCOS, oestrogen secretin tumours

Answer 419

70% by the age of 50

Female Pathology Flashcards

(533 cards)