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Female Pathology > Female Pathology > Flashcards

Female Pathology Flashcards

1
Q

What percentage of the breast tissue is fat?

A

90%

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2
Q

What are the two types of epithelium in the breast?

A

The epithelium of the breast:

  • Lobules: clusters of glands that make milk during lactation
  • Ducts: the plumbing that makes the milk to the nipple
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3
Q

What is significant about the terminal duct lobular unit?

A

At the tip of the duct is the terminal duct lobular unit. This is where most breast pathology and most neoplasm arise.

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4
Q

What are the Montgomery glands?

A

Montgomery glands are around the nipple and produce liquid to help lubricate the area.

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5
Q

Describe the role of prolactin in milk production

A

When a baby sucks on the nipple, prolactin is released from the anterior pituitary. There will be a neural pathway which involves the secretion of prolactin and inhibition of dopamine.
Prolactin will cause the synthesis and secretion of milk.

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6
Q

Describe the role of oxytocin in milk production

A

Oxytocin is responsible for milk let down. This will cause contraction of the myoepithelial ducts and cause milk ejection. It is released from the posterior pituitary.

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7
Q

Where do breasts sprout from?

A

Breast bud

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8
Q

Describe what happens to the breast during puberty

A
  • Puberty: ducts sprout from the breast bud. In females, puberty initiates further development establishing the adult mammary gland
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9
Q

Describe what happens to the breast during pregnancy

A
  • Pregnancy/lactation: increase in the number and size of lobular epithelial cells. Vacuolated cytoplasm. Secretions in lactation.
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10
Q

Describe what happens to the breast during menopause

A
  • Menopause: lobules atrophic and less fibrous stroma
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11
Q

What are the two cell layers of the breast?

A

There are two cell layers in the breast:

  • Luminal: lining of the duct
  • Myoepithelial cells
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12
Q

What is significant about myoepithelial cells and malignancy?

A

Myoepithelial cells are important as these are lost in malignancy.

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13
Q

Will hyperplasia of the breast cease when the stimulus is removed?

A

Yes

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14
Q

Will malignancy of the breast cease when the stimulus is removed?

A

No

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15
Q

What is dysplasia?

A

Dysplasia describes tissue that is:
- Not normal
- Not invasive
It is the presence of cells or an abnormal type within a tissue, which may signify a stage preceding the development of cancer. Dysplasia is non-invasive and has no capacity to metastasise.

Dysplasia is somewhere on the pathway to becoming malignant.

The dysplasia is still within the epithelium where it arose.

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16
Q

What are the four categories of benign breast pathology?

A
  • developmental
  • inflammatory
  • hyperplastic
  • bening neoplasms
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17
Q

What are some examples of developmental breast conditions?

A
  • ectopic breast tissue
  • breast hypoplasia
  • congenital nipple inversion
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18
Q

Describe ectopic breast tissue

A

This is the commonest congenital abnormality. It is where there is breast tissue outside the breast. Ectopic breast tissue occur when there is a failure of resolution of the milk line, which is an ectodermal thickening from the axilla to the groin. The milk line can be placed elsewhere, sometime with nipple or it is sometime just glandular material only. All other types of breast disease can happen in ectopic breast tissue.

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19
Q

What is the milk line?

A

Ectodermal thickening from the axilla to the groin

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20
Q

What is breast hypoplasia?

A

This is incomplete development of the breast

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21
Q

What conditions are associated with Breast hypoplasai?

A

This is associated with ulnar-mammary syndromes, Poland’s syndrome Turner’s syndrome and congenital adrenal hyperplasia.

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22
Q

Is ulnar-mammary syndrome associated with breast hypoplasia?

A

Yes

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23
Q

Is Poland’s syndrome associated with breast hypoplasia?

A

Yes

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24
Q

Is Turner’s syndrome associated with breast hypoplasia?

A

Yes

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25
Q

Is congenital adrenal hyperplasia associated with breast hypoplasia?

A

Yes

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26
Q

Describe congenital nipple inversion

A

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.

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27
Q

What are some examples of benign inflammatory breast conditions?

A
  • acute mastitis
  • granulomatous conditions
  • peuidcutal mastitis
  • fat necrosis
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28
Q

Describe Actue mastitis

A

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.

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29
Q

Why is actue mastins associated with breast feeding?

A

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.

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30
Q

Describe granulomatous conditions of the breast

A

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).

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31
Q

What are some causes of granulomatous conditions of the breast

A

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).

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32
Q

What is the treatment of idiopathic breast Granulomatous?

A

Steroids

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33
Q

Describe Periductal mastitis

A

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.

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34
Q

Describe fat necrosis

A

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.

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35
Q

What is the significance of inflammatory cancer?

A

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.

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36
Q

Give some examples of hyperplastic changes in the breast

A
  • fibrocystic change

- racial scar

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37
Q

Describe fibrocystic change

A

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

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38
Q

What is the pathology of firbrocystic change?

A

Aberrant response of normal breast tissue to fluctuations in cyclical hormones

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39
Q

What is adenosis?

A

This is where there are more glands and lobular tissue

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40
Q

What is sclerosing adenosis?

A

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

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41
Q

What is apocrine metaplasia?

A
  • Apocrine metaplasia: where the epithelial cells of cysts change to look like apocrine sweat glands
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42
Q

What are some symptoms of fibrocystic change?

A

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

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43
Q

When are symptoms of fibrocystic change worse?

A

Before mensuration

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44
Q

Describe a Racial scar

A

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

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45
Q

What are some features of a racial scar?

A

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
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46
Q

Are myoepithelail cells seen in a racial scar?

A

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

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47
Q

Give some examples of benign neoplasm of the breast

A
  • fibroadenoma
  • phyllodes tumour
  • intraduit papilloma
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48
Q

Describe fibroadenoma

A

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.

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49
Q

Are malignant cancers fixed or loose?

A

Breast cancer is rock hard, fixed and tethered.

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50
Q

Describe the lump of a fibroadenoma

A

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

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51
Q

Describe Phyllodes tumour

A

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.

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52
Q

Describe intraductory papilloma

A

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

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53
Q

What is papillomatosis?

A

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

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54
Q

What is nipple adenoma?

A

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

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55
Q

What is the difference between fibroadenoma and phyllodes tumour?

A

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.

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56
Q

What is the most common cancer diagnosed in women?

A

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).

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57
Q

How many women are diagnosed with breast cancer in the UK?

A

1/8

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58
Q

What is the age range of breast cancer?

A

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.

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59
Q

What is the medium age for breast cancer?

A

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

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60
Q

What are some risk factors for breast cancer?

A
  • 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)
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61
Q

What are some reproductive risk factors for breast cancer?

A

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

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62
Q

What are some hormonal risk factors for breast cancer?

A

HRT and oral contraceptive therapy

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63
Q

What are some anatomical risk factors for breast cancer?

A

Dense breast on mammography

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64
Q

What are some behavioural risk factors for breast cancer?

A

Alcohol and Smoking and obesity

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65
Q

What are some genetic risk factors for breast cancer?

A

Positive family history.

Some rare genetic (BRCA and Li Fraumeni and Cowden syndrome)

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66
Q

Is early menarche a risk factor for breast cancer?

A

Yes

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67
Q

Is HRT therapy a risk factor for breast cancer?

A

Yes

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68
Q

Is oral contraceptive therapy a risk factor for breast cancer?

A

Yes

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69
Q

Is a late first pregnancy (< 30 years) a risk factor for breast cancer?

A

Yes

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70
Q

What are some symptoms and signs of breast caner?

A

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.

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71
Q

What is Peu d’orange sign?

A

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

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72
Q

Is pain a usual symptom of breast cancer?

A

No

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73
Q

Describe the breast screening service

A

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

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74
Q

How often are women aged 50-70 called for breast screening?

A

Every three years

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75
Q

What are the characteristics of tumours discoveed in screening?

A
  • asymptomatic
  • small
  • lower grade and stage than symptomatic tumours
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76
Q

What is the most common method for diagnosing breast cancer?

A

Core biopsy

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77
Q

What is a triple assessment?

A

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

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78
Q

Describe Wide local excision

A

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.

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79
Q

Describe mastectomy and when it must be useful

A

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.

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80
Q

Describe the old and new axillary surgery

A

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

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81
Q

Describe the process of removing the sentinel node

A

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.

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82
Q

What happens when sentinel node is negative for breast cancer?

A

If sentinel node is negative, no further treatment is required

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83
Q

What happens when sentinel node is positive for breast cancer?

A

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

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84
Q

When is radiotherapy given for breast cancer?

A

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.

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85
Q

Describe hormonal theory in breast cancer

A

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.

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86
Q

What is the mechanism of action of Tamoxifen?

A

Block hormones.

- hormone positive breast cancer

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87
Q

Where can oestrogen be produced in post-menopsasual women

A

Soft tissue for example fat

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88
Q

What drug can be used to inhibit oestrogen production in post-menopausal women?

A

Aromatase inhibitor

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89
Q

What is Neo-adjuvant chemotherapy?

A
  • Before surgery to reduce the size of a tumour
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90
Q

What is adjuvant chemotherapy?

A
  • 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.
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91
Q

What are the two types of dysplastic lessons of the breast?

A
  • Ductal carcinoma in-situ (DCIS)
  • Lobular carcinoma in-situ (LCIS)

Both of these come from TDLU.

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92
Q

What is a dysplastic lesion of the breast?

A

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.

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93
Q

Describe Lobular carcinoma in situ

A

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.

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94
Q

Describe DCIS

A

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.

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95
Q

Describe ductal carcinoma

A
  • Around 70-80% of all breast cancer
  • Also called invasive carcinoma NST – “No Special Type”
  • Classic histological features of malignancy: variation in size, necrosis
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96
Q

What is the most common breast malignant cancer?

A

Ductal carcinoma (accounting for around 70-80%)

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97
Q

Describe lobular carcinoma

A
  • 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
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98
Q

What are the features of lobule carcinoma?

A
  • small cells
  • bland cells
  • discohesive cells (loss of E-cadherin)
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99
Q

What is lost in lobular carcinoma?

A

E-cadherin

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100
Q

What are some examples of special types of breast cancer

A
  • Papillary / micropapillary
  • Tubular
  • Medullary
  • Mucinous
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101
Q

What are some cancers of the epithelium in the breast tissue?

A
  • Sarcoma
  • Lymphoma
  • Malignant phyllodes
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102
Q

Does luminal A ER+ have a good or bad prognosis?

A

Good

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103
Q

Does luminal B ER+ have a good or bad prognosis?

A

No

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104
Q

What are the two molecular subtypes of ER+ breast cancer?

A

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

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105
Q

What are the three molecular subtypes of ER- breast cancer?

A

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

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106
Q

What is the mechanism of hercepin?

A

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.

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107
Q

Describe the three grades of breast cancer?

A
  • Grade 1 – slow growing
  • Grade 2 – intermediate growing
  • Grade 3 – fast growing
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108
Q

What is grade one breast cancer?

A

Slow growing

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109
Q

What is grade two breast cancer?

A

Intermediate growing

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110
Q

What is grade three breast cancer?

A

Fast growing

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111
Q

Describe the NPI calculation

A

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

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112
Q

What does S Stand for in NPI = [0.2 x S] + N + G ?

A

Size of lesion in cm

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113
Q

What does N Stand for in NPI = [0.2 x S] + N + G ?

A

Node staus

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114
Q

What does G Stand for in NPI = [0.2 x S] + N + G ?

A

Grade of tumour

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115
Q

What is the cervix?

A

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

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116
Q

Prior to puberty, what is the epithelium the ectocervix?

A

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

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117
Q

Prior to puberty, what is the epithelium the endoocervix?

A

the endocervix is lined by columnar (glandular) epithelium.

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118
Q

Describe the transformation zone that occurs after puberty in the cervix

A

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.

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119
Q

Where is cervical neoplasia most likely to develop?

A

The transformation zone, a zone of unstable differentiations.

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120
Q

What virus causes HPV?

A

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

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121
Q

What are the two main cancerous strains of HPV?

A

16 and 18

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122
Q

What cancer can HPV cause?

A

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

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123
Q

How is HPV transmitted?

A

Sexually transmitted infection of HPV to the stratified epithelial tissue.

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124
Q

Is HPV more likely to cause cancer when there is one infection of multiple infections?

A

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.

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125
Q

What does the presence of dyskaryosis suggest?

A

CIN: cervical intraepithelial neoplasia

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126
Q

What is dysaryosis?

A

Nuclear abnormalities

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127
Q

Describe CIN 1

A

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.

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128
Q

What percentage of the cervix does CIN 1 affect?

A

1/3

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129
Q

What percentage of the cervix does CIN 2 affect?

A

2/3

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130
Q

What percentage of the cervix does CIN 3 affect?

A

All (more than 2/3)

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131
Q

Describe CIN 2

A

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.

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132
Q

Describe CIN 3

A

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.

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133
Q

How many times should the probe be turned in cervical screening?

A

5-6 times clockwise

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134
Q

Who is screened for cervical cancer?

A

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

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135
Q

How many times are women aged 25-50 called for cervical screening?

A

Every 3 years

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136
Q

How many times are women aged 50-65 called for cervical screening?

A

Every 5 years

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137
Q

If the cervical screening report is negative, what is the outcome?

A

Routine screening

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138
Q

If the cervical screening report is borderline, what is the outcome?

A

Repeat in 6 months

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139
Q

If the cervical screening report is three times borderline, what is the outcome?

A

Refer to colposcopy

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140
Q

If the cervical screening report is twice low grade dyskaryosis, what is the outcome?

A

Colposcopy

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141
Q

If the cervical screening report is high grade dyskaroysis, what is the outcome?

A

Colposocpy

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142
Q

What type of cancer is CIN?

A

Squamous carcinoma

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143
Q

What type of cancer is cGIN?

A

Adenocarcinoma

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144
Q

When was the HPV vaccination introduced?

A

2008

- catch up programme for older girls

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145
Q

What strains of HPV are used in the HPV vaccination and what do they cause?

A

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.

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146
Q

Who is the HPV vaccination aimed at?

A

12/13 year olds

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147
Q

Describe the pocess of colposcopy

A
  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
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148
Q

What is the cervix washed with in colposcopy?

A

Acetic acid

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149
Q

What kind of light filter is applied in colposcopy?

A

Green light

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150
Q

What percentage of cervical carcinomas are due to HPV?

A

99%

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151
Q

What kind of virus is HPV?

A

DNA

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152
Q

What is the effect on HPV from early genes E1 to E7?

A

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

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153
Q

What is the effect on HPV from late genes L1 to L7?

A

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

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154
Q

What appears when there is abnormal change in the cervix when acetic acid is applied?

A

Whitsh appearance.

This is will get more dense as the grade increases.

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155
Q

What happens to blood vessel in CIN 3?

A

Mosaic pattern

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156
Q

What is the most common treatment for cervical cancer?

A

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.

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157
Q

What are some complications of cervical cancer treatment?

A 
Immediate
–	Pain
–	Haemorrhage
Delayed
–	Secondary haemorrhage (1-2%)
–	Infection
–	Cervical stenosis (~1%)
–	No good evidence of impact on fertility
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158
Q

Describe cGIM

A

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

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159
Q

What are some cervical caner symtpoms?

A
  • Post coital bleeding (after sexual intercourse)
  • Intermenstrual bleeding.
  • Irregular vaginal bleeding.
  • Pain.
  • None.
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160
Q

What hormones maintains the elasticity of the vagina?

A

Oestrogen

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161
Q

What is the effect of low oestrogen on the cervix?

A

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

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162
Q

Are cancers of the vagina common?

A

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.

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163
Q

What are some examples of infections on the vagina?

A

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

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164
Q

What is the histological feature of thrush?

A

Threads appearing.

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

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165
Q

What is the feature of Actinomyces?

A

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

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166
Q

What does Actinomyces have a link with?

A

The coil

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167
Q

Are skin tags common on the vagina?

A

Yes

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168
Q

Are melanocytes nevi common on the vagina?

A

Yes

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169
Q

Are benign cysts common on the vagina?

A

Yes

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170
Q

Describe squamous cell carcinoma with vulvar intraepithelial neoplasia

A
  • 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.
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171
Q

Describe vulvar cancer (SCC associated with Dermatoses)

A
  • 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.
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172
Q

What percentage of vulvar cancer is caused by HPV?

A

20%

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173
Q

What is Lichen sclerosis?

A

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

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174
Q

What is inflammation of the fallopian the called?

A

Salpingitis

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175
Q

What is Salpingitis?

A

Inflammation of the fallopian tube

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176
Q

Is Salpingitis part of the spectrum of pelvis inflammatory disease?

A

Yes

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177
Q

What is the usual cause of Salpingitis?

A

Bacterial infection.

- chlamydia, gonorrhoea

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178
Q

What is Tuberculous salpingitis ?

A

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

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179
Q

What are some symptoms of salpingitis?

A
  • fever
  • lower abdominal pain
  • pelvic pain
  • pelvic masses will occur if they are distended with exudate or secretions
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180
Q

What are some complications of salpingitis?

A

 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

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181
Q

Where is there an increased risk of ectopic pregnancy with salpingitis?

A

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

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182
Q

Is Tubo-ovarian abscesses a complications salpingitis?

A

Yes

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183
Q

Are primary adenocarcinomas (glands) arising from the fallopian tubes rare or common?

A

Rare

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184
Q

What genetic link is there with Fallopian tube carcinomas?

A

BRCA1 mutations

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185
Q

What is a serous tubal intraepithelial carcinoma (STIC)?

A

• 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.

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186
Q

Is STIC confined in the epithelium.

A

Yes

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187
Q

What is an example of a mutation that is linked to STIC?

A

p53

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188
Q

Describe the cortex of the ovary

A

This is where the follicles are

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189
Q

Describe the medulla of the ovaries

A

This is where there are vessels and connective tissue

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190
Q

What is ovarian stromal hyperplasia?

A

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

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191
Q

What are the three examples of non-neoplastic cysts in the ovary?

A

Inclusion, Follicular and Luteal cysts

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192
Q

Describe follicular cysts

A

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

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193
Q

Describe a luteal cyst

A

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

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194
Q

What are the hormone levels in PCOS?

A

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

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195
Q

What is the level of LH in PCOS?

A

High

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196
Q

What is the level of FSH in PCOS?

A

Low

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197
Q

What are the macroscopic/microscopic features of PCOS?

A
  • 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)
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198
Q

Is insulin resistance a feature of PCOS?

A

Yes

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199
Q

What is Ovarian Adnexal Torsion

A

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.

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200
Q

What is a tubal pregnancy?

A

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

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201
Q

How common is ovarian cancer?

A

5th most common cancer in women

- fifth leading cause of death in women

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202
Q

What there cell types are the tumours of ovaries related to?

A
  • 1- surface (coelomic) epithelium
  • 2- germ cells
  • 3- sex cord/stromal cells.
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203
Q

What is nulliparity?

A

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

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204
Q

What is the effect on the oral contraceptive pill on ovarian cancer?

A

Reduces risk

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205
Q

About 5%-10% of ovarian cancers are familial. What genes are they related to?

A

Mostly related to BRCA1 and BRCA2 gene mutations.

Lifetime risk of ovarian cancer is ~30% in BRCA1 carriers; lower in BRCA2 carriers.

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206
Q

HER2 can be over expressed in ovarian cancer. Does this have a good or bad prognosis?

A

Poor

• HER2 overexpressed in 35% of ovarian cancers

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207
Q

KRAS mutations are present in 30% of ovarian tumours. What is the most common tumour related to this mutation?

A

Mucinous cystadenocarcinomas.

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208
Q

P53 mutations are present in 50% of ovarian tumours. What is the most common tumour related to this mutation?

A

High grade serous cancers

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209
Q

What percentage of serous ovarian tumours are benign?

A

60%

  • 25% malignant
  • 15% borderline
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210
Q

What is endometriosis?

A

This is the presence of endometrial tissue outside the uterus

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211
Q

What is adenomyosis?

A

This is the present of endometrial tissue within the myometrium

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212
Q

What is the presence of endometrial tissue in the myometrium called?

A

Adenomyosis

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213
Q

What are some sites of endometriosis?

A 
Ovaries
Peritoneal surfaces (uterine ligaments and rectovaginal septum)
Large and small bowel
Appendix
Mucosal of the cervix
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214
Q

Can endometriosis be on the small bowel?

A

Yes

215
Q

Can endometriosis be on the large bowel?

A

Yes

216
Q

Can endometriosis be on the appendix?

A

Yes

217
Q

What is dysmenorrhoea?

A

This is painful menstruation

218
Q

What is painful menstraution called?

A

Dysmenorrhoea

219
Q

What are some symptoms of endometriosis

A

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

220
Q

Describe the metastatic theory of endometriosis

A
  • The metastatic theory: retrograde menstruation or surgical procedures introduce endometrium to site out with the uterine cavity
221
Q

Describe the metaplastic theory of endometriosis

A
  • 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
222
Q

In adenomyosis, where will the endometrial glands be?

A

In the myometrium

223
Q

In adenomyosis, will the glands in the myometrium be surrounded by storma?

A

Yes

224
Q

Is there a risk of haemorrhage in adenomyosis?

A

Yes

225
Q

What are endometrial polyps?

A

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

226
Q

Can endometrial polyps be associated with tamoxifen?

A

Yes. This is a drug for breast cancer.

227
Q

What can endometrial polyps present with?

A

Abnormal bleeding

228
Q

What will the microscopic signs of endometrial polyps be?

A

haphazardly arranged glands with preservation of low gland to stormal ratio

229
Q

What is hysteroscopy?

A

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

230
Q

What happens to blood vessels in endometrial polyps?

A

Thick walled

231
Q

What happens to the storma in endometrial polyps?

A

Become fibrous

232
Q

What can happen to glands in endometrial polyps?

A

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

233
Q

What is endometrial hyperplasia associated with?

A

Prolonged oestrogen stimulation of the endometrium

234
Q

What is adenocarcinoma associated with?

A

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

235
Q

Name two conditions that are associated with prolonger oestrogen stimulation?

A

Endometrial Hyperplasia and Adenocarcinoma

236
Q

What are some possible underlying causes of endometrial hyperplasia and adenomcarcinoma?

A

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
237
Q

What are some endogenous sources of excess oestrogen?

A
  • Endogenous sources of oestrogen: obesity, PCOS, oestrogen secreting ovarian tumours
238
Q

What are some exogenous sources of excess oestrogen?

A
  • Exogenous sources of oestrogen such as oestrogen only HRT
239
Q

What is atypical endometrial hyperplasia and what is it a precursor for?

A

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.

240
Q

What is the management for endometrial hyperplasia?

A

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

241
Q

What is the management for endometrial adenocarcinoma?

A

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

242
Q

What are some histological features of endometrial adenocarcinoma?

A

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

243
Q

What is a leiomyoma?

A 
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
244
Q

Is leiomyoma benign or malignant?

A

Benign

245
Q

What are some symtpoms of leiomyoma?

A
  • Asymptomatic
  • Abnormal bleeding
  • Urinary frequency if large
  • Impaired fertility
246
Q

What is the management of a leiomyoma?

A

Management:

  • Varies depending on number, size and symptom
  • Medical: progesterone secreting IUS, hormonals therapies, tranexamic acid GnRH agonists
247
Q

What is a leiomyosarcoma?

A

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.

248
Q

Is Leiomyosarcoma benign or malignant?

A

Malignant

249
Q

What is the peak incidence of Leiomyosarcoma?

A

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

250
Q

What is endometrial stromal sarcoma?

A

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.

251
Q

What is the apperance of endometrial stromal sarcoma?

A

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

252
Q

What is a molar pregnancy?

A

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.

253
Q

What type disease is a molar pregnancy?

A

Gestational trophoblastic disease

254
Q

What is a hydatidiform mole?

A

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.

255
Q

What is a partial molar pregnancy?

A

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

256
Q

What is a complete molar pregnancy?

A

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).

257
Q

What appearance does the villa have in a compete mole?

A

Grape like

258
Q

What is a risk of invasive mole in a complete mole?

A

10%

259
Q

What is a risk of choriocarcinoma in a complete mole?

A

2.5%

260
Q

What are three types of cancer related to the ovary?

A
  • 1- surface (coelomic) epithelium
  • 2- germ cells
  • 3- sex cord/stromal cells
261
Q

What affect does the oral contraceptive pill have on ovarian cancer?

A
  • reduces risk
262
Q

What are the four types of epithelial tumours of the ovary?

A

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

263
Q

Where do serous and mucinous tumours arise?

A

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

264
Q

Where do endometriod and transitional tumours arise?

A

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

265
Q

When do most women present with ovarian cancer?

A

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

266
Q

What are benign serous ovarian tumours called?

A

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

267
Q

What are malignant serous ovarian tumours called?

A

The malignant type of serous tumors are called serous cystadenocarcinomas.

268
Q

What is the most common gene mutation in HGSC in serous ovarian tumours?

A

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

269
Q

What is the most common mutation in LGSC in serous ovarian tumours?

A

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

270
Q

What is the morphology of benign serous tumours?

A

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.

271
Q

What is the morphology of benign malignant tumours?

A

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

272
Q

What are psammoma bodies?

A

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

273
Q

Where are psammoma bodies found?

A

Serous tumours of the ovary

274
Q

What are benign mucinous tumours called?

A

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

275
Q

What are malignant mucinous tumours called?

A

Malignant mucinous tumors are called mucinous cystadenocarcinomas.

276
Q

What is the condition called when cancer metastatses to the ovarian and mimics a mucinous tumour?

A

‘Krukenberg tumours’

277
Q

What is the morphology of mucinous tumours?

A

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

278
Q

Describe ovarian endometroid carcinoma

A

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.

279
Q

What is ovarian clear cell carcinoma associated with?

A

Ovarian clear cell carcinoma is also associated with endometrioses.

280
Q

Describe germ cells of the ovary

A

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.

281
Q

What is the name of the cyst in germ cell tumour?

A

Dermoid cyst

282
Q

Describe a malignant germ cell tumour

A

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).

283
Q

What is the hallmark of malignant ovarian teratomas?

A

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

284
Q

Are Cystic teratomas prone to torsion?

A

Yes

285
Q

What do ovarian sex cord stromal tumours include?

A

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.

286
Q

What is common with ovarian sex cord stromal tumours?

A

Hormone over-production

287
Q

What is the epithelium of a Brenner tumour?

A

Transitional

288
Q

Describe a Brenner tumour

A

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.

289
Q

Why are ovarian tumours clinically challenging?

A

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.

290
Q

What is pelvic inflammatory disease?

A

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.

291
Q

What is a tube-ovarin abscess?

A

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.

292
Q

What is a chorioncarcinoma?

A

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.

293
Q

What are some characteristics of cancer?

A
  • Uncontrolled proliferation
  • Loss of original function (anaplasia)
  • Invasiveness
  • Metastasis (malignant cells)
294
Q

What type of cancer can surgery remove?

A

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

295
Q

What type of cancer is irradiation good for?

A

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

296
Q

What a cell that has doubled 30 times be detectable in the liver?

A

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.

297
Q

Is the immune system able to recognise cancer cells?

A

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

298
Q

What is the body’s own best anti-cancer mechanism?

A

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.

299
Q

What do solid tumours consist of?

A
  • 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).
300
Q

What do resting cells in a tumour give risk to?

A

Relapse

301
Q

What are the three phases of interphase in he cell cycle?

A

G1, S and G2

- there is also G0

302
Q

What happens in the S phase?

A

DNA synthesis

303
Q

What is the G0 phase?

A

Non-diving stage

304
Q

What gene will be damaged if a cancer cell is able to pass a checkpoint?

A

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

305
Q

What do most anti-cancer drugs target?

A

Cell division. These dogs target rapidly diving cells.

306
Q

What are some side effects of cancer drugs?

A
  • 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)
307
Q

What affect do cancer drugs have on bone marrow?

A
  • bone marrow suppression.
    This can lead to less blood cell generation, leading to anaemia, immune depression, prone to infection and impaired wound healing.
308
Q

What affect do cancer drugs have on bone marrow?

A
  • bone marrow suppression.
    This can lead to less blood cell generation, leading to anaemia, immune depression, prone to infection and impaired wound healing.
309
Q

What affect do cancer drugs have on a Childs growth?

A

Depression

310
Q

What are cell-cycle specific drugs?

A

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

311
Q

What are cell-cycle non-specific drugs?

A

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

312
Q

What are the five types of chemotherapy drugs?

A
  • Alkylating agents
  • Antimetabolites
  • Cytotoxic antibiotics
  • Microtubule inhibitors
  • Steroid hormones and antagonists
313
Q

Describe the general mechanism of action of alkylating agents

A

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.

314
Q

How do alkylating agents disrupt DNA polymerase

A

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.

315
Q

Describe Melphalan (an alkylating agent)

A

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.

316
Q

Give some examples of cancers that can be treated with Melphalan?

A

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

317
Q

Describe Cyclophophamide (an alkylating drug)

A

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.

318
Q

Why can’t Cyclophophamide be used in liver cancer?

A

The liver produces a protective enzyme ALDH.

319
Q

What enzyme does Cyclophophamide require to be activated?

A

Phosphoramidase.

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

320
Q

Why can’t Cyclophophamide be used in bone marrow cancer?

A

ALDHs are present in large concentrations in bone marrow cells

321
Q

Describe Cisplatin (an alkylating agent)

A

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

322
Q

What does Cisplatin target?

A

N7 region of prune nucleotides and forms cross links

323
Q

What is the general mechanism of action of antimetabolites?

A

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

324
Q

What type of chemotherapy drug is Melphalan?

A

Alkylating Agents

325
Q

What type of chemotherapy drug is Cyclophosphamide?

A

Alkylating Agents

326
Q

What type of chemotherapy drug is Cisplatin?

A

Alkylating Agents

327
Q

What type of drug is methotrexate?

A

Antimetabolites

328
Q

What type of drug is 5-flurouracil?

A

Antimetabolites

329
Q

What type of drug is cytarabine?

A

Antimetabolites

330
Q

Describe methotrexate, a Antimetabolites

A

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.

331
Q

What does methotrexate decrease the formation of?

A

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

332
Q

What does methotrexate decrease the formation of?

A

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

333
Q

What does 5-flurouracil decrease the formation of?

A

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

334
Q

Describe mercaptopurines (purine analogues)

A

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

335
Q

What shape is a cytarabine?

A

Arabinosine - due the change in one hydroxyl group

336
Q

Describe cytarabine

A

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.

337
Q

What type of chemotherapy drug is Dactinomycin?

A

Cytotoxic Antibiotics

338
Q

What type of chemotherapy drug is Doxorubicin?

A

Cytotoxic Antibiotics

339
Q

What type of chemotherapy drug is Vinca Alkaliods (Vincristine)?

A

Cytotoxic Antibiotics

340
Q

Describe the drug dactinomycin (a Cytotoxic Antibiotics)

A

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

341
Q

Where does dactinomycin insert itself into?

A

Minor groove in double DNA helix

342
Q

Describe the drug Doxorubicin (a Cytotoxic Antibiotics)

A

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.

343
Q

What does Doxorubicin bind to?

A

Sugar phosphate backbones

344
Q

What is the structure of Doxorubicin?

A

Aromatic

345
Q

Describe Vinca Alkaloids (Vincristine)

A 
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
346
Q

Describe how prednisone is used as a chemotherapy drug

A

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

347
Q

What is prednisone converted to in the body?

A

Prednisolone

348
Q

What does Prednisolone suppress?

A

Lymphoycte growth

349
Q

What type of drug is tamoxifen?

A

Hormone Antagonists

350
Q

Describe Tamoxifen

A

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

351
Q

What hormone does Tamoxifen block?

A

Oestrogen

352
Q

What cancers can Tamoxifen be used for?

A

Breast

353
Q

What hormone are prostate cancer dependent on?

A

Testosterone

354
Q

What are some treatment for prostate cancer?

A

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

355
Q

What is Bicalutimade (Casodex)?

A

(Testosterone receptor antagonist)

356
Q

A patient’s cervical screening result show moderate dyskryosis. What is the next step?

A

Colposcopy

357
Q

What is Dyskaryosis?

A

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

358
Q

Is CIN malignant?

A

No but has the potential to become malignant

359
Q

What are koilocytes a sign of?

A

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

360
Q

What do type one herpes simplex virus cause?

A

cold sores

361
Q

What do type two herpes simplex virus cause?

A

Genital herpes

362
Q

What virus causes cold sores?

A

type one herpes simplex virus

363
Q

What virus cases genital herpes?

A

two herpes simplex virus

364
Q

When would radical hysterectomy and radiotherapy be used for in cervical cancer?

A

Radical hysterectomy and radiotherapy are used for malignant cases.

365
Q

Describe loop excision of the transformation zone

A

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.

366
Q

What is liquid base cytology?

A

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.

367
Q

What is a characteristic of a kilobyte?

A

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.

368
Q

What happens to the nuclear cytoplasm ration in neoplasm?

A

Increases

369
Q

What would necrosis and inflammation be a sig of on a cervical smear?

A

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.

370
Q

What is the epithelium of the vagina and ectocervix

A

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.

371
Q

Where is mitosis in the cervical stratified squamous epithelium seen?

A

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.

372
Q

What happens to the zone of proliferation as the grade of CIN increases?

A

Increases in size

373
Q

What happens to cells in cervical epithelium as the ascend from the basal layer to the surface?

A

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.

374
Q

What is the endothelium of the endocervix?

A

The endocervix is lined by a glandular, columnar mucosa.

375
Q

If there is no invasion through the basement membrane, can it be classified as a squamous carcinoma?

A

No

376
Q

Can CIN3 extend from into the endocervical glands?

A

Yes. This is not an invasion.

377
Q

What HPV are genital warts related to?

A

6 and 11

378
Q

What HPV are common warts related to?

A

2 and 7

379
Q

What HPV are plantar warts related to?

A

1, 2, 4 and 63

380
Q

Why woulda polyp bleed?

A

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

381
Q

What is another name for uterine fibroids?

A

Leiomyomas

382
Q

What are fibroids?

A

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.

383
Q

What is a leiomyoma?

A

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

384
Q

What is an example of a congenital abnormal in leiomyoma?

A

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

385
Q

What is a malignant tumour of the smooth muscle called?

A

Leiomysarcoma

386
Q

What happens to the ectocervix as it grows?

A

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.

387
Q

What is the relationship between ultrasound and fat?

A

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.

388
Q

What are the two types of ultrasound technique for gynaecology imaging?

A

Transabdominal and Tranvaginal

389
Q

What is transbdominal ultrasound?

A

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.

390
Q

Why does the bladder have to be distended in a transabdominal scan?

A

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

391
Q

What is the direction of the probe in a transverse ultrasound?

A

Side to side

392
Q

What is the direction of the probe in a longitudinal ultrasound?

A

Up and down

393
Q

What is a transvagianal scan?

A

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

394
Q

Is the bladder present in a transvaginal scan?

A

No

395
Q

What size should the endometrium be in a postmenopausal women?

A

<5mm

396
Q

What is MRI good for?

A

Soft tissue detail

397
Q

What does a bright part mean on an MRI?

A

Fluid

398
Q

What type of MRI is set to see the layers of the uterus?

A

T2

399
Q

What does the uterus lie between?

A

The rectum and the bladder

400
Q

Describe benign follicles?

A

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.

401
Q

When should a functional cyst be tested in a post-menopasual women?

A

When it is >3cm

- Ca125 should be checked

402
Q

What is a haemorrhage cyst?

A

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.

403
Q

Will a haemorrhage cyst clear up in 6 weeks?

A

Yes

404
Q

Describe an endometrioma

A

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.

405
Q

Will an endometrioma go away after 6 weeks?

A

No

406
Q

What are some characteristics of a dermoid cyst on CT?

A

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.

407
Q

What are some characteristics of a dermoid cyst on ultrasound?

A

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.

408
Q

What are some characteristics of a dermoid cyst on an x-ray?

A

Calcification

409
Q

What will a scan of PCOS show?

A

Multiple follicles and no obvious dominant follicle

410
Q

What is an ovarian torsion?

A

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.

411
Q

What cyst is an ovarian torsion associated wiht?

A

Dermoid cyst

412
Q

What are the signs of an ovarian torsion of ultrasound?

A

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

413
Q

Will an ovarian torsion show vascularity?

A

No

414
Q

What are some symptoms of an ovarian torsion?

A

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

415
Q

What are some signs and symptoms of ovarian malignancy?

A
  • Abdominal distension
  • Pelvic or abdominal pain
  • Feeling full and loss of appetite
  • Increasing urinary urgency or frequency
  • Irritable bowel disease > 50
416
Q

What is the calculation for the risk of malignant index?

A

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.

417
Q

What is the menopausal score of RMI?

A

Menopausal score
• premenopausal – 1
• postmenopausal – 3

418
Q

What is the ultrasound score of RMI?

A

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

419
Q

What are some features of ovarian malignant on ultrasound?

A
  • Irregular solid or multi-loculated cystic mass
  • Solid components on cyst wall
  • Bilateral ovarian lesions
  • Ascites, peritoneal nodules, or other evidence of metastases
420
Q

What are the malignant features of a serous tumour?

A

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

421
Q

What are the benign features of a serous tumour?

A

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.

422
Q

What is stage one of ovarian cancer?

A

Disease confined to ovary

423
Q

What is stage two of ovarian cancer?

A

Disease confided to pelvis

424
Q

What is stage three of ovarian cancer?

A

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

425
Q

What is stage four of ovarian cancer?

A

Distant metastases including the liver parenchyma

426
Q

Give an example of a GI tumour that can spread to the ovary?

A

Krunkenberg tumours.

427
Q

Describe fibroids

A

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

428
Q

Are fibroids sown as hypoechoic in ultrasound on the ovary?

A

Yes

429
Q

How thick will the endometrium be in endometrial cancer?

A

In post-menopausal women, over 5mm.

MRI will show local invasion and CT may show distant metastases.

430
Q

What is stage one of endometrial cancer?

A

Carcinoma in uterus

431
Q

What is stage two of endometrial cancer?

A

Outside the uterus with the lesser (true) pelvis

432
Q

What is stage three of endometrial cancer?

A

Spread to the cervix

433
Q

What is stage four of endometrial cancer?

A

Beyond the pelvic

434
Q

What is parametrial invasion?

A

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

435
Q

What is the parametrium?

A

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

436
Q

What surgery is carried out when the parametrium is not invaded?

A

Surgery

437
Q

What surgery is carried out when the parametrium is invaded?

A

Chemotherapy/.radiation

438
Q

What are some symptoms of vagina cancer?

A

Bleeding, lump or itch that won’t go away

439
Q

What is usually associated with vaginal cancer?

A
  • HPV virus

- Cervix cancer metastasis

440
Q

What are the features of vaginal cancer on ultrasound?

A

Enlarged vagina

441
Q

Which type of mucinous tumours are more common? Benign or Malignant

A

Benign

442
Q

Are mucinous malignant tumours hard to differentiation from metastases from the GI tract?

A

Yes

443
Q

What percentage of clear cell tumours are carcinomas?

A

Over 90%

444
Q

What condition are ovarian clear cel tumours associated with?

A

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

445
Q

What is main treatment for ovarian clear cell carcinoma?

A

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

446
Q

Do high grade clear cel carcinomas have p53 mutations?

A

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

447
Q

What is Meig’s syndrome?

A

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

448
Q

What is CIN?

A

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

449
Q

What is a cytadenoma?

A

A benign cystic neoplasm of epithelial origin.

450
Q

What is a cystuadenocarcinoma?

A

A malignant cystic neoplasm of epithelial origin.

451
Q

What is atypical ductal hyperplasia?

A

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

452
Q

What is atypical lobular hyperplasia?

A

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

453
Q

What is the commonest type of breast cancer?

A

Invasive duct carcinoma

454
Q

What is the second most common type of breast cancer?

A

Invasive lobular carcinoma.

455
Q

What breast cancer has lost E-cadherin?

A

Invasive lobular carcinoma.

456
Q

What has invasive lobular carcinoma lost?

A

E-cadherin

457
Q

What drug for breast cancer targets Her2?

A

Herceptin

458
Q

Is invasive ductal carcinoma the most common type of breast cancer?

A

Yes

459
Q

Are mitotic figures a feature of proliferative endometrium?

A

Yes

460
Q

Does secretory endometrium have eosinophilic material?

A

Yes

461
Q

What is a Salpingo-oophorectomy ?

A

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

462
Q

Is the corpus albicans an area of dense collagen?

A

Yes

463
Q

Why would a 49 year might not show primary oocytes?

A

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

464
Q

What is Hemosiderin?

A

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

465
Q

What happens to endometriosis after menopause?

A

it will regress

466
Q

What is CDX2?

A

Transcription factor associated with the GI tract

467
Q

What is cytokeratin 20?

A

Keratin expressed commonly in colonic epithelium.

468
Q

Would a bilateral lesion likely be a second lesion of the GI tract?

A

Yes

469
Q

What is the genotype of ovarian teratomas?

A

46XX

470
Q

Is the genotype of an ovarian term 46XX?

A

Yes

471
Q

What is the most common type of sex cord tumour?

A

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

472
Q

What is a common presentation of granulosa cell tumour?

A

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

473
Q

What is a breast abscess very common?

A

During lactation

474
Q

What is the effect of prolactin producing tumours on the breast?

A

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

475
Q

What are the characterisitcs of duct estasia?

A

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.

476
Q

Does nipple discharge of duct estasia have neutrophils

A

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

477
Q

What are some examples of drugs that can cause gynaecomastia?

A

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

478
Q

Describe a lipoma

A

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

479
Q

What would a breast abscess often contain on aspiration?

A

Macrophages

480
Q

What is extramammary Pagets disease?

A

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.

481
Q

What are some characteristics of fibrocystic change in the breast?

A
  • Apocrine metaplasia
  • Cyst formation
  • Stromal fibrosis
  • Adenosis
482
Q

What are some conditions that breast hypoplasia is associated with?

A
  • ulnar-mammory syndrome
  • Poland’s syndrome
  • Turners syndrome
  • congenital ardrenal hygerpalsia
483
Q

Does periductal mastitis have. relationship to smoking?

A

yes

484
Q

What is the most lily cause of fibrocystic change in the breast?

A

Aberrant response to flucntations in cyclical hormones.

485
Q

Is there adenosis in fibrocystic change in the breast?

A

Yes

486
Q

Is there epithelial hyperplasia in fibrocystic change in the breast?

A

Yes

487
Q

Is there apocrine metaplasia in fibrocystic change in the breast?

A

Yes

488
Q

What is the most common cause of acute mastitis?

A

Staph aureus

489
Q

Will there be cysts in fibrocystic breast change?

A

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

490
Q

What are the features of a radial scar?

A

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.

491
Q

What is the common cage onset for fibroadenoma?

A

<50 years

492
Q

What is the median age of onset for breast cancer?

A

60 years

493
Q

Is oral contraceptive a risk factor for breast cancer?

A

Yes

494
Q

Can peu d’organe be seen with breast cancer?

A

Yes: but this is rare

495
Q

When is radiotherapy given for breast cancer?

A

After a wide local incision

496
Q

How is DCIS seen on mammography?

A

Microcalcification

497
Q

What percentage of breast cancer does lobular cancer account for?

A

10-15%

498
Q

What are some examples of alkylating agents for cancer chemo?

A
  • melphalan
  • cyclophosphamide
  • cisplatin
499
Q

What type of chemo drug is 5-fluroouracil?

A

Anti-metabolite

500
Q

What are some example of cytotoxic antibodies for chemo?

A
  • dactinomycin

- doxorubicin

501
Q

Does darker skin absorb less vitamin D?

A

Yes

502
Q

Can a patient be on steroids when they have the flu jab?

A

No

503
Q

When should a chest x-ray be requested after a a lengthy cough?

A

A cough lasting 4 weeks requires a chest x-ray

504
Q

When should an x-ray be required with a neck-lump?

A

3 weeks

505
Q

When should an x-ray be required with a sort throat?

A

4 weeks

506
Q

What affect do PPIs have on sodium?

A

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

507
Q

When is the whopping cough vaccine valid until?

A

Age 12: pregnant women will be offered it

508
Q

What herpes type causes cold sores?

A

Type one

509
Q

What herpes type cause genital herpes?

A

Type two

510
Q

What are features of kilobytes?

A

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

511
Q

What is HPV 6 and 11 associated with?

A

Genital warts

512
Q

What is HPV 2 and 7 associated with?

A

Common warts

513
Q

What is the epithelium of the endocervix?

A

Columnar

514
Q

What is tuberculosis salpingitis?

A

This is secondary to a primary lesion

515
Q

What are some complications from salpingitis?

A
  • abscess
  • increased risk of tubers ectopic pregnancy
  • infertility
516
Q

What are some symptoms of salpingitis?

A

Symptoms of salpingitis include:

  • Abnormal vaginal discharge
  • Spotting between periods
  • Painful periods
  • Pain during ovulation
  • Abdominal pain
  • Pain during sexual intercourse
517
Q

Does ovarian cancer have a good prognosis?

A

No

518
Q

What are the four types of epithelial ovarian cancers?

A
  • mucinous
  • serous
  • transitional
  • endometrial
519
Q

What percentage of serous ovarian tumours are benign?

A

60%

520
Q

Do serous ovarian tumours have cysts?

A

Yes

521
Q

Do serous ovarian tumours contain psammoma boides?

A

Yes: plaques of calcium and cellular debris

522
Q

What is a krunkenbrug tumour?

A

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

523
Q

Do Ovarian clear cell carcinoma have p53 mutations?

A

No

524
Q

Describe the process of a colposcopy

A
  • cervix washed
  • washed with acetic acid
  • application of iodine
  • green light filter
  • abnormal area can be biopsied
525
Q

What is the most common type of ovarain cancer?

A

HGSC

526
Q

What are some symptoms of cervical cancer?

A
  • post coital bleeding
  • intermenstrual bleeding
  • irregular vaginal bleeding
  • pain
527
Q

Describe trush of the vagina

A

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.

528
Q

Describe bacterial vaginosis

A

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).

529
Q

What is recent Trush infections associated with?

A

Diabetes

530
Q

Is tamoxifen a risk factor for endometrial polyps?

A

Yes

531
Q

What are some endogenous sources of oestrogen?

A

Obesity, PCOS, oestrogen secretin tumours

532
Q

Is atypical endometrial hyperplasia a known precursor of endometriod adenocarcinoma?

A

Yes

533
Q

What is the epidemiology of a leiomyoma?

A

70% by the age of 50

Female Pathology (1 decks)

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