Female Reproductive Tract Pathology

Question 1

What is a functional ovarian cyst?

Answer 1

Cyst formed when the follicle doesn’t release an egg and swells

Question 2

What is endometriosis?

Answer 2

Chronic inflammatory condition caused by ectopic endometrial tissue (commonly in the ovaries)

Question 3

Blood-filled cyst on ovary.

Diagnosis?

Answer 3

Endometriosis (chocolate cyst)

Question 4

What is the general management of an ovarian mass?

Answer 4

Exclude malignancy

CA-125 blood test
USS

Question 5

Patient present with weight loss, early satiety, heartburn bloating and diarrhoea.

Diagnosis?

Answer 5

Ovarian cancer

Question 6

What are the risk factors for ovarian cancer?

Answer 6

Family history
Post-menopausal
Nulliparous

Question 7

Where do ovarian cancers spread?

Answer 7

Peritoneal surfaces

Question 8

What tumours commonly metastasise to the ovaries?

Answer 8

Breast

GI

Question 9

In suspected ovarian cancer, what investigations should you do and why?

Answer 9

CA-125 tumour marker (raised in ovarian cancer)
CEA tumour marker (excludes colorectal primary)

USS (image tumour)
CT (image peritoneal surfaces)

Question 10

How do you treat ovarian cancer?

Answer 10

Surgery, examine peritoneal surfaces and adjuvant chemotherapy

Question 11

Gynaecological cancer most likely to recur.

Answer 11

Ovarian

Question 12

Name the 3 layers of the uterine wall

Answer 12

Endometrium: inner
Myometrium: muscular middle
Perimetrium: outer

Question 13

What is dysfunctional uterine bleeding (DUB)?

Answer 13

Menorrhagia without organic cause (thought to be hormone dysfunction) common in extremes of reproductive years

Question 14

What is an endometrial polyp and who gets them?

Answer 14

Benign growth of endometrium

Women going through menopause

Question 15

What is adenomyosis and how does it present?

Answer 15

Endometrium breaking into myometrium

Heavy/painful bleeding

Question 16

What is the commonest uterine mass?

Answer 16

Leiomyoma

Question 17

What is leiomyoma?

Answer 17

“fibroids”

Benign proliferation of smooth muscle in myometrium

Question 18

How do fibroids present?

Answer 18

Often asymptomatic.

Menorrhagia, pain

Question 19

What is red degeneration?

Answer 19

Painful haemorrhagic infarction of leiomyoma common in pregnancy

Question 20

What causes endometrial hyperplasia?

How does it present?

What are the 3 classes?

Answer 20

Excess oestrogen
Post-menopausal bleeding

Simple: generalised hyperplasia
Complex: focal hyperplasia with normal cytology
Atypical: focal hyperplasia with atypical cytology

Question 21

How does endometrial cancer present?

Answer 21

Post-menopausal bleeding

Question 22

What is Lynch syndrome? What does it increase your risk of?

Answer 22

Autosomal dominant DNA mismatch repair defect

Colorectal, endometrial, ovarian cancer

Question 23

What do Lynch syndrome tumours show?

Answer 23

Micro-satellite instability (MSI)

Question 24

What are the risk factors for endometrial cancer? Explain them.

Answer 24

Family history (Lynch syndrome)

Obesity (adipose tissue converts androgens to oestrogen and obesity increases oestrogen levels in blood through SHBG/insulin dysfunction)

Question 25

What are the two classes of endometrial cancer and which is the commonest?

Answer 25

Endometroid carcinoma (type 1) and serous/clear cell carcinoma (type 2) Endometroid carcinoma is the commonest

Question 26

What are the precursor lesions for the two types of endometrial cancer?

Answer 26

Endometroid carcinoma: atypical endometrial hyperplasia Serous/clear cell carcinoma: serous intraepithelial carcinoma

Question 27

What is the relationship of the 2 types of endometrial cancer to oestrogen?

Answer 27

Endometroid carcinoma is caused by excess oestrogen Serous/clear cell carcinoma is not caued by oestrogen (rather by TP52 mutation)

Question 28

What is the - transformation zone? - ectocervix? - endocervix?

Answer 28

TZ: junction between ecto/endocervix Endocervix: columnar epithelium inside cervix Exocervix: squamous epithelium outside cervix

Question 29

Where do nabothian cysts arise and what causes them?

Answer 29

Cervix Caused by cervical erosion: endocervical epithelium exposure to acidic vagina causes squamous metaplasia

Question 30

What causes cervicitis and why is it important to recognise?

Answer 30

Inflammation commonly by chlamydia/gonorrhoea Asymptomatic but can cause PID/infertility

Question 31

What is cervical intraepithelial neoplasia (CIN)? How is it graded?

Answer 31

Asymptomatic, preinvasive squamous dysplasia at the TZ (picked up at screening) graded depending on extend of dysplasia CIN1: basal third CIN2: extends to middle third CIN3: full thickness

Question 32

Describe the development of cervical cancer.

Answer 32

normal > koilocytosis > CIN 1>3 > cancer

Question 33

What is the name for the cytology pattern which indicates HPV infection

Answer 33

Koilocytosis

Question 34

What are the risk factors for cervical cancer?

Answer 34

HPV 16/18 infection Smoking Multiple sexual partners Early first sexual encounter (vulnerable TZ)

Question 35

How does cervical cancer present?

Answer 35

Early disease asymptomatic Late disease: bleed, discharge, pain, renal failure (obstructive uropathy)

Question 36

Who gets cervical screening?

Answer 36

25-50: 3 years | 50-65: 5 years

Question 37

What does cervical screening pick up?

Answer 37

Screening identifies cells which have the potential to become pre-cancerous These aren’t positive cancer results but could develop into cancer untreated Treatment at this stage is effective Screening “stops and treats the cancer before you get it”

Question 38

What HPV strains cause cervical cancer and which cause warts?

Answer 38

6,11 – cause warts, low risk 16, 18 – cause cancer, high risk

Question 39

Who gets vaccinated against HPV? What does this vaccinate them against?

Answer 39

Girls S1-S3 MSM < 45 HPV 6,11,16,18 (quadrivalent - gardasil)

Question 40

What is vulvar intraepithelial neoplasia?

Answer 40

Cancerous precurose affecting old/young woman (bimodal) More likely to progress in elderly

Question 41

Who gets vulvar invasive squamous carcinoma and what determines their prognosis?

Answer 41

Elderly woman Inguinal lymph node spread

Question 42

Vulvar invasive squamous carcinoma management.

Answer 42

Vulvectomy and inguinal lymphadenectomy