Gynae histopath Flashcards Preview

Pathology > Gynae histopath > Flashcards

Flashcards in Gynae histopath Deck (47):
1

What is PID?

Infection ascedning from cervix/vag to uterus & tubes (endometritis & salpingitis) causing inflammation and fomration of adhesions

2

Most common causative organisms for PID in UK? (2)

Chlamydia Trachomatis
Neisseria gonorrhea
in other places TB & schisto are common

3

Clinical presentation of PID (6)

Lower abdo pain, fevers, chills
Dyspareunia
Vaginal bleeding/ discharge
adnexal tenderness
Cervical excitation

4

Complications of PID (6)

Infertility
Sepsis
Fitz-hugh-curtis syndrome - peri hepatic adhesions (RUQ pain)
Plical fusion
increased risk of ectopic
chronic pelvic pain
tubo-ovarian abscess

5

What is endometriosis?

Presence of endometrial glands/ stroma outside the uterus

6

Common places for endometriosis? (4)

POD
ovaries
uterine ligament
rectovaginal septum

7

Clinical features of endometriosis? (5)

pelvic pain, dysmennorhhea, reduced fertility, deep dyspareunia
Nodules/ tenderness in vag/posterior fornix/uterus ;
immobile uterus which is retroverted in advanced disease

8

What is adenomyosis?

Presence of endometrial tissue in the myometrium

9

Clinical features of adenomyosis (4)

Deep dyspareunia, menorrhagia, dysmenorrhea, globular uterus

10

What is a leiomyoma (fibroid)?

benign tumour of SM origin
(most common tumour of the female genital tract) 20% of women > 35 will have

11

3 sites where fibroids can be found

Submucosal
Intra mural
Subserosal
oestrogen dependent - enlarge during pregnancy, regress during menopause

12

Macroscopic appearance of fibroids (4)

Round, discrete, firm, gray/ white tumours of variable size

13

Microscopic appearance of fibroids (1)

Bundles of SM cells

14

Clinical features of fibroids (5)

Reduced fertility
Menorrhagia
dysmenorrhea
pressure symptoms - urgency/freq or tenesmus
Red degeneration of fibroids in pregnancy

15

What % of women with PMB will have a malignancy?

10% - PMB is endometrial cancer unless proven otherwise

16

Endometrial cancer is subdivided into which types?

Endometroid (80%) & non-endometroid (20%)

17

Pathophysiology of endometrioid endometrial cancer? (2)

Related to oestrogen excess
Peri-menopausal women
these are mainly adenocarcinomas (85%) but can show squamous differentiation

18

Risk factors for endometroid cancer? (7)

Oestrogen excess - obesity, anovulatory amenorrhoea (e.g. PCOS), nulliparity, early menarche, late menopause, tamoxifen
Also DM & HTN

19

Subtypes of non-endometroid endometrial cancer (3)

Serous
Papillary
clear cell

20

Pathophysiology of non-endometroid endometrial cancer

Unrelated to oestrogen excess; usually in elderly women with endometrial atrophy

21

Normally what type of cells make up the vulva? i.e. normal vulval histology

Squamous epithelium

22

VIN pathology (similar to CIN)

Dysplasia of epithelium - associated with HPV
graded VIN I, II & III
but progression to invasive disease is lower than for CIN (5%)

23

Vulval carcinoma arises from (2) (mainly squamous cell carcinoma)

VIN
or other skin abnormality e.g. Paget's of vulva

24

Ovarian carcinomas - 3 types

Epithelial
Germ cell
Sex-cord/ stroma

25

Subtypes of ovarian epithelial carcinomas (4)(70%)

Serous
Mucinous
Clear cell
Endometriod
these are derived from the epithelium that covers the ovary. THey can be benign, borderline, or malignant serous

26

Characterisitics of serous epithelial ovarian carcinoma (2)

Most common
Psammoma bodies
mimics tubular epithelium - so columnar

27

Characterisitcs of mucinous ovarian carcinomas (2)

Mucin secreting cells - similar to those of endocervical mucosa
Or intestinal type metastatic from appendix in some cases causing PSEUDOMYXOMA PERITONEI (fills peritoneal cavity with mucin - compression of organs and scarring)
No Psammoma bodies

28

Characteristics of endometriod ovarian carcinomas (1)

Mimics endometrium - form tubular glands

29

Characteristics of Clear cell ovarian carcionmas (2)

Abundant clear cytoplasm - IC glycogen
HOBNAIL appearance

30

Subtypes of germ cell ovarian carcinomas: (3) (20%)

Teratoma
Dysgerminoma
Choriocarcinoma
Derived from germ cells (produce gametes). Usually benign in adults, MALIGNANT in children

31

Characterisitcs of a dysgerminoma (1)

Female counterpart of testicular seminoma

32

Characteristics of ovarian Teratoma (4)

Can be ecto, meso or endo - mostly ecto
Mature teratomas (dermoid cyst): benign; usually cystic
e.g. bone, hair, teeth etc.
Immature teratomas - MALIGNANT - usually SOLID
Contain immature embroyonal tissue

33

Characteristics of choriocarcinoma (1)

Secretes hCG

34

Subtypes of Sex cord/ stroma tumours (10%)

Fibroma - from cells of ovarian stroma
Granulosa-thecal cell tumours
Sertoli-leydig tumour

35

Characteristics of ovarian fibromas (2)

No hormone production
V. Osmotically active > cause ascites + pleural effusion = MEIG'S syndrome

36

Characteristics of granulosa-theca cell tumours (3)

Produce Oestrogen:
Look for oestrogenic effects: in children precocious puberty, irregular menses, breast enlargement, endometrial/ breast cancer

37

Characteristics of Sertoli-Leydig cell tumours (3)

Secrete androgens:
Look for defeminsation: breast atrophy, virilisation (hirsuitism, deepened voice, enlarged clit)

38

Describe the normal cervix histology (3)

Outer cervix = squamous epithelium
Endo cervical canal = columnar glandular epithelium
Junction between them is the squamous columnar junction (SCJ) AKA transition zone - susceptible to malignancy

39

what is CIN? (1)

Dysplasia at the TZ due to HPV 16/18 infection

40

Grading of CIN on cytology (3)

Graded mild, moderate or severe dyskaryosis on cytology.

41

Grading of CIN on histology (3)

CIN 1 - dysplasia confined to lower third of epithelium
CIN 2 - dysplasia lower 2/3rds
CIN 3 - Full thickness of epithelium - but BM intact

60- 90% of CIN 1 reverts to normal in 2 yrs , 30% of CIN 3 goes to cervical cancer over 10 yrs

42

Risk factors for CIN (4)

Early age at 1st intercourse
Multiple partners
multiparity
smoking
HIV/ immunosuppression

43

What is CGIN? How to treat it?

Cervical glandular intraepithelial neoplasia - less common + harder to diagnose on cytology
Treatment requires excision of entire endocervix (this can compromise fertility)

44

Cervical carcinoma usually arises from what? (1)

CIN

45

Types of Cervical carcinoma (2)

Mostly squamous (70/80 %)
20% adenocarcinomas, adenosquamous & others

46

What marks the change between CIN & Cervical cancer?

invasion of BM

47

Clinical features of cervical carcinoma (4) (majority of lesions benign - staged using FIGO)

PCB, IMB, PMB, discharge, pain