Gynae Histopathology

Question 1

What is the definition of PID

Answer 1

Pelvic inflammatory disease is the infection ascending from the vagina and cervix to the uterus and tubes leading to endometritis and salpingitis. It also leads to the formation of adhesions and scar tissue which can cause irreversible damage even after the infection is cleared.

Question 2

What are the two most common organisms causing PID?

Answer 2

Chlamydia trachomatis and Neisseria gonorrhea are the most common organisms causing PID in the UK.

Question 3

Give 2 other organisms causing PID in developing countries

Answer 3

TB schistosomiasis

Question 4

Give 6 clinical features of PID

Answer 4

lower abdo pain, dyspareunia, vaginal bleeding/dischage, fever, adnexal tenderness and cervical excitation

Question 5

Give 8 complications of PID

Answer 5

1. Infertility
2. Increased ectopic pregnancy risk
3. Intestinal obstruction (and subsequent bacteremia)
4. Tubo-ovarian abscess
5. Chronic pelvic pain
6. Peritonitis
7. Plical (mucosal fold) fusion
8. Fitz Hugh Curtis syndrome (basically hepatic pain and adhesions)

Question 6

Define endometriosis and give 3 common anatomical locations

Answer 6

Presence of endometrial glands or stroma in abnormal locations outside the uterus (e.g. ovaries, uterine ligaments, rectovaginal septum, pouch of douglas, bladder

Question 7

Give 3 issues patients may develop with endometriosis

Answer 7

pain, scarring, infertility

Question 8

Give 3 types of pain seen in endometriosis

Answer 8

Dysmenorrhoea, deep dysparenuina, pelvic pain

Question 9

Give 2 other potential clinical findings on examination with endometriosis

Answer 9

nodules/tenderness in vagina, posterior fornix or uterus

immobile uterus which becomes retroverted in advanced disease.

Question 10

Give 2 macroscopic findings of endometriosis upon laparoscopy

Answer 10

red-blue to brown nodules - ‘powder burns’

‘chocolate cysts’ in ovaries (endometriomas)

Question 11

Define adenomyosis

Answer 11

Presence of endometrial glands or stroma deep within the myometrium

Question 12

Give 3 symptoms and 1 anatomical feature of adenomyosis

Answer 12

dysmenorrhea, menorrhagia, deep dyspareunia

globular uterus

Question 13

Define leiomyoma

Answer 13

A fibroid. A benign tumour of smooth muscle origin.

Question 14

What is the incidence of fibroids in women under 35

Answer 14

occurs in 20%. most common FGTract tumour

Question 15

Are fibroids E2 dependent? Why is this important?

Answer 15

Yes. Become larger in pregnancy and smaller post menopause.

Question 16

What are the 3 categories of fibroids? Define them

Answer 16

Submucosal: fibroids that develop in the muscle layer beneath the womb’s inner lining and grow into the cavity of the womb
Intramural: the most common type of fibroid, which develop in the myometrium
Subserosal: fibroids that develop outside the wall of the womb into the pelvis and can become very large

Question 17

Describe fibroids macroscopically

Answer 17

Well defined, discrete, round, firm, gray/white masses of variable sizes.

Question 18

Describe fibroids microscopically

Answer 18

Bunches of well differentiated smooth muscle cells.

Question 19

Give 4 potential clinical features oh having fibroids

Answer 19

menorrhagia, dysmenorrhea, pressure effects (e.g. urinary frequency, tenesmus), subfertility

Question 20

Are leiomyosarcomas (malignant) more likely to arise from fibroids (leiomyomas) or de novo?

Answer 20

De novo more likely, usually occur in post-menopausal women.

Question 21

Postmenopausal bleeding is WHAT until proven otherwise?

Answer 21

ITS THE CANCER. ENDOMETRIAL CANCER.

Question 22

What percentage of women with postmenopausal bleeding will have a malignancy?

Answer 22

10%

Question 23

Give 2 clinical features of Fitz Hugh Curtis syndrome

Answer 23

RUQ pain from peri-hepatitis and violin string peri-hepatic adhesions. Complication of PID.

Question 24

What are the 2 main types of endometrial carcinomas and their proportions

Answer 24

Endometroid (80%) and non-endometrioid (20%)

Question 25

Describe the pathophysiology of endometrioid carcinoma

Answer 25

related to E2 excess, most common in peri-menopausal women. Mainly adenocarcinomas (85%), may show some columnar -> squamous differentiation.

Question 26

Give 6 E2 excess related risk factors and 2 general risk factors for endometrioid endometrial carcinoma

Answer 26

1. Obesity, amenorrhea (e.g. PCOS, hypothalamic), nulliparity, early menarche, late menopause, tamoxifen/other E2 agonist in endometrium 2. DM, HTN

Question 27

Give 3 cell types which are classified as non-endometrioid endometrial carcinomas

Answer 27

papillary, serrous, clear cell

Question 28

Describe the pathophysiology of non-endometrioid endometrial carcinoma

Answer 28

unrelated to estrogen excess. most common in elderly women with endometrial atrophy

Question 29

What is normal vulval tissue

Answer 29

squamous epithelium

Question 30

what is VIN and describe it's pathophysiology

Answer 30

vulval intraepithelial neioplasia (VIN). similar to CIN Dysplasia of epithelium, associated with HPV. progression to invasive disease is approx 5% (lower than CIN)

Question 31

Describe 2 conditions from which vulval carcinomas can arise

Answer 31

Can arise from VIN or from other skin abnormalities (e.g. Paget's of the vulva)

Question 32

Briefly describe the 5 levels of FIGO staging (0-IV)

Answer 32

stage 0: carcinoma in situ (common in cervical, vaginal, and vulval cancer) stage I: confined to the organ of origin stage II: invasion of surrounding organs or tissue stage III: spread to distant nodes or tissue within the pelvis stage IV: distant metastasis(es)

Question 33

Ovarian carcinoma are subdivided into 3 main types. What are they and their proportions. Describe whether they are likely to be benign or malignant.

Answer 33

Epithelial (70%) can be benign or malignant, Germ cell (20%) usually benign in adults and malignant in children, Sex cord/stroma (10%) can differentiate into e2 or androgen secreting tumours.

Question 34

What are the 4 types of epithelial cell derived ovarian carcinoma and detail their characteristics

Answer 34

1. Serous- most common, similar to tubal (columnar) epithelium. PSAMMOMA bodies COMMON. 2. Mucinous- mucin secreting cells, similar to endocervical mucosa or can be metastatic from intestine (psuedomyxoma peritonei). NO PSAMMOMA bodies 3. Endometrioid- similar to endometrium (ie tubular glands) 4. Clear cell- Lots of clear cytoplasm containing glycogen. HOBNAIL appearance around edge.

Question 35

What are the 3 types of germ cell derived ovarian carcinoma and detail their characteristics

Answer 35

1. Dysgerminoma- undifferentiates usually malignant 2. Teratoma- can be mature (e.g. dermoid cyst which can contain skin, hair, teeth, bone, cartilage) or immature (usually malignant solid, containging embyonic tissue).

Question 36

What are the 3 types of sex cord/stromal cell derived ovarian carcinoma and detail their characteristics

Answer 36

1. Fibroma- no hormones produced. 50% are associated with ascites and pleural effusion (Meig's syndrome) 2. Granulosa-thecal cell tumour- secrete E2. look for estrogenisation (menstrual changes, breast changes, other E2 cancers) 3. Sertoli-leydig tumour- secrete androgens. look for hirsuitism

Question 37

What are CIN and CGIN

Answer 37

cervical intraepithelial neoplasia (dysplasia at the TZ due to HPV infection) and cervical glandular intraepithelial neoplasia

Question 38

Describe normal cervical histology (outer vs inner)

Answer 38

outer cervix- squamous epithelia endocervical canal- columnar glandular epithelium separated by squamocolumnar junction.

Question 39

Describe the TZ

Answer 39

transformation zone => columnar become squamous (metaplasia) at SCJ. Normal process, but this area is susceptible to malignant change.

Question 40

Describe CIN CYTOlogical grading

Answer 40

1. mild dyskaryosis (dyskaryosis is characterized by hyperchromatic nuclei and/or irregular nuclear chromatin) 2. moderate " 3. severe "

Question 41

Describe CIN HISTOlogical grading

Answer 41

CIN 1- dysplasia confined to lower third of epithelium CIN 2- dysplasia lower 2/3 of epithelium CIN 3- full epithelium, but BM intact 60-90% of CIN 1 reverts to normal over 2 years 30% of CIN 3 becomes cervical cancer over 10 years

Question 42

Give 6 risk factor for CIN (for HPV 16/18 infection)

Answer 42

1. Their first D at an early age 2. Multiple D's 3. Mulitparity 4. Smoking 5. HIV 6. Other immunosuppression

Question 43

How do you treat CGIN

Answer 43

Whip out all of the endocervix (can compromise fertility). | CGIN is less common than CIN and more difficult to diagnose on cytology.

Question 44

What condition does cervical carcinoma usually arise from

Answer 44

CIN

Question 45

What are the histological types of cervical cancer and their percentages?

Answer 45

Squamous cell carcinoma (70-80%) is the most common | ~20% are adenocarcinoma, adenosquamous or others

Question 46

What is the differentiating factor between CIN and cervical cancer

Answer 46

invasion of the basement membrane

Question 47

What are clinical signs of cervical cancer

Answer 47

Post-coital bleeding, Intermenstrual bleeding, postmenopausal bleeding, discharge, pain.