Flashcards in Gynae Histopathology Deck (47):
What is the definition of PID
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.
What are the two most common organisms causing PID?
Chlamydia trachomatis and Neisseria gonorrhea are the most common organisms causing PID in the UK.
Give 2 other organisms causing PID in developing countries
Give 6 clinical features of PID
lower abdo pain, dyspareunia, vaginal bleeding/dischage, fever, adnexal tenderness and cervical excitation
Give 8 complications of PID
2. Increased ectopic pregnancy risk
3. Intestinal obstruction (and subsequent bacteremia)
4. Tubo-ovarian abscess
5. Chronic pelvic pain
7. Plical (mucosal fold) fusion
8. Fitz Hugh Curtis syndrome (basically hepatic pain and adhesions)
Define endometriosis and give 3 common anatomical locations
Presence of endometrial glands or stroma in abnormal locations outside the uterus (e.g. ovaries, uterine ligaments, rectovaginal septum, pouch of douglas, bladder
Give 3 issues patients may develop with endometriosis
pain, scarring, infertility
Give 3 types of pain seen in endometriosis
Dysmenorrhoea, deep dysparenuina, pelvic pain
Give 2 other potential clinical findings on examination with endometriosis
nodules/tenderness in vagina, posterior fornix or uterus
immobile uterus which becomes retroverted in advanced disease.
Give 2 macroscopic findings of endometriosis upon laparoscopy
red-blue to brown nodules - 'powder burns'
'chocolate cysts' in ovaries (endometriomas)
Presence of endometrial glands or stroma deep within the myometrium
Give 3 symptoms and 1 anatomical feature of adenomyosis
dysmenorrhea, menorrhagia, deep dyspareunia
A fibroid. A benign tumour of smooth muscle origin.
What is the incidence of fibroids in women under 35
occurs in 20%. most common FGTract tumour
Are fibroids E2 dependent? Why is this important?
Yes. Become larger in pregnancy and smaller post menopause.
What are the 3 categories of fibroids? Define them
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
Describe fibroids macroscopically
Well defined, discrete, round, firm, gray/white masses of variable sizes.
Describe fibroids microscopically
Bunches of well differentiated smooth muscle cells.
Give 4 potential clinical features oh having fibroids
menorrhagia, dysmenorrhea, pressure effects (e.g. urinary frequency, tenesmus), subfertility
Are leiomyosarcomas (malignant) more likely to arise from fibroids (leiomyomas) or de novo?
De novo more likely, usually occur in post-menopausal women.
Postmenopausal bleeding is *WHAT* until proven otherwise?
ITS THE CANCER. ENDOMETRIAL CANCER.
What percentage of women with postmenopausal bleeding will have a malignancy?
Give 2 clinical features of Fitz Hugh Curtis syndrome
RUQ pain from peri-hepatitis and violin string peri-hepatic adhesions. Complication of PID.
What are the 2 main types of endometrial carcinomas and their proportions
Endometroid (80%) and non-endometrioid (20%)
Describe the pathophysiology of endometrioid carcinoma
related to E2 excess, most common in peri-menopausal women. Mainly adenocarcinomas (85%), may show some columnar -> squamous differentiation.
Give 6 E2 excess related risk factors and 2 general risk factors for endometrioid endometrial carcinoma
1. Obesity, amenorrhea (e.g. PCOS, hypothalamic), nulliparity, early menarche, late menopause, tamoxifen/other E2 agonist in endometrium
2. DM, HTN
Give 3 cell types which are classified as non-endometrioid endometrial carcinomas
papillary, serrous, clear cell
Describe the pathophysiology of non-endometrioid endometrial carcinoma
unrelated to estrogen excess. most common in elderly women with endometrial atrophy
What is normal vulval tissue
what is VIN and describe it's pathophysiology
vulval intraepithelial neioplasia (VIN). similar to CIN
Dysplasia of epithelium, associated with HPV.
progression to invasive disease is approx 5% (lower than CIN)
Describe 2 conditions from which vulval carcinomas can arise
Can arise from VIN or from other skin abnormalities (e.g. Paget's of the vulva)
Briefly describe the 5 levels of FIGO staging (0-IV)
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)
Ovarian carcinoma are subdivided into 3 main types. What are they and their proportions. Describe whether they are likely to be benign or malignant.
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.
What are the 4 types of epithelial cell derived ovarian carcinoma and detail their characteristics
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.
What are the 3 types of germ cell derived ovarian carcinoma and detail their characteristics
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).
What are the 3 types of sex cord/stromal cell derived ovarian carcinoma and detail their characteristics
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
What are CIN and CGIN
cervical intraepithelial neoplasia (dysplasia at the TZ due to HPV infection) and cervical glandular intraepithelial neoplasia
Describe normal cervical histology (outer vs inner)
outer cervix- squamous epithelia
endocervical canal- columnar glandular epithelium
separated by squamocolumnar junction.
Describe the TZ
transformation zone => columnar become squamous (metaplasia) at SCJ. Normal process, but this area is susceptible to malignant change.
Describe CIN CYTOlogical grading
1. mild dyskaryosis (dyskaryosis is characterized by hyperchromatic nuclei and/or irregular nuclear chromatin)
2. moderate "
3. severe "
Describe CIN HISTOlogical grading
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
Give 6 risk factor for CIN (for HPV 16/18 infection)
1. Their first D at an early age
2. Multiple D's
6. Other immunosuppression
How do you treat CGIN
Whip out all of the endocervix (can compromise fertility).
CGIN is less common than CIN and more difficult to diagnose on cytology.
What condition does cervical carcinoma usually arise from
What are the histological types of cervical cancer and their percentages?
Squamous cell carcinoma (70-80%) is the most common
~20% are adenocarcinoma, adenosquamous or others
What is the differentiating factor between CIN and cervical cancer
invasion of the basement membrane