Gynae Path 1 Flashcards
What are the parts of the gynaecological tract?
Vulva Vagina Cervix Uterine body Fallopian tube Ovaries
How are neoplasia classified?
Classification:
WHO Classification of Tumours of the Female Genital Tract 2020
Staging:
The International Federation of Gynaecology and Obstetrics (FIGO)
Grading:
Varies with tumour type
What are the congenital abnormalities of the genital tract?
Duplication- bicornate, septated
Agenesis
What is inflammation of the GU tract called?
Vulva: vulvitis Vagina: vaginitis Cervix: cervicitis Endometrium: endometritis Fallopian tube: salpingitis Ovary: oopheritis
Which infections Cause discomfort but no serious complications?
Candida: Diabetes mellitus, oral contraceptives and pregnancy enhance development of infection
Tichomonas vaginalis: protozoan
Gardenerella: gram negative bacillus causes vaginitis
Which infections have serious complications?
Chlamydia: major cause of infertility
Gonorrhoea: major cause of infertility
Mycoplasma: causes spontaneous abortion and chorioamnionitis
HPV: implicated in cancer
What can cause PID?
Gonococci, chlamydia, enteric bacteria
usually starts from the lower genital tract and spreads upward via mucosal surface
Staph, strept, coliform bacteria and clostridium perfringens
secondary to abortion
usually start from the uterus and spread by lymphatics and blood vessels upwards
deep tissue layer involvement
What are the complications of PID?
Peritonitis
Bacteraemia
Intestinal obstruction due to adhesions
Infertility
What causes salpingitis?
Usually direct ascent from the vagina
What does salpingitis end up as?
Resolution Complications: Plical fusion Adhesions to ovary Tubo-ovarian abscess Peritonitis Hydrosalpinx Infertility Ectopic pregnancy
What is the most common cause of ectopic pregnancy?
Tubal
What pathologies exist in the cervix?
Inflammation
Polyps
Dysplasia and carcinoma
What is the epidemiology of cervical cancer?
2nd most common cancer affecting women worldwide
Mean age 45-50yrs
What are the RFs of cervical cancer?
Human Papilloma Virus -present in 95% Many sexual partners Sexually active early Smoking Immunosuppressive disorders
What are the low risk types of HPVs?
Most common types: 6, 11
Other types: 40, 42, 43, 44, 54, 61, 72, 73, 81
Genital and oral warts
Low grade cervical abnormalities
What are the high risk types of HPVs?
Most common types: 16, 18
Other types: 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68,82
Low & high grade cervical abnormalities
Cervical cancer
Vulval, vaginal, penile, and anal cancer
What does prognosis depend on?
Tumour type
Tumour grade
Tumour stage: FIGO Stage I (90%) – IV (10%) 5 year survival
Lymphovascular space invasion
What happens when one is infected with HPV ?
For most people, nothing will happen
The body’s immune system eliminates HPV
HPV becomes undetectable within 2 yrs in ~90%
Relatively few will develop symptoms
Persistent infection with high-risk HPV types is associated with pre-cancerous and cancerous cervical changes
How does HPV transform cells ??
Two proteins E6 and E7 encoded by the virus have transforming genes.
E6 and E7 bind to and inactivate two tumour suppressor genes:
Retinoblastoma gene (Rb) (E7) P53 (E6)
Both effects interfere with apoptosis and increase unscheduled cellular proliferation both of which contribute to oncogenesis.
Infection is either latent or productive.
What are the 2 distinct biological states of HPV infection? (1)
HPV DNA continues to reside in the basal cells
Infectious virions are not produced
Replication of viral DNA is coupled to replication of the epithelial cells occurring in concert with replication of the host DNA
Complete viral particles are not produced
The cellular effects of HPV infection are not seen
Infection can only be identified by molecular methods
What are the 2 distinct biological states of HPV infection? (2)
Viral DNA replication occurs independently of host chromosomal DNA synthesis.
Large numbers of viral DNA are produced and result in infectious virions.
Characteristic cytological and histological features are seen
Why is screening important?
Invitation of women most at risk of disease for screening to identify those who have indications of asymptomatic cervical abnormalities which require further investigation to avoid the possibility of developing into cervical cancer
Cervical cytology has a sensitivity ranging between 50% - 95% and specificity of at most 90% in detecting high grade CIN and SCC.
Now screening is focusing on detection of high risk HPV by molecular genetic approaches.
What are the intervals of screening?
25-49 = 3yrs
50-64 = 5yrs
65+ if one of the last 3 tests was abnormal
What is the Hybrid Capture II (HC2) HPV DNA Test?
A nucleic acid solution hybridization assay with signal amplification that uses long synthetic RNA probes complementary to the DNA sequence of:
5 low-risk HPV types ( types 6, 11, 42, 43 and 44)
13 high risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68).
RNA probe cocktails to the most common cancer-associated HPV types
