Gynae Pathology

Question 1

What do you call inflammation or infection of the fallopian tube?

Answer 1

Salpingitis

Question 2

Name three infections of the female genital tract that cause discomfort but no serious complications

Answer 2

Candida
Trichomonas vaginalis
Gardnerella

Question 3

Name four infections of the female genital tract with serious complications

Answer 3

Chlamydia - infertility
Gonorrhoea - infertility
Mycoplasma - spontaneous abortion and chorioamnionitis
HPV - cancer

Question 4

What increases the chance of getting a candida infection?

Answer 4

Diabetes mellitus, oral contraceptives, pregnancy

Question 5

What type of organism is trich?

Answer 5

Protazoan

Question 6

What is gardnerella?

Answer 6

Gram -ve bacillus which causes vaginitis

Question 7

Which organism can cause spontaneous abortion and chorioamnitis?

Answer 7

Myoplasma genitalium

Question 8

Name three organisms causing PID due to ascending from lower genital tract

Answer 8

Gonorrhoea
Chlamydia
Enteric bacteria

Question 9

Name four other organisms causing PID

Answer 9

Staph
Strep
Coliform bacteria
Clostridium difficile

Deep tissue layer invovlement
Start at uterus and spread by lymph nodes
Secondary to abortion

Question 10

Complications of PID

Answer 10

Infertility
Peritonitis
Bacteremia/sepsis
Intestinal obstruction due to adhesions

Question 11

List some complications of salpingitis

Answer 11

Ectopic pregnancy
Hydrosalpinx
Tuboovarian abscess
Peritonitis
Adhesions to the ovary
Infertility
Plical fusion

Question 12

What is the second most common type of cancer in women worldwide?

Answer 12

Cervical cancer

Question 13

List sites of ectopic pregnancies. Which site is most common?

Answer 13

Peritoneum
Abdomen
Tubal - 95 percent
Ovarian

Question 14

Epidemiology of cervical cancer

Answer 14

Mean age: 45-50 years old

Question 15

RF for cervical cancer

Answer 15

HPV
Smoking
Multiple partners
Immunosuppression
Sexual activity from an early age

Question 16

Which are low risk HPVs?

Answer 16

6 and 11

They cause genital and oral warts

Question 17

High risk HPVs

Answer 17

16 and 18

Low and high grade cervical dysplasia

Question 18

Name the parts of the cervix, and what type of cells line these.

Answer 18

Mucinous epithelium lines the endocervix
Stratified epithelium lines the ectocervix
Transitional zone in the middle

Question 19

What do you call it when some of the cells become cancerous? Explain this

Answer 19

Cervical intraepithelial neoplasia

This is where the cells have acquired some genetic and phenotypical changes, but haven’t invaded past the basement membrane yet

Question 20

Which type of epithelium is more commonly involved in intraepithelial neoplasia of the cervix?

Answer 20

CIN (squamous) < CGIN (glandular)

Question 21

What is the prognosis of squamous or adenocarcinomas dependent on?

Answer 21

Tumour type
Tumour grade
Tumour stage - FIGO staging I-IV
Lymphovascular space invasion

Question 22

What are the two modes of existence of HPV?

Answer 22

Latent or productive phase

Question 23

Explain the pathogenesis of cancer from HPV

Answer 23

HPV is a DNA virus which encodes two proteins which inactivate tumour suppressor genes.

E6 suppresses p53 (proliferation)
E7 suppresses Rb (apoptosis)

Both interfere with apoptosis and allow uncontrolled proliferation.

Question 24

In some cases, the body can eliminate HPV within how many years?

Answer 24

2 years

Question 25

Screening program for cervical cancer

Answer 25

25-49 - every 3 years 50-64 - every 5 years

Question 26

When is the HPV vaccine given?

Answer 26

Aged 12-13 girls and boys Second dose 6 to 24 months after 1st dose

Question 27

List three types of cancers which are screened for

Answer 27

Bowel Breast Cervical

Question 28

Causes of endometrial hyperplasia

Answer 28

PCOS Perimenopause (oestrogen) Persistent anovulation Ovarian granulosa cell tumours Oestrogen therapy Endometrial carcinoma

Question 29

Epidemiology of endometrial cancer

Answer 29

Most common gynae cancer in global north

Question 30

RF for endometrial cancer

Answer 30

Obesity Diabetes mellitus Nulliparity Excessive oestrogen stimulation

Question 31

List some histological subtypes of endometrial cancer

Answer 31

Endometrioid Serous Clear cell Squamous Mesonephric Mucinous Carcinosarcoma Mixed cell Undifferentiated

Question 32

Most common histological subtype of endometrial cancer

Answer 32

Endometrioid - atypical endometrial hyperplasia Oestrogen dependent High and low grade

Question 33

Compare endometriod endometrial cancer with clear cell carcinoma and serous carcinoma

Answer 33

Clear cell and serous are: Less common Older, postmenopausal women No precursor / not oestrogen dependent High grade, stage Whereas endometriod cancer is More common Any age Oestrogen dependent Low and high grade Occurs through multiple gene mutations

Question 34

What mutations are seen in serous cell carcinoma?

Answer 34

P53 (90 percent) P13KCA mutations in 15 percent of Her-2 amplification

Question 35

What mutations are seen in clear cell carcinoma?

Answer 35

PTEN CTNNB1 Her-2 amplificaiton

Question 36

FIGO staging for endometrial cancer - what are the main things they look for?

Answer 36

Stage 1 - confined to CORPUS uteri Stage 2 - invades cervical stroma Stage 3 - local or regional spread Stage 4 - bladder/bowel/distant invasion