Gynae - vulva, vagina, uterus Flashcards
(51 cards)
1
Q
Infections of genitalia - 7 types of bacteria
A
- Herpes virus
- Molluscum contagiosum
- HPV
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Candida
- Trichomonas
2
Q
pelvic inflammatory disease (PID) clinical symptoms (4)
A
- pelvic pain
- adnexal tenderness (abnormal growth near the uterus)
- fever
- vaginal discharge
3
Q
diseases affecting vulva (3 types)
A
- bartholin cyst
- non-neoplastic epithelial disorders
Lichen simplex chronicus, Lichen sclerosus - neoplasms
(benign) hidradenoma, condylomas
(malignant) VIN, SCC, Paget’s (vulva)
4
Q
vulva paget’s disease
- type of tumour
- micro appearance
- clinical appearance
- prognosis
A
- in-situ adenocarcinoma
- atypical large cells
confined to lining epithelium (basement membrane)
arises from primitive ducts and spreads along lining epithelium - redness, exise area w/ margins
- good prognosis
5
Q
intraepithelial tumours (3)
A
- VIN (Vulvar intraepithelial neoplasia)
- VAIN (Vaginal Intraepithelial Neoplasia)
- CIN (Cervical Intraepithelial Neoplasia)
6
Q
diseases affecting vagina
A
- Congenital anomalies
- VAIN
- Adenocarcinoma - caused by mother taking DES drug during pregnancy
- Embryonal rhabdomyosarcoma = sarcoma botryoides
7
Q
clear cell adenocarcinoma (CCA) of vagina
- affects who
- discoverable at what age
- micro appearance
- precursor
A
- young women w/ mothers treated w/ DES drug during pregnancy
- 15-20yrs
- Vacuolated tumor cells in clusters and gland-like structures
- precursor: vaginal adenosis = presence of glandular epithelium in vagina
8
Q
Embryonal rhabdomyosarcoma = sarcoma botryoides
- what type of tumour
- affects who
- treatment
A
botryoides = grape-like branches
rhabdomyosarcoma = tumour in soft tissue
- affects infants/children
- surgery + chemotherapy
9
Q
cervical intraepithelial neoplasia (CIN)
- types
- where does it affect most commonly
A
- CIN I/ II/ III
(CIN I is the lowest grade w/
mild dysplasia; CIN III - severe dysplasia/carcinoma in situ) - usually happens in the transformation zone (btw ectocervix and endocervix)
simple columnar -> stratified squamous
10
Q
CIN risk factors
A
- Early age at first intercourse
- Multiple sexual partners/ partner has multiple sexual partners
- Increased parity (give birth many times)
- cancer-associated HPV**
- Certain HLA and viral subtypes
- Exposure to oral contraceptives and nicotine
- Genital infections (chlamydia)
11
Q
cervical cancer screening
- age group
- frequency
A
25-69 yrs
every 3 years
12
Q
HPV micro features
A
- multinucleation
- perinuclear halo
- crinkled nuclei
13
Q
cervical neoplasia -> cervical cancer pathogenesis (3 steps)
A
- HPV infection
HPV disable protective functions of p53 and R8 -> unchecked cell proliferation** - progression (1 year)
- invasion
14
Q
cervical carcinoma gross appearance (3)
A
- fungating
- ulcerating
- infiltrative
15
Q
types of cervical carcinomas
A
- Squamous cell carcinoma** (forms majority of cervical cancers)
- Adenocarcinoma
- Adenosquamous
- Undifferentiated
16
Q
3 types of squamous cell carcinomas
A
- large cell non-keratinising
- large cell keratinisng
- small cell (SCC)
17
Q
spread of cervical cancer
A
- local invasion: (related structures) uterus, vagina, bladder, rectum
- lymphatics
- hematogenous (bloodstream): lung, liver, bone, brain
18
Q
staging of carcinoma cervix
- what is it based on
A
based on local invasion
1: only cervix
2: upper vagina/ parametrium
3: pelvic wall/ lower vagina
4: rectum
19
Q
diseases affecting uterine corpus
A
- Endometrium – normal, polyps, hyperplasia, carcinoma, stromal neoplasms
- Myometrium - leiomyomas, leiomyosarcoma, adenomyosis
- Mixed mullerian tumour (carcinosarcoma)
20
Q
diseases affecting endometrium of uterine corpus (lining of the uterus)
A
- polyps
- hyperplasia (cystic/ complex)
- carcinoma
- stromal neoplasm
21
Q
diseases affecting myometrium of uterine corpus
A
- leiomyomas (SM tumour)
- leiomyosarcoma
- adenomyosis - inner lining of the uterus (endometrium) breaks through the muscle wall of the uterus (myometrium)
22
Q
endometrial hyperplasia
- cause
- effect
- 2 types
A
caused by unopposed estrogen stimulation + mutation of PTEN tumour suppressor gene
causes abnormal vaginal bleeding
- typical vs atypical hyperplasia
(atypical has higher risk of progressing to endometrial carcinoma)
23
Q
cystic hyperplasia micro appearance
A
Irregularly dilated glands
looks like proliferative glands
24
Q
complex hyperplasia micro appearance
+ complication
A
Glandular crowding and irregular shape
Loss of PTEN tumour suppressor gene -> High risk of cancer
25
endometrial carcinoma**
| - affects which age group
postmenopausal women
26
causes of endometrial carcinoma (2)
| + risk factors**
- prolonged estrogen stimulation (type 1)
- p53 gene mutation (type 2)
risk factors: late menopause/early menarche.
obesity
27
3 ways that prolong estrogen stimulation
- Endometrial hyperplasia
- Ovarian estrogen secreting tumours
- ERT (enzyme replacement therapy)
28
tumour caused by p53 gene mutation
- prognosis
- differentiation
(No preexisting hyperplasia)
- Poor prognosis
- Poorly differentiated serous type
29
progress of tumour formed by prolong estrogen stimulation (type 1)
+ grading and prognosis
```
proliferative endometrium
-> non-typical hyperplasia
-> typical hyperplasia
-> grade 1 uterine endometrial carcinoma
better prognosis than type 2
```
30
staging of uterine endometrial carcinoma
- stages
- invasion of what structures
4 stages
1: Corpus only (affects majority)
2: Corpus & cervix
3: Invasion into pelvis
4: Outside pelvis
31
leiomyoma of uterus
- affects who
- progression
- complications
Most common uterine neoplasm
>30 yrs, regresses after menopause
- Increase in size with nuclear estrogen receptor/ progestins (hormones affecting progesterone receptor) and pregnancy
- presents w/ multiple tumours
stimulations of hormone receptors can cause increase in size + hemorrhagic degeneration
32
leiomyoma of uterus
| - which parts does it affect (4)
- pedunculated (outside myometrium - uterine cavity/ outside uterus)
- subserosal
- intramural
- submucosal
33
clinical symptoms (3) + complications (2) of leiomyoma
(ABS - IS)
- Abnormal bleeding (heavy menses)
- Bladder compression
- Sudden pain
- infertility
- spontaneous abortion
34
leiomyoma **
- gross appearance
- histo features
red degeneration:
- beefy red appearance due to rapid growth and infarction with subsequent haemorrhagic degeneration
- well circumscribed, smooth round nodule in wall of uterus
histo:
- well circumscribed tumour w/ interlacing bundles of uniform spindled cells:
blunt ended nuclei and eosinophilic cytoplasm
35
leiomyosarcoma
- histo appearance
- complications
- Increased mitosis
- necrosis
- atypia
Metastasize to lungs/brain
low 5 year survival
36
endometriosis definition
Presence of endometrial glands and stroma in abnormal locations outside the uterus
37
endometriosis**
- location
- clinical symptoms
- complications
- mostly in abdominal cavity (undergoes cyclic bleeding even when it is not in the uterus)
- dysmenorrhea (pain during menstruation)
pelvic pain
infertility
- may progress to endometrial/ clear cell carcinoma
38
adenomyosis**
- definition
- 2 types
- ectopic endometrial deposits in MYOMETRIUM
w/ overgrowth of muscle and connective tissue
```
- diffused (deposits confined within myometrium) - more common
vs localised (looks like fibroid, w/ brown coci)
```
39
abnormal bleeding in prepuberty**
```
precocious puberty (early puberty <8yrs)
hypothalamic/pituitary/ovarian problems
```
40
abnormal bleeding in adolescence**
anovulation (lack of menses)
| coagulation disorders
41
abnormal bleeding in reproductive stage**
```
pregnancy complications (abortion, trophoblastic disease, ectopic pregnancy)
leimyoma, adenomyosis, polyps, endometrial hyperplasia, endometrial carcinoma
```
42
abnormal bleeding in perimenopausal stage**
dysfunctional uterine bleeding
anovulation
carcinoma, hyperplasia, polyps
43
abnormal bleeding in postmenopausal stage**
endometrial atrophy
| carcinoma**, hyperplasia, polyps
44
investigations to identify etiology of bleeding
- pelvic ultrasound
- hysteroscopy (if u/s found to have endometrial polyp)
- endometrial sampling
45
treatment of polyps
hysteroscopic polypectomy
46
treatment of adenomyosis
mirena (hormonal IUD - intrauterine device)
| hysterectomy
47
treatment of leiomyoma
myomectomy
| hysterectomy
48
treatment of malignancy
THBSO (Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy)
49
why does leiomyoma -> heavy menses?
tumour expands myometriumci - increase surface area of endometrial cavity (extra outpouching) -> increase shedding
50
CIN III histo features
- full thickness dysplasia of squamous mucosa
- loss of maturation
- cytologic atypia: cells have high n/c ratio, irregular nuclear membrane
51
squamous cell carcinoma of cervix
- histo features
- diagnostic test
- tumour invades into surrounding cervical stroma
- presence of keratin pearls
- intercellular bridges
cytokeratin stain positive
