HistoPath - Gynae Flashcards by Alexandra Chan

What are the congenital abnormalities of the uterus

Duplication (i.e. uterus didelphys)
Agenesis

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Give examples of common infections of the genital tract

Infections that cause discomfort with NO serious complications
- Candida: more common in DM, OCP, pregnancy
- Trichomonas vaginalis: protozoan
- Gardenerella: Gram-negative bacillus causes vaginitis

Infections that cause SERIOUS complications
- Chlamydia: major cause of infertility
- Gonorrhoea: major cause of infertility
- Mycoplasma: causes spontaneous abortion and chorioamnionitis
- HPV: implicated in cancer

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What are the common causes of PID

Ascending from LGT: Chlamydia, Gonorrhoea
Secondary to TOP: staph aureus, strep, clostridium perfringens (spread via lymphatics and blood vessels)

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What are the complications of PID

Peritonitis
Bacteraemia and sepsis
Chronic PID
Adhesions → intestinal obstruction
Fitz-Hugh-Curtis syndrome

Salpingitis:
Tubo-ovarian abscess
Ectopic pregnancy
Infertility
Plical fusion
Hydrosalpinx (fallopian filled with fluid)

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What is the most common site of ectopic pregnancy

Ampulla of fallopian tube

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Define endometriosis

presence of endometrial tissue outside the uterus

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What are the theories of endometriosis pathogenesis

Metaplasia of pelvic peritoneum (coelomic) → implantation
Retrograde menstruation

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What are the symptoms and signs of endometriosis

Dysmenorrhoea
Pelvic pain
Dyspareunia
Subfertility

Nodules
Tenderness
Fixed retroverted uterus

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What malignancies is endometriosis associated with

Strongly: clear cell (mesonephroid/epithelial) ovarian cancer
Less strongly: endometroid (epithelial) ovarian cancer

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What would be found on histology for endometriosis

Laparoscopically: powder burns (red/blue vesicles) and endometriomas

Micro: endometrial glands and stroma

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What is adenomyosis and what are the signs on examination

Ectopic endometrial tissue in the myometrium
O/E boggy uterus

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What are leiomyomas and what are the types

Smooth muscle tumour of the myometrium
MOST COMMON (20% of >35yo) uterine tumour
Usually multiple
May be submucosal, intramural, or subserosal (outermost)

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What is a malignant leiomyoma

leiomyosarcoma
RARE and usually solitary
Usually post-menopausal women
5-year survival of 20-30%
Local invasion and spread via the blood stream

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What are the histological features of leiomyomas

Macro: sharp, circumscribed mass, discrete benign tumour
Micro: bundle of smooth muscle cells

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What is endometrial hyperplasia and what are the causes

Increase in stroma and glands (usually driven by oestrogen)

Peri-menopausal
Persistent anovulation (because of persistently raised oestrogen levels)
PCOS can also cause persistently elevated levels of oestrogen giving rise to endometrial hyperplasia
Granuloma cell tumours of the ovary
Oestrogen therapy

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What is the most common gynaecological malignancy in developed countries

Endometrial cancer

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Describe type 1 endometrial cancers

Type 1 (85%): endometrioid (+mucinous and secretory adenocarcinoma)
- Younger (peri-menopausal)
- Oestrogen-dependent
- Associated with atypical endometrial hyperplasia
- Low grade tumours
- Associated with PTEN, K-Ras, FGFR2, p53 etc.

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Describe type 2 endometrial cancers

15%: serous and clear cell
- Older patients
- Not oestrogen dependent
- Atrophic endometrium
- High grade, deeper invasion
- Associated with Her-2, p53, PTEN etc.

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Describe is the staging for endometrial cancer

FIGO
I = limited to uterus
II = spread to cervix
III = spread adjacent (pelvis)
IV = distant spread

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What are the prognostic factors of endometrial cancer

Type, grade (glands vs solid, degree of cytological aplasia), stage
Tumour ploidy - diploid have a better prognosis
Hormone receptor expression

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What are the risk factors for endometrial cancer

Nulliparity
Obesity
Early menarche
Late menopause
COCP
HRT
Tamoxifen
Diabetes Mellitus

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What is gestational trophoblastic disease and what are the types

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spectrum of tumours characterised by proliferation of trophoblastic tissue
- Complete (2.5% malignancy; 10% invasive moles)
- Partial mole
- Invasive mole
- Choriocarcinoma

What are complete and partial moles

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Complete = empty egg fertilised by 2 sperm (or 1 which duplicates DNA)
46 XY or 46 XX (paternal origin only)

Partial = normal egg fertilised by 2 sperm (or 1 which duplicates DNA)
69 XXX or 69 XXY (1x maternal and 2x paternal origin)

What is the prevalence of complete/partial moles and what are the clinical features

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Prevalence: 1 in 1000 pregnancies

Features:
- Spontaneous abortion
- USS – snowstorm, cluster of grapes
- Very high hCG

What are the features of choriocarcinoma (prevalence, origin, invasion, response to therapy)

Incidence: 1 in 20,000-30,000 pregnancies 50% arise in moles 25% arise in previous abortion 22% arise in normal pregnancy Rapidly invasive, widely metastasising (lung, vagina, brain, liver, kidney) Responds well to chemotherapy

What are the types of ovarian cyst

Follicular (dominant follicle does not rupture) Luteal cysts (CL does not break down → intraperitoneal cysts → "Ring of fire" on US Endometriotic cyst

What are the risk factors for ovarian tumours

Nulliparity Early menarche Late menopause Genetic predisposition Infertility Endometriosis HRT Inflammation (PID) FHx ovarian/breast cancer

What are the types of ovarian tumours

Epithelial, germ cell, sex chord (Stromal) Epithelial Type 1: endometrioma, clear cell, mucinous, low-grade serous Type 2: serous Germ cell Teratoma Dysgerminoma Choriocarcinoma Endodermal sinus tumour Sex chord/stromal Fibroma Granulosa cell tumour Sertoli-Leydig cells Thecoma

Describe serous cystadenomas

Epithelial tumours - most common Mostly benign 30-50% are bilateral Ciliated cells, Psamomma body seen If malignant = cystadenocarcinoma NOT associated with KRAS, BRAF

Describe mucinous cystadenoma

Mostly benign Mucin secreting cells (epithelium resemble gastrointestinal or endocervical epithelium) Pseudomyoxoma peritonei Associated with KRAS mutations

Describe endometriomas

Epithelial Mostly malignant Associated with Endometriosis and Endometrioid carcinoma Chocolate cysts

Describe clear cell tumours

Epithelial Mostly malignant Strong association with endometriosis Clear cells (cytoplasm is clear due to the presence of a lot of glycogen) Hobnail appearance

Describe teratomas

Germ cell tumour <20yo Arise from all 3 germ cell layers Mature (most common): benign, tissues mature to adult-type tissue e.g. teeth, hair - "Dermoid cyst" Immature: embryonic elements present (most commonly neural tissue), malignant Mature cystic with malignant transformation: SCC

Describe dysgerminoma

Germ cell tumour Female testicular seminoma

Describe choriocarcinoma

Germ cell tumour Malignancy of the trophoblastic cells of placenta Raised HCG

Describe endodermal sinus tumours

Germ cell tumours From extra-embryonic tissue e.g. amniotic sac

Describe fibromas

Sex cord stromal tumour Arises from fibroblasts No endocrine production

What is Meig's syndrome

1. Fibroma 2. Ascites 3. Pleural effusion

Describe granulosa cell tumours

Sex cord stromal tumour Variable behaviour May produce oestrogen → precocious puberty Cal exner bodies

Describe sertoli-Leydig cells

Sex cord stromal tumour Secrete testosterone (androgenic) → virilisation, defeminisation Associated with Peutz-Jegher Syndrome

Describe thecomas

Sex cord stromal tumour Arises from thecal cells Secretes oestrogen

Describe Krukenberg tumours

Bilateral metastases composed of mucin-producing signet ring cells Most often from gastric or breast cancer

Which familial syndrome give rise to ovarian cancer

BRCA1: Familial breast-ovarian cancer syndrome BRCA1: Site-specific ovarian cancer Cancer family syndrome (Lynch type II) BRCA: serous tumours HNPCC: mucinous and endometrioid carcinomas

What is lichen sclerosus

Thinning epithelium with a layer of hyalinisation underneath Sometimes associated with epithelial dysplasia and development of malignancy

What are the types of vulval cancer

Type 1: usual type RF: HPV, smoking 35-55 Warts Type 2: Differentiated Keratinated SqCC (most common) RF: lichen sclerosus Older females

What are the types of vulval cancer

Type 1: usual type RF: HPV, smoking 35-55 Warts Type 2: Differentiated Keratinated SqCC (most common) RF: lichen sclerosus Older females

What are the risk factors for cervical cancer

45-50 years HPV 16 and 18 (6 and 11 for warts) Many sexual partners Sexually active early Smoking Immunosuppression (i.e. HIV)

What is the pathogenesis of HPV infection

In most people, the immune system eliminates HPV → undetectable within 2 years HPV 16 and 18 → encodes for proteins E6 and E7 which binds and inactivates TSGs - E6: p53 - E7: retinoblastoma

What is the difference between latent and productive HPV infection

Latent = HPV resides in cell and only replicates when the cell divides - Complete viral particles not produced - Cellular changes of HPV not seen Productive = HPV replicates independently of cell cycle - Cellular changes of HPV are seen - Halo around the nucleus (koilocyte)

What are the stages of CIN

CIN I: lower 1/3 CIN II: lower 2/3 CIN III: entire epithelium Invasion through BM → invasive malignancy (most commonly SqCC)

Describe the staging for Cervical cancer

FIGO 0: CIN 1: Cervix 2: upper 1/3 vagina 3. Lower 2/3 vagina + pelvic side wall 4. Mets

What are the screening approaches to cervical cancer

Cervical cytology Hybrid Capture II (HC2) HPV DNA Test

Which HPV vaccines are available

Bivalent (16 + 18) Quadrivalent (6, 11, 16, 18) National vaccination programme for girls aged 12 + boys aged 13

HistoPath - Gynae Flashcards

(53 cards)