Histopathology 5 - Gynaecological pathology

Question 1

What is uterine didelphys?

Answer 1

duplication

Question 2

What type of organism is gardenerella?

Answer 2

gram neg bacillus → vaginitis

Question 3

what is the main organism in PID?

Answer 3

Chlamydia > gonococci, enteric bacteria

Usually starts in uterus and spreads upwards via lymphatics and blood vessels

Question 4

What is salpingitis?

Answer 4

Infection of fallopian tubes

Question 5

What are the possible complications of untreated salpingitis?

Answer 5

Plical fusion

Adhesions to ovary

Tubo-ovarian abscess

Peritonitis

Hydrosalpinx (fallopian filled with fluid)

Infertility

Ectopic pregnancy

Question 6

what is the most common site of ectopic pregnancy?

Answer 6

ampulla of fallopian tube

Question 7

What are the high risk forms of HPV for cervical cancer?

Answer 7

16 and 18

low risk wart types - 6 and 11 -> genital and oral warts

Question 8

what is the productive stage of HPV infection and what would you see on microscopy?

Answer 8

Cellular changes of HPV seen

Halo around the nucleus (koilocyte)

Question 9

How does HPV lead to neoplatic transformation of cervical cells?

Answer 9

HPV encode proteins E6 and E7 which bind to and inactivate TSGs:

E6 - p53

E7 - retinoblastoma

Interferes with apoptosis and increased cellular proliferation which contributes to oncogenesis

Question 10

Recall the stages of progression from normal cervical cells to cervical carcinoma

Answer 10

Normal
T positive HPV (abnormal cells)
CIN 1 (lower 1/3 of cells neoplastic)
CIN 2 (2/3 of cells neoplastic)
CIN 3 (full thickness neoplastic)

Metaplasia (does not cross BM)
Carcinoma

Question 11

what are the two types of cervical cancer?

Answer 11

squamous cell carcinoma

adenocarcinoma (20%)

squamous (CIN) > glandular (CGIN)

Question 12

What age range is invited to cervical screening?

Answer 12

25-64

Question 13

Which HPV strains are included in the quadrivalent vaccine?

Answer 13

6,11,16,18

Question 14

Who is offered the PHV vaccine and when is it given?

Answer 14

1st dose - year 8

2nd dose - 6-24 months after 1st dose

offered for both girls and boyes againsed 12-13

Question 15

What is leiomyoma of the uterus?

Answer 15

Smooth muscle cell tumour of the myometrium

Question 16

What is a fibroid?

Answer 16

Leiomyoma

Question 17

How are fibroids classified?

Answer 17

As either intramural, submucosal or subserosal

Question 18

what is the malignant counterpart of leiomyoma?

Answer 18

leiomyosarcoma

post menopausal, bad prognosis

Question 19

What is the biggest risk factor for endometrial hyperplasia?

Answer 19

Persistent oestrogen

Nulliparity

Obesity

COCP

Early menarche

Diabetes mellitus

Tamoxifen/HRT

Late menopause

Question 20

What is the difference between type 1 and 2 endometrial carcinomas?

Answer 20

Type 1: endometrioid
Type 2: Serous/ clear cell carcinoma

Question 21

What is the relative prevelance of type 1 vs type 2 endometrial carcinoma?

Answer 21

Type 1 = 80-85%
Type 2 = 10-15%

Question 22

Recall the genetic associations of serous and clear cell endometrial carcinomas

Answer 22

Serous: p53 mutation
Clear cell: PTEN mutation

Question 23

Which type of endometrial carcinoma is high grade and which is low grade?

Answer 23

Type 1 = low grade
Type 2 = high grade

Question 24

Which type of endometrial carcinoma is most likely to arise in atrophic endometrium?

Answer 24

Type 2

Question 25

Which type of endometrial carcinoma is more oestrogen dependent?

Answer 25

type 1

Question 26

What is endometriosis?

Answer 26

Presence of endometrial glands and stroma outside of the uterus - bleeding of ectopic material is painful

Question 27

Recall the FIGO stages of endometrial cancer

Answer 27

Stage 1: Confined to uterus Stage 2: Spread to cervix Stage 3: Spread to adnexa, vagina, local lymph nodes (pelvic/ para-aortic) Stage 4: Bladder/bowel, distant metastases

Question 28

Recall the different types of gestational trophoblastic disease

Answer 28

Partial/ complete mole Invasive mole Choriocarcinoma

Question 29

How does gestational trophoblastic disease usually present?

Answer 29

As spontaneous abortion

Question 30

What is the cause of gestational trophoblastic disease?

Answer 30

Fertilisation of one egg by 2 sperm

Question 31

Describe the prognosis of choriocarcinoma

Answer 31

Very aggressive but also very responsive to treatment

Question 32

What is adenomyosis?

Answer 32

Ectopic endometrial tissue within the myometrium

Question 33

What is the main symptom of adenomyosis?

Answer 33

Dysmennorhoea

Question 34

What type of tumour are 95% of ovarian neoplasms?

Answer 34

Epithelial tumours

Question 35

Describe the 2 different types of ovarian carcinoma

Answer 35

``` Type 1 (low grade - endometriod/mucinous/clear cell) Type 2 (high grade, associated with p53 mutations - serous) ```

Question 36

What type of epithelium are most ovarian carcinomas derived from?

Answer 36

Serous

Question 37

Recall 3 syndromes which may predispose to ovarian cancer

Answer 37

familal breast-ovarian Ca syndrome site specific ovarian cancer HPNCC (endometriod/clear cell types - CEO)

Question 38

Which types of ovarian carcinoma are associated with endometriosis?

Answer 38

Endometrioid and clear cell carcinoma

Question 39

Which mutations are implicated in high grade serous carcinoma?

Answer 39

p53 BRCA1/2 abnormalities important to test - homologous deficiency testing - as BRCA 2 survival better than BRCAneg or BRCA1, and can ?response to therapy - PARP inhibitor

Question 40

Which mutations are implicated in low grade serous carcinoma?

Answer 40

KRAS, BRAF NO BRCA

Question 41

Which mutations are implicated in mucinous carcinomas?

Answer 41

KRAS

Question 42

Recall the 4 types of sex cord stromal tumours, and the malignant potential of each

Answer 42

Fibromas (from fibroblasts) = benign Granulosa cell tumours = variable behaviour, may prod oestrogen Thecoma (thecal cells) = benign, may prod oestrogens, rarely androgens Sertoli-Leydig cell tumours = variable behaviour

Question 43

Which mutations are involved in microcystic stromal tumour

Answer 43

CTNNB1 stains positive for beta-catenin

Question 44

In what age group of women are germ cell tumours seen?

Answer 44

bimodal 15-21 then 65-69

Question 45

Recall the different types of germ cell tumour in women

Answer 45

Undifferentiated germ cells: dysgermioma Tumour of extra-embryonic tissue: endodermal sinus tumour Trophoblast tumour: choriocarcinoma Cancer of embryonic tissue: teratoma

Question 46

Which mutations are implicated in adult type granulosa cell tumours (GCT)

Answer 46

FOX1/2

Question 47

Which type of germ cell tumour may have teeth and hair?

Answer 47

dermoid - mature teratoma

Question 48

What type of cancer ismature cystic teratoma with malignant transformation?

Answer 48

rare, post menopausal women squamous cell carcinoma

Question 49

Recall 2 types of cancer that commonly metastasise to the ovary

Answer 49

Krukenburg tumours Colon cancer

Question 50

Describe Krukenberg tumours

Answer 50

bilateral mets - mucin prod signet ring cells gastric/breast origin