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Pathology (Guide) > Histopathology - Gynaecological Pathology > Flashcards

Histopathology - Gynaecological Pathology Flashcards

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1
Q

What is pelvic inflammatory disease?

A

An ascending infection from the vagina + cervix up to the uterus + fallopian tubes, leading to inflammation + the formation of adhesions

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2
Q

Which bacteria cause PID from ascension up the genital tract?

A
  • Neisseria gonorrhoea
  • Chlamydia trachomatis
  • Enteric bacteria
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3
Q

Which bacteria cause PID secondary to abortion/termination of pregnancy?

A
  • S. aureus
  • Streptococcus
  • C. perfringens
  • Coliforms
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4
Q

What are the two most common causative organisms of PID in the UK?

A
  • C. trachomatis
  • N. gonorrhoea
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5
Q

What are the two most common causative organisms of PID in the world?

A
  • TB
  • Schistosomiasis
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6
Q

How does PID clinically present?

A
  • Bilateral lower abdominal pain
  • Deep dyspareunia
  • Vaginal bleeding/discharge
  • Fever
  • Adnexal tenderness
  • Cervical excitation
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7
Q

What are the complications of PID?

A
  • Fitz-Hugh-Curtis Syndrome (10%)
  • Infertility
  • Increased risk of ectopic pregnancy
  • Bacteraemia (leading to sepsis)
  • Tubo-ovarian abscess
  • Chronic PID
  • Peritonitis
  • Pilcal fusion
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8
Q

What are the signs + symptoms of Fitz-Hugh-Curtis Syndrome?

A
  • RUQ pain from peri-hepatitis
  • “VIOLIN STRING” peri-hepatic adhesions
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9
Q

What is pilcal fusion?

A

When fimbrial ends of fallopian tubes adhere together

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10
Q

What is endometriosis?

A

The presence of endometrial glands or stroma in abnormal locations outside the uterus

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11
Q

What are the three aetiological theories of endometriosis?

A
  1. Retrograde menstruation flow
  2. Metaplastic transformation of coelomic epithelial cells
  3. Vascular/lymphatic dissemination of endometrial cells
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12
Q

How does endometriosis present clinically?

A
  • Cyclical pelvic pain
  • Dysmenorrhoea
  • Deep dyspareunia
  • Decreased fertility
  • Cyclical PR bleeding
  • Haematuria
  • Bleeding from umbilicus
  • Nodules/tenderness in vagina, posterior fornix or uterus
  • Immobile + retroverted uterus in advance disease
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13
Q

What are the macroscopic features of endometriosis?

A
  • Red-blue to brown vesicles (POWDER BURNS)
  • Endometriomas (blood-filled CHOCOLATE CYSTS on ovaries)
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14
Q

What are the microscopic features of endometriosis?

A
  • Endometrial glands + stroma
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15
Q

What is adenomysosis?

A

The presence of ectopic endometrial tissue deep within the myometrium

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16
Q

How does adenomysosis present clinically?

A
  • Heavy menstrual bleeding
  • Dysmenorrhoea
  • Deep dyspareunia
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17
Q

What are some buzzwords associated with adenomysosis?

A
  • Bulky uterus
  • Subendothelial linear striations
  • Globular uterus
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18
Q

What is a leiomyoma (fibroid)?

A

A benign tumour of the smooth muscle origin
- Most common tumour of femal genital tract (20% occurrence in >35y.o.)

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19
Q

What are the three types of leiomyomas?

A
  • Submucosal
  • Intramural
  • Subserosal
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20
Q

Why is oestrogen stimulation important for leiomyomas?

A
  • Enlarge during pregnancy
  • Regress post-menopause
  • Oestrogen-dependent growth
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21
Q

What are the macroscopic features of a leiomyoma?

A
  • Sharply circumscribed
  • Discrete, firm, gray-white tumours
  • Size variable
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22
Q

What are the microscopic features of a leiomyoma?

A
  • Bundles of smooth muscle cells
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23
Q

What are the clinical features of a leiomyoma?

A
  • Heavy menstrual bleeding
  • Dysmenorrhoea
  • Pressure effects (urinary frequency, tenesmus)
  • Subfertility
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24
Q

What happens to leiomyomas during pregnancy?

A

Red degeneration of fibroids
- Haemorrhagic infarction leasd to severe abdominal pain

Post-partum torsion

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25
What are the different types of endometrial carcinomas?
Sarah Eats Meet, Paul Can't Stand (it): - S: Secretory - E: Endometrioid - M: Mucinous - P: Papillary - C: Clear cell - S: Serous
26
What are the most common types of endometrial carcinomas?
- Adenocarcinomas (85%) - SCC (15%)
27
What is the occurrence of endometriod carcinomas?
80%
28
What are the types of endometrioid carcinomas?
- Secretory - Endometroid - Mucinous
29
What is the pathophysiology of endometrioid carcinomas?
- Related to oestrogen excess (oestrogen-dependent) - Usually in peri-menopausal women
30
What are some risk factors for endometrioid carcinomas?
E2 excess: - Obesity - Nulliparous women - Early menarche - Late menopause - Tamoxifen - Anovulatory amenorrhoea (e.g. PCOS) DM HTN
31
What are the types of non-endometrioid carcinomas?
- Papillary - Clear Cell - Serous
32
What mutations are present in clear cell non-endometrioid carcinomas?
- PTEN - p53 - HER-2
33
What is the pathophysiology of non-endometrioid carcinoma?
- Unrelated to oestrogen excess (oestrogen-independent) - Usually in elderly women with endometrial atrophy
34
How is endometrial carcinoma staged?
FIGO - Stage 1: Cancer only in uterus - Stage 2: Spread to cervix - Stage 3: Spread to pelvic area - Stage 4: Metastasis to rectum/bladder/distal organs
35
What is the normal vulval histology?
Squamous epithelium (95%)
36
What is VIN?
- Like CIN - Dysplasia of epithelium of vulval cells
37
How is vulval cancer graded?
VIN I, II, III
38
What is the usual type of vulval abnormalities?
- A/W: HPV 16/18, smoking, immunosuppression - Warty, basaloid, mixed - Women 35-55yrs
39
What si the differentiated type of vulval abnormalities?
- A/W: Lichen sclerosis + more common progression to cancer - Keratinised squamous cells - Older women
40
What are some symptoms of vulval carcinoma?
- Visible, painless lesion - ?Ulcerated - Itching + irritation - Difficulty urinating - FLAWS
41
What is vulval carcinoma?
- Mainly SCC - Clear cell adenocarcinoma = teenagers + COCP, rare, A/W Diethyltilbestrol (5%) - Primary vaginal carcinoma = older women + lichen sclerosis, usually SCC (95%)
42
What are the two types of ovarian cysts and which is mots common?
- Follicular cyst (Most common) - Corpus luteal (common in early pregnancy)
43
What are some features of follicular ovarian cysts?
- Due to non-rupture of dominant follicle/failure of atresia in non-dominant follicle - Commonly regress after several menstrual cycles
44
What are some features of corpus luteal ovarian cysts?
- During menstrual cycle if fertilisation doesn't occur the corpus luteum breaks down + disappears; if it doesn't happen then it bceomes filled with blood/fluid + become cyst - May present with intraperitoneal bleeds
45
What are some features of ovarian carcinoma?
- Leading cause of death from gynaecological malignancy in UK - Ovary = collection of several different cell types each with neoplastic development opportunity (90% = epithelial ovarian cancers) - Peak incidence = 75-84yrs
46
What are the three different cell types that ovarian cancer can arise from, and their prevalence?
- Epithelial (70%) - Germ cell (20%) - Sex cord stromal (10%) - Metastatic
47
What are the benign epithelial ovarian cancers?
- Serous cystadenoma - Mucinous cystadenoma
48
What are some characteristics and the histology of serous cystadenomas?
- Most common benign epithelial tumour - Mimics tubal epithelium (e.g. columnar epithelium) - Affects women: 30-40yrs Histo: - COLUMNAR EPITHELIUM - PSAMMOMA BODIES
49
What are some characteristics and the histology of mucinous cystadenomas?
- 2nd most common benign epithelial tumour - MUCIN SECRETING CELLS (similar to those of endocervical mucosa) - Affects younger-women - Most common oestrogen-secreting tumour - K-ras mutation in 75% - Appendix tumour can metastasis to abdomen, peritoneum + ovaries leading to pseudomyxoma peritonei (Cx = v. rare) Histo: - MUCIN SECRETING CELLS
50
What are the two malignant types of epithelial ovarian carcinoma?
- Endometrioid - Clear cell
51
What are some characteristics and histological features of endometrioid ovarian carcinomas?
- Mimics endometrium = forms tubular glands - Endometriosis = RF - CA-125 often raised Hist: - TUBULAR GLANDS
52
What are some characteristics + histological features of clear cell ovarian carcinomas?
- Strong association with endometriosis Histo: - CLEAR CELLS - CLEAR CYTOPLASM - HOBNAIL APPEARANCE
53
What are the benign germ cell ovarian carcinomas called?
- Dysgerminoma - Teratoma
54
What are some features of a dysgerminoma ovarian carcinoma?
- Usually benign in adults (95%), malignant in children - Female counterpart of testicular seminoma - Rare - Most common ovarian malignancy in young women - Sensitive to radiotherapy
55
What are some features of teratoma ovarian carcinomas?
- Most common ovarian tumour in younger women (15-21yrs) - Shows differentiation towards somatic structures - A/w: Ovarian torsion Mature teratomas: - DERMOID CYST - Benign - 95% of teratomas - Usually cystic - Differentation of germ cells into mature tissues - Bilateral + asymptomatic Immature Teratomas: - Malignant - Usually solid - Contains immature, embryonal tissues - Secretes AFP
56
What is the malignant clear cell ovarian carcinoma and its features?
Choriocarcinoma - Secretes bhCG
57
What are the types of sex cord/stroma ovarian carcinomas?
- Fibroma - Granulosa-theca cell tumour - Sertoli-Leydig
58
What are some features of a fibroma ovarian carcinoma?
- No hormone production - ~Menopause - 50% A/W: Meig's Syndrome - From cells of ovarian stroma
59
What is the triad of Meig's syndrome?
- Fibroma - Ascites - Right-sided pleural effusion
60
What are some general + histological features of a granulosa-theca cell tumour?
- Produce E2 - Oestrogenic effects: irregular menstrual cycles, breast enlargement, endometrial/breast cancer Histo: - CALL-EXNER BODIES
61
What are some features of Sertoli-Leydig cell tumour ovarian carcinomas?
- SECRETE ANDROGENS - Look defeminisation: Breast atrophy - Look for virilisation: Hirsutism, deepended voice, enlarged clitoris
62
What is a metastatic ovarian carcinoma?
- Krukenberg tumour
63
What are some general + histological features of a Krukenberg tumour?
- Bilateral mets - Malignancy of ovary that has metastasised from gastric/colonic cancer (Most common = gastric adenocarcinoma at pylorus) Histo: - MUCIN PRODUCING SIGNET RING CELLS
64
What is the staging criteria used for ovarian cancer?
FIGO Staging: - Stage I = ONLY in ovaries - Stage II: Spread to pelvis - Stage III: Spread to abdomen (inc. regional LN mets) - Stage IV: Metastasis outside abdominal cavity
65
What is normal cervical histology?
- Outer ectocervix = continous with vagina, covered by squamous epithelium - Endocervical canal lined by columnar glandular epithelium - Squamocolumnar junction separates ecto + endo cervix
66
What is the transformation zone?
- The area where columnar epithelium transforms into squamous cells (squamous metaplasia) - Normal physiological process - Area susceptible to malignant change due to high rates of cell turnover
67
What is CIN?
- Dysplasia at the TZ as a result of infection by HPV 16 + 18 (HPV 6 + 11 = lower risk)
68
How is CIN graded?
- Mild, moderate or severe dyskaryosis on cytology - CIN1-3 on histology (from biopsy) - CIN I = dysplasia confined to deepest 1/3 of epithelium - CIN II = lower 2/3 - CIN III = Full thickness, BM intact
69
What are some RFs for CIN?
- Early age at first intercourse - Multiple partners - Multiparity - Smoking - HIV or immunosuppression
70
What is cGIN?
- Cervical galndular intraepithelial neoplasia - Less common + more difficult to diagnose on cytology - Tx = excision of entire endocervix which can compromise fertility
71
What are some features of cervical carcinoma?
- 2nd most common cancer in women worldwide - Peak incidences: 30-39yrs + >70yrs - 80% = adenocarcinomas - 20% = SCC - Arises from CIN (invasion through basement membrane marks change from CIN III to carcinoma)
72
What are somr RFs to cervical carcinoma?
Early exposure to HPV - Early first sexual experience - Multiple partners - Non-barrier contraception COCP High parity Smoking Immunosuppression
73
What are the two HPV vaccines and their differences?
- Cervavix: bivalent = HPV 16 + 18 - Gardasil: quadrivalent = HPV 6, 11, 16 + 18
74
What are the two biological states of HPV infection?
1. Non-productive/latent 2. Productive: causes cytological + histological changes
75
What is the pathophysiology of HPV causing cervical carcinoma?
- HPV virus encodes E6 + E7 proteins (inactivate 2 TSGd) - E6 inactivates p53 = proliferation - E7 inactivates retinoblastoma (Rb) gene = proliferation
76
How does cervical carcinoma present clinically?
- Post-coital bleeding - Intermenstrual bleeding - Postmenopausal bleeding - Discharge - Pain
77
How is cervical carcinoma staged?
FIGO: - Stage 0 = CIN - Stage I = only cervix - Stage II = Spread into upper 1/3 vagina - Stage III = spread into pelvic side wall +/or lower 1/3 vagina - Stage IV: metastasis beyond pelvis to bladder/bowel

Pathology (Guide) (84 decks)

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