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Flashcards in Histopathology - Gynaecological Pathology Deck (50):
1

Peritoneum

Pelvic mesothelium

2

Fallopian tube

Ciliated serous epithelium

3

Endometrium

Endometrioid epithelium – glycogen secreting

4

Endocervix

Mucin secreting endocervical epithelium

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Ectocervix

Squamous epithelium

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Endometrium:

1. Normal tissue
2. Hyperplastic tissue: under hormonal stimulated more glands per unit area (more cells not bigger).
3. Neoplasia – autonomous – cells mutated therefore don’t respond to removal of stimulation.

7

Endometrial Hyperplasia

• Disease of perimenopausal women
• Reflection of anovulatory cycles
• May result in menorrhagia
• Ultra scan > thickened endometrium

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Endometrial hyperplasia types

• Simple cystic hyperplasia
• Complex hyperplasia
• Atypical hyperplasia

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Endometrial hyperplasia Risks/Causes

• Obesity - more oestrogen
• Anovulatory cycles
• Prolonged exposure to oestrogen
• Polycystic ovary disease
• Functioning (steroid secreting) ovarian or adrenal tumours

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Atyical Hyperplasia

AKA Endometrial Intraepithelial Neoplasia (EIN)

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Atypical Hyperplasia presence of

Cytological abnormality (deregulation of cell division machinery)

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Atypical Hyperplasia risk of

Progression of Adenocarcinoma = 25-40% (40-50 yrs)

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Treatment

Hysterectomy (older)
Progesterone therapy (young)

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Endometrial Carcinoma epi

Most common malignant tumour of female genital tract in the develop world

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Endometrial cancer risk of

Unopposed oestrogen treatment
Polycystic ovarian syndrome
Obesity

16

Endometrial Carcinoma: Genetic factors

HNPCC (Lynch Syndrome) risk 20-30%
→ Endometrial pre colorectal cancer

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Endometrial Carcinoma: Presentation

Postmenopausal bleeding

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Endometrial Carcinoma: Tumour structure

Low grade and low stage – good prognosis

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Endometrial Carcinoma: Commonest morphology is

Endometrioid – loks like parent tissue

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Endometrial Carcinoma:Grading on

Gland formation and nuclear atypia

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Endometrial Carcinoma:Prognosis depends on

Grade and stage

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Endometrial Carcinoma:Spread

Lymphatic, direct or transtubal to peritoneum (seed into peritoneum via fallopian).

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Endometrial Carcinoma: Two types of endometrial carcinoma

Type 1: Oestrogen driven
Type 2: Developing de novo

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Endometrial Carcinoma: Oestrogen driven

Endometrioid pattern
Lesions grade according to their amount of gland formation

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Endometrial Carcinoma: Developing de novo

High grade serous papillary
Clear cell carcinoma

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Cervix: UK epi

11th most common cancer in women

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Cervical screening programme

• Accessible site for exfoliative cytology
• Pre-invasive state
• Slow progression of disease
• Stepwise progression of disease
• Eradication of early cancer feasible

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Structure of cervix composed of 2 parts

• Ectocervix
• Endocervix

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Ectocervix

• Squamous epithelium (stratified) w/ glycogen with lactobacilli which help maintain acidic environment to prevent infection

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Endocervix

• Columnar cells: Mucin secreting glandular epithelium

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Transformation zone

• Zone between original and functional squamo-columnar junction
→Metaplasia (associated with the stress from acidic ectocervix) is occurring allowing for one epithelium to change into another. The junction position varies through life according to hormonall stage e.g. menarche and menopaus

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Cervical carcinoma: Risk factors

Early age at first intercourse – pick up infection early = HPV
Multiple partners
Smoking – immunomodulatory
Genital infections
Partner with multiple partners

33

Cervical carcinoma: HPV and squamous neoplasia:

1. Normal epithelium and Negative
2. Low grade dysplasia and koilocytosis. Low and high risk HPV. Viral replication with or without integration.
3. Invasive Carcinoma, High risk HPV, Viral integration and secondary chromosomal abnormalities.
4. High grade dysplasia. High risk HPV. Viral integration

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Cervical carcinoma: Neoplasia of the cervix

Cervical intraepithelial neoplasia (CIN): turns into invasive squamous cell carcinoma

Cervical glandular intraepithelial neoplasia (CGIN): turns into adenocarcinoma

Carcinoma:
• Can presents with post coital bleeding
• Prevention is better than cure
• Prognosis is stage dependent

35

Ovarian Neoplasia: Classification (related to anatomical compartments)

1. Surface epithelial stromal tumour
2. Sex cord stromal tumours
3. Germ cell tumour
4. Metastatic tumours

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Ovarian Neoplasia: Epi

Accounts for 30% of female genital tract cancers

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Ovarian Neoplasia: Aetiology

High parity and use of oral contraceptives are associated with reduced risk
7% of women with ovarian cancer have one or more relatives with disease

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Ovarian Neoplasia: Genetic factors

BRCA 1 and BRCA 2 – breast and ovarian
HNPCC

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Surface Epithelial Tumours: Epithelial subtypes

Serous, endometroid, mucinous and transitional

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Surface Epithelial Tumours: Biological behaviour is dictated by nature of epithelium

1. Benign – ciliated, mucinous or columnar epithelium
2. Borderline – papillary proliferation without invasion
3. Malignant (adenocarcinoma) – invasive malignant epithelium – poor prognosis

41

Adenocarcinoma: Epi

• Commonest subtype is serous followed by endometrioid
• Primary mucinous carcinoma of the ovary are rare

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Adenocarcinoma: Clinical presentation

Often advanced disease and ascites (reduced albumin therefore osmotic draw)

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Adenocarcinoma: Prognosis is

Stage dependent

44

Germ cell tumours: histo and epi

Histogenesis for primordial germ cells
Hetergenous group of tumours
Accoutn for 30% of ovarian tumours
95% are mature cystic teratoma/dermoid cyst

45

Sex cord Stromal Tumours: Epi

Account 8% of all ovarian neoplasms

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Sex cord Stromal Tumours: Cell of origin

Include granulose cells, theca cells, sertoli cells, Leydig cells and fibroblast of stromal origin.

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Sex cord Stromal Tumours: Can produce

Estrogen

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Metastatic Tumours: Epi

Account for 5-10% of ovarian neoplasms

49

Metastatic Tumours: Primary sites include

Stomach
Colon
Appendix
Breast
Pancreas
→Spread as ovary has good blood supply

50

Metastatic Tumours: Krukenberg

Metastatic tumour with signet ring forms

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