Histopathology - Gynaecological Pathology

Question 1

Peritoneum

Answer 1

Pelvic mesothelium

Question 2

Fallopian tube

Answer 2

Ciliated serous epithelium

Question 3

Endometrium

Answer 3

Endometrioid epithelium – glycogen secreting

Question 4

Endocervix

Answer 4

Mucin secreting endocervical epithelium

Question 5

Ectocervix

Answer 5

Squamous epithelium

Question 6

Endometrium:

Answer 6

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.

Question 7

Endometrial Hyperplasia

Answer 7

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

Question 8

Endometrial hyperplasia types

Answer 8

• Simple cystic hyperplasia
• Complex hyperplasia
• Atypical hyperplasia

Question 9

Endometrial hyperplasia Risks/Causes

Answer 9

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

Question 10

Atyical Hyperplasia

Answer 10

AKA Endometrial Intraepithelial Neoplasia (EIN)

Question 11

Atypical Hyperplasia presence of

Answer 11

Cytological abnormality (deregulation of cell division machinery)

Question 12

Atypical Hyperplasia risk of

Answer 12

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

Question 13

Treatment

Answer 13

Hysterectomy (older)
Progesterone therapy (young)

Question 14

Endometrial Carcinoma epi

Answer 14

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

Question 15

Endometrial cancer risk of

Answer 15

Unopposed oestrogen treatment
Polycystic ovarian syndrome
Obesity

Question 16

Endometrial Carcinoma: Genetic factors

Answer 16

HNPCC (Lynch Syndrome) risk 20-30%

→ Endometrial pre colorectal cancer

Question 17

Endometrial Carcinoma: Presentation

Answer 17

Postmenopausal bleeding

Question 18

Endometrial Carcinoma: Tumour structure

Answer 18

Low grade and low stage – good prognosis

Question 19

Endometrial Carcinoma: Commonest morphology is

Answer 19

Endometrioid – loks like parent tissue

Question 20

Endometrial Carcinoma:Grading on

Answer 20

Gland formation and nuclear atypia

Question 21

Endometrial Carcinoma:Prognosis depends on

Answer 21

Grade and stage

Question 22

Endometrial Carcinoma:Spread

Answer 22

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

Question 23

Endometrial Carcinoma: Two types of endometrial carcinoma

Answer 23

Type 1: Oestrogen driven

Type 2: Developing de novo

Question 24

Endometrial Carcinoma: Oestrogen driven

Answer 24

Endometrioid pattern

Lesions grade according to their amount of gland formation

Question 25

Endometrial Carcinoma: Developing de novo

Answer 25

High grade serous papillary | Clear cell carcinoma

Question 26

Cervix: UK epi

Answer 26

11th most common cancer in women

Question 27

Cervical screening programme

Answer 27

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

Question 28

Structure of cervix composed of 2 parts

Answer 28

* Ectocervix | * Endocervix

Question 29

Ectocervix

Answer 29

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

Question 30

Endocervix

Answer 30

• Columnar cells: Mucin secreting glandular epithelium

Question 31

Transformation zone

Answer 31

• 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

Question 32

Cervical carcinoma: Risk factors

Answer 32

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

Question 33

Cervical carcinoma: HPV and squamous neoplasia:

Answer 33

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

Question 34

Cervical carcinoma: Neoplasia of the cervix

Answer 34

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

Question 35

Ovarian Neoplasia: Classification (related to anatomical compartments)

Answer 35

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

Question 36

Ovarian Neoplasia: Epi

Answer 36

Accounts for 30% of female genital tract cancers

Question 37

Ovarian Neoplasia: Aetiology

Answer 37

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

Question 38

Ovarian Neoplasia: Genetic factors

Answer 38

BRCA 1 and BRCA 2 – breast and ovarian | HNPCC

Question 39

Surface Epithelial Tumours: Epithelial subtypes

Answer 39

Serous, endometroid, mucinous and transitional

Question 40

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

Answer 40

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

Question 41

Adenocarcinoma: Epi

Answer 41

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

Question 42

Adenocarcinoma: Clinical presentation

Answer 42

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

Question 43

Adenocarcinoma: Prognosis is

Answer 43

Stage dependent

Question 44

Germ cell tumours: histo and epi

Answer 44

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

Question 45

Sex cord Stromal Tumours: Epi

Answer 45

Account 8% of all ovarian neoplasms

Question 46

Sex cord Stromal Tumours: Cell of origin

Answer 46

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

Question 47

Sex cord Stromal Tumours: Can produce

Answer 47

Estrogen

Question 48

Metastatic Tumours: Epi

Answer 48

Account for 5-10% of ovarian neoplasms

Question 49

Metastatic Tumours: Primary sites include

Answer 49

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

Question 50

Metastatic Tumours: Krukenberg

Answer 50

Metastatic tumour with signet ring forms