L1 + 2 Pathology of the female reproductive tract

Question 1

Where do neoplasms originate from

Answer 1

• Cellular components of tissues

Question 2

What is oestrogen secreted by

Answer 2

Oestrogen is secreted by the ovary stimulates maturation of squamous epithelial cells

Question 3

Glycogen production during puberty by the vagina

Answer 3

• Glycogen is formed within mature squamous epithelial cells
• Glycogen in cells shed from the surface is a substrate for vaginal anaerobic organisms (dominated by lactobacilli)

Question 4

What maintains the acidic environment in a vagina at puberty

Answer 4

• Lactobacilli produce lactic acid keeping vaginal pH below 4.5

Question 5

Parts of the cervix

Answer 5

• Ectocervix
• Endocervix
• Transformation zone

Question 6

Types of cells in the ectocervix

Answer 6

• Stratified squamous epithelium

Question 7

Types of cells in the endocervix

Answer 7

• Single layer of tall, mucin producing columnar cells

- The endocervix is lined by columnar epithelium

Question 8

Features of the endocervix

Answer 8

• The endocervix has a deceptively large surface area
• Columnar epithelium lines tiny blind ending channels(‘clefts’)
• These radiate out from the endocervical canal into the surrounding stroma

Question 9

What is the junction between the ectocervix and endocervix called

Answer 9

• The junction between the two is called the ‘squamo-columnar’ junction

Question 10

Describe the formation of the transformation zone

Answer 10

• During puberty, the cervix changes shape
• The lips of the cervix grow
• The distal end of the endocervix opens
• Endocervical mucosa becomes exposed to the acidic vaginal environment
• It is not suited to this, so undergoes an adaptive change called metaplasia
• Reserve cells in this area proliferate and mature to form squamous epithelium, this process is called squamous metaplasia

Question 11

What is metaplasia

Answer 11

• A transformation of cell type from one kind of mature differentiated cell type to another kind of mature differentiated cell type

Question 12

Features of the initial layer of metaplastic squamous epithelium that forms in the cervical transformation zone

Answer 12

• At first, the metaplastic squamous epithelium is thin and delicate (lots of proliferation and maturation is incomplete)
• With time, the metaplastic epithelium comes to be as strong and well formed as that on the ectocervix

Question 13

What does the endometrium consist of during the proliferative phase(before ovulation)

Answer 13

• Tubular glands
• Specialised stroma
• Blood vessels

Mitoses in glands

Question 14

What does the endometrium consist of during the secretory phase

Answer 14

• Cork screw glands
• Specialised stroma
• Blood vessels

Secretions in glands

Question 15

Common features of neoplasia - in the female genital tract

Answer 15

Neoplasia -
‘New growth’ - abnormal, uncoordinated and excessive cell growth

• Persists following withdrawal of stimulus and associated

Question 16

Nomenclature of neoplasms

Answer 16

• Different neoplasms have different behaviour

- Accurate identification and naming therefore important for treating the patient

Question 17

What are neoplasms are classified according to

Answer 17

According to their behaviour and histogenesis

Behaviour - benign or malignant

Histogenesis - recognising the cell of origin

Question 18

Features of benign neoplasms

Answer 18

• Remains localised and doesn’t invade surrounding tissues
• Generally grow slowly
• Good resemblance of parent tissue

Question 19

What is a ‘fibroid’ leiomyoma

Answer 19

• A benign neoplasm of smooth muscle
• Localised
• Slow growing
• Closely resembles parent tissue

Question 20

Consequences of benign neoplasms

Answer 20

• Pressure on adjacent tissue
• Obstruction of lumen of a hollow organ
• Hormone production
• Transformation into a malignant neoplasm
• Symptoms for the patient

Question 21

How might pressure on adjacent tissue due to benign neoplasms manifest

Answer 21

• Bladder (frequency), rectosigmoid (constipation)

Question 22

How might obstruction to lumen of a hollow organ due to a benign neoplasm manifest

Answer 22

• Adjacent(ureters) blocking endocervix

Question 23

How might hormone production impairment due to benign neoplasm manifest

Answer 23

• Erythropoietin producing polycythaemia??

Question 24

How might the transformation of a benign tumour into a malignant tumour manifest

Answer 24

• Abnormal uterine bleeding, pain

- Probably malignancy arises de novo

Question 25

Behaviour of malignant neoplasms

Answer 25

- Invade into surrounding tissues - Spread via lymphatics to lymph nodes and blood vessels to other sit - Generally grow relatively quickly - Variable resemblance to parent tissue

Question 26

Malignant neoplastic tissue vs normal tissue

Answer 26

- Loss of differentiation - Loss of cellular cohesion - Enlarged irregular dark nuclei - Increased numbers of mitoses

Question 27

Consequences of malignant neoplasms

Answer 27

- Destruction of adjacent tissue - Metastasis - Blood loss from ulcerated surfaces - Obstruction of a hollow viscera - Production of hormones - Weight loss and debility - Anxiety and pain

Question 28

Histogenesis of neoplasms

Answer 28

- Classification by cell of origin - Determined by examining tissue under the microscope - Resemblance to parent tissue correlates with clinical behaviour

Question 29

What suffix do neoplasms have

Answer 29

- oma

Question 30

What are carcinomas

Answer 30

- Malignant epithelial tumours are carcinomas

Question 31

How are carcinomas named

Answer 31

- Carcinomas are named for the epithelial cell type which they resemble

Question 32

What are carcinomas of glandular epithelium called

Answer 32

- adenocarcinomas

Question 33

What are malignant stromal tumours called

Answer 33

- Sarcomas

Question 34

What is dysplasia

Answer 34

- For some malignant neoplasms a 'pre-malignant' state is identified which is termed dysplasia - Disordered growth and differentiation characterised by increased proliferation(more mitoses), atypia of cells and decreased differentiation

Question 35

Features of dysplasia

Answer 35

- There is an accumulation of cells which look somewhat like malignant cells but do not invade the basement membrane - Dysplastic lesions may(but don't always) progress to invasive malignancy - Recognising dysplastic lesions allows early treatment before invasion occurs

Question 36

Examples of where dysplasia might occur

Answer 36

Dysplasia often occurs in sites where there is metaplasia: - Squamous metaplasia of the cervical transformation zone - Squamous metaplasia of the bronchial epithelium - Glandular metaplasia of the distal oesophagus

Question 37

Ratio of nuclear size to cytoplasmic volume - dyasplastic cells vs normal cells

Answer 37

- Normal surface cells have a small nucleus and lots of cytoplasm - Dysplastic cells have a higher ratio of nuclear size to cytoplasmic volume, and the nuclei show the same features that we associate with malignancy

Question 38

Difference between dysplasia and carcinoma

Answer 38

- The difference between dysplasia and carcinoma is invasion through the basement membrane

Question 39

What can HPV infection cause

Answer 39

- Cervical intraepithelial neoplasia and cervical cancer

Question 40

Features of human papillomavirus

Answer 40

- Human papillomoaviruses (HPVs) infect epithelium - Confined to local site of infection without viraemia - Over 130 HPV types, some of which infect the anogenital mucosa - Double stranded DNA virus 7.9 Kbp

Question 41

How are HPVs grouped

Answer 41

- HPVs may be grouped according to risk association with malignancy

Question 42

Screening - HPV

Answer 42

Population based screening - Cervical sample cytology - Cervical sample HPV test

Question 43

HPV treatment

Answer 43

- Colposcopy - Treatment of high grade dysplasia - Large loop excision of the transformation zone

Question 44

Where is cervical cancer more common

Answer 44

- Cervical cancer is predominantly a disease of the developing world

Question 45

Where is endometrial cancer present mostly

Answer 45

- Endometrial cancer is presently most common in north america and europe

Question 46

Trend in prevelance of cervical cancer

Answer 46

- The incidence of cervical cancer has been declining(in europe)

Question 47

High risk HPV

Answer 47

- 16 and 18

Question 48

Low risk HPV

Answer 48

- 6 and 11