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203 - Theme 3 - Gynaecological pathology, common gynaecological disorders and sexual health > L1 & L2 - Pathology of the Female Reproductive Tract 1 & 2 > Flashcards

L1 & L2 - Pathology of the Female Reproductive Tract 1 & 2 Flashcards

1
Q

What type of epithelium in vulva and vagina?

A

Stratified squamous epithelium

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2
Q

Vagina at puberty

A

Oestrogen secreted by the ovary stimulates maturation of squamous epithelial cells

Glycogen is formed within mature squamous epithelial cells

Glycogen in cells shed from the surface is substrate for vaginal anaerobic organisms (dominated by lactobacilli)

Lactobacilli produce lactic acid keeping vaginal pH below 4.5

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3
Q

3 parts of cervix

A

Ectocervix

Endocervix

Transformation zone

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4
Q

Ectocervix formed of

A

stratified squamous epithelium

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5
Q

Endocervix formed of

A

single layer of tall, mucin producing columnar cells

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6
Q

Endocervix has a large SA due to

A

Columnar epithelium lines tiny blind ending channels (‘clefts’)

These radiate out from the endocervical canal into the surrounding stroma

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7
Q

What type of epithelium lines the endocervix?

A

columnar epithelium

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8
Q

What is the junction between the ecto and endocervix called?

A

Squamo-columnar junction

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9
Q

Formation of the transformation zone

A

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 vaginal environment

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10
Q

Describe the process of squamous metaplasia (transformation zone)

A

The distal endocervical columnar epithelium is 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

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11
Q

Define metaplasia

A

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

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12
Q

Describe how the characteristics of the metaplastic squamous epithelium change over time

A

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

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13
Q

What is the myometrium?

A

Bundles of smooth muscle, vasculature and nerves

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14
Q

Endometrium: proliferative phase (before ovulation)

A

Tubular glands

Specialised stroma

Blood vessels

Mitoses in glands

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15
Q

Endometrium: secretory phase

A

Cork screw glands

Specialised stroma

Blood vessels

Secretions in glands

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16
Q

Define neoplasia

A

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

Persists following withdrawal of stimulus and associated with genetic alterations

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17
Q

Nomenclature of neoplasms

A

Different neoplasms have different behaviour

Accurate identification and naming therefore important for treating the patient

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18
Q

How are neoplasms classified?

A

According to their behaviour and histogenesis

Behaviour: benign or malignant

Histogenesis: recognising the cell of origin

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19
Q

Benign neoplasms

A

Remains localised and doesn’t invade surrounding tissues

Generally grow slowly

Good resemblance of parent tissue

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20
Q

Leiomyoma of the myometrium ‘fibroid’

A

A benign neoplasm of smooth muscle

Localised

Slow growing

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21
Q

Consequences of benign neoplasms

A

Pressure on adjacent tissue

Obstruction of lumen of a hollow organ

Hormone production

Transformation into a malignant neoplasm

Symptoms for the patient

22
Q

Clinical problems of benign neoplasms

A

Pressure on adjacent tissue
-bladder (frequency) Rectosigmoid (constipation)

Obstruction to lumen of a hollow organ
-adjacent (ureters) blocking endocervix

Hormone production
-? erythropoietin producing polycythaemia

Transformation into malignant neoplasm
-probably malignancy arises de novo

Abnormal uterine bleeding, pain

23
Q

Malignant neoplasms

A

Invade into surrounding tissues

Spread via lymphatics to lymph nodes and blood vessels to other sites (metastasis)

Generally grow relatively quickly

Variable resemblance to parent tissue

24
Q

How does malignant neoplastic tissue look different to normal tissue?

A

Loss of differentiation

Loss of cellular cohesion

Enlarged irregular dark nuclei

Increased numbers of mitoses

25
Q

Consequences of malignant neoplasms

A

Destruction of adjacent tissue

Metastasis

Blood loss from ulcerated surfaces

Obstruction of hollow viscera

Production of hormones

Weight loss and debility

Anxiety and pain

26
Q

Histogenesis of neoplasms

A

Classification by cell origin

Determined by examining tissue under the microscope

Resemblance to parent tissue correlates with clinical behaviour

27
Q

Suffix of neoplasms

A

-oma

28
Q

Malignant epithelial tumours are called

A

carcinomas

29
Q

Carcinomas are named for

A

the epithelial cell type which they resemble

30
Q

Adenocarcinomas are

A

carcinomas of glandular epithelium

31
Q

Malignant stromal tumours are called

A

sarcomas

32
Q

Malignant tumour of vulva

A

Squamous cell carcinoma

33
Q

Malignant tumour of vagina

A

Squamous cell carcinoma

34
Q

Malignant tumour of cervix

A

Squamous cell carcinoma

Adenocarcinoma

35
Q

Malignant tumour of endometrium

A

Glandular - adenocarcinoma

Stroma - stromal sarcoma

36
Q

Malignant tumour of myometrium

A

sm muscle - leiomyosarcoma

37
Q

For some malignant neoplasms a ‘pre-malignant’ state is identified

A

Termed dysplasia

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

38
Q

Define dysplasia

A

Disordered growth and differentiation characterised by increases proliferation (more mitoses), atypia of cells and decreased differentiation

39
Q

Dysplasia terminology for cervix

A

Generic: dysplasia

UK: Cervical intra-epithelial neoplasia (CIN)

US: Squamous intra-epithelial lesion (SIL)

40
Q

How does the degree of neoplasia affect the likelihood of developing invasive malignancy?

A

E.g. CIN 1, CIN 2, CIN3

CIN3 highest percentage predicted to progress into malignancy

41
Q

Dysplasia often occurs in sited where there is metaplasia. Name some sites in the body

A

Squamous metaplasia of the cervical transformation zone

Squamous metaplasia of the bronchial epithelium

Glandular metaplasia of the distal oesophagus

42
Q

How do normal epithelium cells and dysplastic epithelium differ?

A

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

43
Q

What is the difference between dysplasia and carcinoma?

A

Invasion through the basement membrane

44
Q

What infection causes CIN and cervical cancer?

A

HPV

45
Q

Human Papillomavirus

A

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 7.9Kbp

46
Q

How may HPVs be grouped?

A

According to risk association with malignancy

High risk HPV - 16, 18

Low risk HPV - 6, 11

47
Q

How to avoid HPV

A

HPV vaccination

Population based screening

  • cervical sample cytology
  • cervical sample HPV test

Colposcopy

Treatment of high grade dysplasia

Large loop excision of the transformation zone

48
Q

Where is endometrial cancer most common

A

North America and Europe

49
Q

The incidence of cervical cancer is

A

decreasing

50
Q

The incidence of endometrial cancer is

A

increasing

51
Q

Explain the peaks in cervical cancer

A

The separate peaks in cervical cancer incidence reflect a birth cohort effect

This happens when a group of people experience different circumstances to those born immediately before or after

An increase in cervical cancer incidence and mortality was seen in women reaching the age of sexual debut during WW1 and again in WW2

52
Q

Key facts about the incidence of cervical cancer

A

Decreased since early 1980s

Follows the intro of NHS cervical screening programme

Birth cohort effect exists, believed to reflect different exposure to HPV at time women reached age of sexual debut

HPB vaccine is creating new birth cohorts

203 - Theme 3 - Gynaecological pathology, common gynaecological disorders and sexual health (4 decks)

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