L30 - PATHOLOGY OF THE FEMALE GENITAL TRACT

Question 1

List 2 causes inflammation of vulva, vagina?

Answer 1

UTI e.g. Candida albicans

STD infection

Question 2

List 2 non-neoplastic epithelial disorders of vulva and mucosa?

Answer 2

Lichen Sclerosis

Squamous hyperplasia

Question 3

List 3 major types of neoplasm of the Vulva and vagina? ***

Answer 3

Adenocarcinoma

Invasive squamous cell carcinoma (SCC)

Vulvar and Vaginal Squamous Intraepithelial Lesion (SIL)

Question 4

List 2 diseases of cervix caused by low-risk HPV?

Answer 4

 Condyloma accuminata (anogenital warts)

 Condyloma planum (flat)

Question 5

List 4 Risk factors of cervical carcinoma?**

Answer 5

• HPV infection: High risk ***
• Early marriage and pregnancy
• Sexual promiscuity and STD
• Smoking

Question 6

1 test for HPV status of cervical cancers?**

Answer 6

HPV molecular testing

Genotype + detection of HPV

Question 7

Define the 2 types of Vulvar intra-epithelial neoplasia (VIN) or Vulvar Squamous Intraepithelial Lesion (SIL)?

Answer 7

Classic type: asso. with HPV infection

Differentiated type: asso. with chronic irritation such as lichen sclerosis or squamous hyperplasia, NO HPV INFECTION

Question 8

3 causes of Invasive squamous cell carcinoma at vulva, vagina and cervix?

Answer 8

1) High-risk HPV infection&raquo_space; Classic VIN/HSIL&raquo_space; Basaloid or warty SCC
2) Differentiated VIN/SIL&raquo_space; Keratinizing SCC
3) Second malignancy: cervical origin (LSIL/ invasive)

Question 9

High risk, Low risk HPV genotypes?

Answer 9

High risk oncogenic: cause HSIL or CA: genotype 16,18…

Low risk non-ongenic: cause Anogenital warts or LSIL: genotype 6,11

Question 10

What type of cervical cancer do most HSIL progress to ?

Answer 10

Carcinoma&raquo_space; SCC of cervix

Question 11

Prevention of cervical cancer? (2)

Answer 11

Avoid risk factors

HPV Bivalent, Tetravalent, Nonavalent vaccines

Question 12

How to tell HSIL from invasive cervical cancer?

Answer 12

HSIL = No stromal invasion and dissemination

Question 13

List 4 reasons for the success of cervical cancer screening? exam

Answer 13

• Cervix easily accessible to cytological screening
• Long period of progression from precursor lesion to invasive cancer
• Cost-effective cytology test
• Effective early treatment

Question 14

List 2 main forms of Adenocarcinoma of Vulva and Vagina?

Answer 14

Extramammary Paget’s disease

Primary Adenocarcinoma (asso. w/ DES exposure + Vaginal adenosis)

Question 15

2 detection technique for cervix carcinoma?

Answer 15

1. Exfoliative cytology “Pap smear”: scraping the squamo-columnar junction
2. Colposcopy and biopsy: identify cervical neoplasia

Question 16

Endocervical polyp: presentation?

Answer 16

Single polyp

Usually asymptomatic/ vaginal bleeding or discharge

Question 17

Histological features of SIL in the Cervix? Location?

Answer 17

@ Transformation zone of Cervix

Malignant features:
increase in N:C ratio, nuclear pleomorphism, increased and abnormal mitotic figures

Question 18

List 4 common diseases of Cervix? (3 = major types of cervical neoplasia)

Answer 18

Endocervical polyp

Squamous Intra-epithelial Lesion (SIL)

Invasive SCC

Adenocarcinoma

Question 19

Gross feature, 2 spread + 2 complication of Invasive SCC in cervix?

Answer 19

Ulcerative, indurated

Local invasion of pelvic structures + LN spread

Ureter obstruction + Renal failure

Question 20

Cervical Adenocarcinoma Location in cervix? Ddx from SIL, SCC?

Answer 20

endocervical epithelium = Adenocarcinoma

Ddx: Transformation zone = SIL, SCC

Question 21

3 Causes of Endometrial hyperplasia? progression to which cancer?

Answer 21

Hyper-estrogen stimulation:

1) Functioning ovarian tumours
2) Repeated anovulatory cycles
3) Prolonged exogenous estrogen use (e.g. Tamoxifen)

Atypical hyperplasia&raquo_space; Endometrial ADENOCARCINOMA

Question 22

5 Risk factors not causes of endometrial hyperplasia and endometrial carcinoma?

Answer 22

obesity, diabetes, hypertension, infertility

Genetic: Hereditary nonpolyposis colorectal cancer (HNPCC)

Question 23

Compare the 2 major types of endometrium carcinoma?

Answer 23

Type I: endometrioid, hyper-estrogen stimulation, indolent

Type II: serous, clear cell, not high oestrogen, aggressive with poor prognosis

Question 24

Spread of endometrium carcinoma?

Answer 24

Local: myometrium, parametrium, fallopian tubes, ovaries, vagina and pelvis

Para-aortic LN involvement

Question 25

List 2 examples of endometrial stroma tumours?

Answer 25

Stromal Sarcoma Mixed mullerian tumours

Question 26

Cell origin of Gestational Trophoblastic Diseases? List some examples of GTDs?

Answer 26

origin = placental trophoblasts hydatidiform mole, invasive mole, choriocarcinoma, PSTT, ETT

Question 27

List 3 major neoplasms arising from Myometrium of uterus? **

Answer 27

-Adenomyosis Smooth muscle tumours: - Leiomyoma *common* - Leiomyosarcoma

Question 28

Gross morphology of Myometrium Adenomyosis? | Presentation?

Answer 28

nests of endometrial glands and stroma Enlarged uterus with whorled surface + cystic space with blood menorrhagia or dysmenorrhoea

Question 29

Myometrium Leiomyoma: number, sites and extent of involvement, gross morphology?

Answer 29

multiple, @ smooth muscle white, whorled, Well-circumscribed spherical nodules

Question 30

Compare the gross morphology of Leiomyosarcoma with Leiomyoma of Myometrium?

Answer 30

Leiomyosarcoma = less well-demarcated with more necrosis and hemorrhage + malignant cell features

Question 31

Cause and Complications of Fallopian tube inflammation?

Answer 31

Infection-caused inflammation: Acute, Chronic, Granulomatous Impair fertility Ectopic pregnancy

Question 32

List the spectrum of diseases at the Fallopian tube? (4) **

Answer 32

Inflammation (Infective) Ectopic pregnancy (rupture = emergency) Endometriosis Tumours

Question 33

Most common primary fallopian tube tumour?

Answer 33

Papillary adenocarcinoma

Question 34

Most common cause of ovarian enlargement? Presentation?

Answer 34

Non-neoplastic cysts: e.g. follicular cysts, corpus luteum cysts Asymptomatic/ Torsion, Hemoperitoneum, Pain, Infarct

Question 35

Divide Ovarian neoplasms into 5 types?

Answer 35

- Surface Epithelial Tumours - Germ Cell Tumours - Sex Cord Stromal Tumours - Metastatic tumours - Miscellaneous - e.g. Lymphoma

Question 36

Genetic risk factors of ovarian surface epithelial tumours? | Presentation?

Answer 36

- Breast and Ovarian Cancer syndrome - HNPCC Pelvic mass, Malignant ascites, Metastatic symptoms

Question 37

List 5 surface epithelial tumours of ovary?

Answer 37

``` Serous tumour Mucinous t Endometrioid t Brenner t Clear cell t ```

Question 38

List 5 types of germ cell tumours of the ovaries?

Answer 38

- Dysgeminoma (=seminoma) - Embryonal carcinoma - Teratoma - Yolk sac tumour - Choriocarcinoma

Question 39

Epidemiology of ovarian germ cell tumours?

Answer 39

Children = >60% of all ovarian neoplasms, 1/3 malignant Adult = rare, mature cystic teratoma, all benign

Question 40

How to tell borderline ovarian surface epithelial tumour from benign/ malignant?

Answer 40

Borderline = low malignant potential Different from the benign tumour: - presence of epithelial budding - increased mitotic activity - nuclear atypia Different from malignant: - no destructive stromal invasion

Question 41

List 3 major sex cord stromal tumours?

Answer 41

a) Granulosa cell tumour b) Thecoma -Fibroma c) Sertoli -Leydig cell tumour

Question 42

3 subtypes of teratoma of ovaries?

Answer 42

(i) Mature Cystic teratoma (ii) Immature teratoma (iii) Teratoma with malignant transformation eg. SCC

Question 43

List 2 germ cell tumours of ovaries that occurs in young women?

Answer 43

Dysgerminoma | Yolk Sac Tumour

Question 44

Which malignant cancers commonly metastasize to ovaries?

Answer 44

carcinoma of breast, lower genital tract and gastrointestinal tract