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What are the types of neoplastic lesions?

It can be split into:
1. Benign.
2. Malignant.


What are the types of non-neoplastic lesions?

1. Infections.
2. Inflammation deposits.
3. Hamartomas.
4. Congenital.


What are the types of malignant neoplastic lesions?

1. Primary.
2. Secondary.


What are the types of primary malignant neoplastic lesions?

1. Epithelial.
2. Mesenchymal (fat, nerves, blood vessels, muscle, bone, cartilage and haemopoietic cells).
3. Mized.
4. Lymphoid.
5. Melanocytic.
6. Germ cell.
7. Other.
8. Neuroendocrine.
9. Fibrous.


What are the class-action of tumours?

1. Epithelial - carcinoma.
2. Lymphoid - lymphoma.
3. Melanocytic - melanoma.
4. Mesenchymal - sarcoma.


What are the type of epithelial tumours?

1. Simple epithelium - carcinoma.
2. Glandular epithelium - adenocarcinoma.
3. Squamous epithelium - squamous cell carcinoma.
4. Urothelium - urothelial carcinoma.


What are the type of lymphoid tumours?

1. Hodgkins disease.
2. Non-hodgkins, T or B cell.


What are they type of mesenchymal tumours?

1. Adipose tissue - liposarcoma.
2. Neural tissue - malignant peripheral nerve sheath.
3. Bone - osteosarcoma.
4. Cartilage - chodrosarcoma.
5. Muscle - leiomyoma/rhabdomyo sarcoma.


Describe the normal ovary?

At birth there are 400,000 primordial follicles which re dormant until puberty. After puberty up to 20 follicles start maturing each cycles under the influence of FSH and LH. Only one follicle reaches maturity and is released. By menopause only a few follicles remain.


Describe the histology of the ovary?

The hilum of the ovary is where all the blood vessels and nerves come in, and there is a cortex as well. In the cortex there are follicles sitting there; to support the follicles is stroma.

N.B. possibly epithelial derived tumours will come from the fallopian tube epithelium.


Describe thye tumours of the ovary?

1. Metastases spread to the ovary from elsewhere.
2. Germ cell tumours e.g. teratoma.
3. Sex cord stromal tumours e.g. fibroma.
4. The majority of tumours arise from the surface or the fibril end of the fallopian tube.


Describe non-neoplastic tumours of the ovary?

1. Polycystic ovarian syndrome - endocrine problem, lots of follicles that partly mature but never ovulate. So you'll get lots of cysts in the cortex of the ovary.
2. Functional ovarian cysts - follicular cyst or corpus leuteum cyst.


Describe benign tumours of the ovary?

1. Epithelial - mucinous cystadenoma (glandular epithelium with mucin in the cytoplasm) or serous cystadenoma (columnar epithelium that is ciliated).
2. Germ cell - dermoid (teratoma).
3. Stromal tumours - fibroid.


Describe malignant tumours of the ovary?

1. Primary - ovarian carcinoma.
2. Secondary - metastatic carcinoma.


What else can occur in POS?

Because the patients never ovulate, they have a continuous estrogenic stimulation, therefore you can develop endometrial hyperplasia and carcinoma.


Describe ovarian neoplasms?

These can get really huge (i.e. 20kg). There are usually multiple cysts. Solid parts, cystic areas. There is an increased nucleus to cytoplasmic ratio. The nuclei are larger in size and coarse chromatin.

They are called cystadenomas if they are predominately cystic. You can call them mucinous cystadenomas if they are predominately mucinous epithelium or serous cystadenomas if they are predominately serous epithelium.


Describe a dermoid cyst?

Also known a teratoma. An oocyte decides to grow on its own without the help of sperm DNA. It tries to recapitulate another human being inside the ovary, however it gets it completely wrong. There are bits of: teeth, hair and skin. They are benign. If one sits in a female ovary for many years, you can develop a squamous cell carcinoma on the skin of the teratoma.


Describe malignant tumours of the ovary?

The classic things that metastasise to the ovary: signet ring cell carcinoma of the stomach.The ovaries aren't very enlarged in this situation. Another tumour that can metastasise is a colorectal carcinoma. These can be cystic and mimic primary ovary neoplasm.


Describe fallopian tubes?

They are 9-11cm long, with free fibril ends (that are composed of finger-like projections adjacent to, but not attached to the ovary) that open into the peritoneal cavity and grab the eggs from the ovary.


Describe a non-neoplastic tumour of the fallopian tube?

1. Salpingitis - inflammation of the fallopian tube.
2. Ectopic pregnancy - pregnancy implanted in the tube of the fallopian tube not the uterus (can cause the patient to bleed to death).


Describe a pre-malignant tumour of the fallopian tube?

Tubal intraepithelial carcinoma. The neoplastic change are still located in the epithelial component above the basement membrane.


Describe benign tumours of the fallopian tubes?

Adenomatoid tumour.


Describe the malignant tumours of the fallopian tubes?

1. Primary - carcinoma (seen in patients with BRCA).
2. Secondary - metastatic carcinoma


What happens in bilateral cell splangitis?

The fibril ends when they become inflamed will stick together. It can get filled with pus or blood.


Describe the uterus?

It is composed of the fundus (top), body and the cervix.


What is the uterus made out of?

It consists of a thick muscular wall (myometrium) lined by endometrium.


What is endometrium made out of?

Glands and stroma.


What is the function of the endometrium?

It contains hormone receptors for oestrogen and progesterone. Following menopause the endometrium becomes inactive.


Describe the menstrual cycle?

In terms of the endometrium there are two phases: 1) proliferative (pre-ovulation) and 2)secretory endometrium. Under the influence of oestrogen the endometrium proliferates. In situations with excess oestrogen, the women are at risk of excessive proliferation.


Describe non-neoplastic endometrium tumours?

1. Endometritis - inflammation of the endometrium. It can happen postpartum. There can also be chronic endometritis.
2. Endometriosis - the endometrium will be somewhere else in the body (locally spread).


Describe pre-malignant endometrium tumours?



Describe benign endometrium tumours?

Endometrial polyp - localised proliferation.


Describe malignant endometrium tumours?

Endometrial adenocarcinoma - it rises from glandular epithelium in the endometrium.


Describe non-neoplastic myometrium tumours?

Adenomyosis - endometriosis but in the uterine wall.


Describe benign myometrium tumours?

Leiomyoma (fibroid). Smooth muscle tumour.


Describe malignant myometrium tumours?

Leiomyosarcoma - malignant smooth muscle tumour.


Describe the cervix?

It is the lower narrow portion of the uterus, it protrudes through into the upper vagina. There is transition from squamous epithelium into glandular epithelium (in the endometrium).


Describe non-neoplastic cervix tumours?

1. Cervicitis - inflammation of the cervix. Essentially open to the outside world.
2. Candida.


Describe pre-malignant cervix tumours?

1. Squamous intraepithelial lesion (SIL).
2. Adenocarcinoma in situ.

Setting up programmes to detect these pre-malignant tumours so that treatment can occur before they invade the basement membrane.


Describe benign cervix tumours?

Endocervical polyp.


Describe malignant cervix tumours?

1. Squamous cell carcinoma.
2. Adenocarcinoma.


Define metaplasia?

This is the replacement of one differentiated cell type with another.


Define dysplasia?

This is genetic alterations to the cell, this allows the cell to be better at reproducing itself. It can stay in the cell cycle and increase turnover. It always occurs above the basement membrane.


Define neoplasia?

This is dysplasia, except it has broken the basement membrane (invaded into the blood vessels).


Describe a pre-cancer (squamous intraepithelial lesion/CIN)?

CIN is cervical intraepithelial neoplasia. It is dysplasia. The pre-cancerous cells are confined to the epithelium (not beyond the basement membrane). The epithelium doesn't have blood vessels and these cells cannot metastasise. Surgically removing the pre-cancer usually cures the patient. Precancerous cells may undergo further mutations that allow invasion through the basement membrane into the stroma. Neoplastic cells can now invade lymphatics or blood vessels and spread/metastasize.


Describe the grade of precancer?

This depends on the severity and extent of the atypia.


Describe congenital abnormalities?

Intersex abnormalities, malformations of the uterus, and there are abnormalities of development of the ovaries e.g. absence of ovaries.