Lecture 22

Question 1

What are the types of neoplastic lesions?

Answer 1

It can be split into:

1. Benign.
2. Malignant.

Question 2

What are the types of non-neoplastic lesions?

Answer 2

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

Question 3

What are the types of malignant neoplastic lesions?

Answer 3

1. Primary.

2. Secondary.

Question 4

What are the types of primary malignant neoplastic lesions?

Answer 4

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.

Question 5

What are the class-action of tumours?

Answer 5

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

Question 6

What are the type of epithelial tumours?

Answer 6

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

Question 7

What are the type of lymphoid tumours?

Answer 7

1. Hodgkins disease.

2. Non-hodgkins, T or B cell.

Question 8

What are they type of mesenchymal tumours?

Answer 8

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

Question 9

Describe the normal ovary?

Answer 9

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.

Question 10

Describe the histology of the ovary?

Answer 10

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.

Question 11

Describe thye tumours of the ovary?

Answer 11

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.

Question 12

Describe non-neoplastic tumours of the ovary?

Answer 12

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.

Question 13

Describe benign tumours of the ovary?

Answer 13

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.

Question 14

Describe malignant tumours of the ovary?

Answer 14

1. Primary - ovarian carcinoma.

2. Secondary - metastatic carcinoma.

Question 15

What else can occur in POS?

Answer 15

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

Question 16

Describe ovarian neoplasms?

Answer 16

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.

Question 17

Describe a dermoid cyst?

Answer 17

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.

Question 18

Describe malignant tumours of the ovary?

Answer 18

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.

Question 19

Describe fallopian tubes?

Answer 19

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.

Question 20

Describe a non-neoplastic tumour of the fallopian tube?

Answer 20

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).

Question 21

Describe a pre-malignant tumour of the fallopian tube?

Answer 21

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

Question 22

Describe benign tumours of the fallopian tubes?

Answer 22

Adenomatoid tumour.

Question 23

Describe the malignant tumours of the fallopian tubes?

Answer 23

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

2. Secondary - metastatic carcinoma

Question 24

What happens in bilateral cell splangitis?

Answer 24

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

Question 25

Describe the uterus?

Answer 25

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

Question 26

What is the uterus made out of?

Answer 26

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

Question 27

What is endometrium made out of?

Answer 27

Glands and stroma.

Question 28

What is the function of the endometrium?

Answer 28

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

Question 29

Describe the menstrual cycle?

Answer 29

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.

Question 30

Describe non-neoplastic endometrium tumours?

Answer 30

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).

Question 31

Describe pre-malignant endometrium tumours?

Answer 31

Hyperplasia.

Question 32

Describe benign endometrium tumours?

Answer 32

Endometrial polyp - localised proliferation.

Question 33

Describe malignant endometrium tumours?

Answer 33

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

Question 34

Describe non-neoplastic myometrium tumours?

Answer 34

Adenomyosis - endometriosis but in the uterine wall.

Question 35

Describe benign myometrium tumours?

Answer 35

Leiomyoma (fibroid). Smooth muscle tumour.

Question 36

Describe malignant myometrium tumours?

Answer 36

Leiomyosarcoma - malignant smooth muscle tumour.

Question 37

Describe the cervix?

Answer 37

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).

Question 38

Describe non-neoplastic cervix tumours?

Answer 38

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

Question 39

Describe pre-malignant cervix tumours?

Answer 39

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.

Question 40

Describe benign cervix tumours?

Answer 40

Endocervical polyp.

Question 41

Describe malignant cervix tumours?

Answer 41

1. Squamous cell carcinoma. | 2. Adenocarcinoma.

Question 42

Define metaplasia?

Answer 42

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

Question 43

Define dysplasia?

Answer 43

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.

Question 44

Define neoplasia?

Answer 44

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

Question 45

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

Answer 45

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.

Question 46

Describe the grade of precancer?

Answer 46

This depends on the severity and extent of the atypia.

Question 47

Describe congenital abnormalities?

Answer 47

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