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Clinical Pathology > Lecture 35 - Uterine and ovarian pathology > Flashcards

Lecture 35 - Uterine and ovarian pathology Flashcards

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1
Q

Endometriosis

A

Ectopic endometrium

number of theories behind it - regurgitation theory, metaplasia theory, stem cell theory, metastasis theory

causes bleeding into tissues and then fibrosis

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2
Q

Symptoms of endometriosis

A

6-10% of women, 30 - 40 years old

History - 25% asymptomatic, dysmenorrhea, dyspareunia, pelvic pain, subfertility, pain on passing stool, dysuria

Lx : Laparoscopy

Rx : Medical (COCP, GnRH agonists/antagonists, progesterone antagonists) or surgical (ablation/ TAH-BSO)

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3
Q

Links to endometriosis

A

Ectopic pregnancy, ovarian cancer, IBD

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4
Q

What is endometritis

A

Inflammation of the endometrium

Pelvic inflammatory disease, retained gestational tissue, endometrial TB, IUCD infection

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5
Q

Histology of endometritis

A

lymphocytes/plasma cells

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6
Q

History of endometritis

A

Abdominal/pelvic pain, pryrexia, discharge, dysuria, abnormal vaginal bleeding

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7
Q

examination/testing for endometritis

A

Biochemistry/microbiology, Ultrasound scan

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8
Q

Treatment/medication for endometritis

A

Analgesia, antibiotics, remove cause

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9
Q

Endometrial polyps

A

Sensile/polypoid E2- dependent uterine overgrowths

< 10% women (40-50’s)

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10
Q

History for endometriall polyps

A

often asymptomatic, Intermenstrual/post menopausal bleeding, menorrhagia, dysmenorrhoea

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11
Q

Investigations for endometriall polyps

A

USS, Hysteroscopy

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12
Q

Treatment for endometriall polyps

A

Expectant, medical, (P4/GnRH agonists), surgical (curettage

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13
Q

Prognosis for endometriall polyps

A

less than 1% are malignant

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14
Q

Leiomyoma (uterine fibroids)

A

Benign myometrial tumours with E2/P4 dependent growth

  • 20% women 30-50’s
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15
Q

Risk factors for Leiomyoma

A

Genetics, nulliparity, obesity, PCOS, Hypertension

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16
Q

History for Leiomyoma

A

Often asymptomatic, menometorrhagia, subfertility, pregnancy problems, pressure sx

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17
Q

investigations for Leiomyoma

A

Bimanusal examination, USS

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18
Q

Treatment for Leiomyoma

A

Medical (IUS,NSAIDs/OCP/P4/FE2+; non-medical (artery embolixation, ablation, TAH

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19
Q

Prognosis for Leiomyoma

A

Menopausal regression, malignancy risk 0.01%

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20
Q

Endometrial hyperplasia

A

excessive endometrial proliferation ( inrease E2, less P4)

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21
Q

risk factors for Endometrial hyperplasia

A

obesity, exogenous E2, PCOS, E2 -producing tumours,tamoxifen, HNPCC ( PTEN mutations)

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22
Q

Types of Endometrial hyperplasia

A

Simple non-atypical, simple atypical

Complex non-atypical, complex atypical

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23
Q

History of Endometrial hyperplasia

A

Abnormal bleeding - IMB/PCB/PMB

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24
Q

Investigations of Endometrial hyperplasia

A

USS, hysteroscopy +/- biopsy

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25
Treatment for Endometrial hyperplasia
Medical (IUS, P4), surgical (TOTAL ABDOMINAL HYSTERECTOMY)
26
Prognosis for Endometrial hyperplasia
endometrial adenocarcinoma, regression
27
Malignant progression of hyperplasia
Normal - Non-atypical hyperplasia (Resembles normal proliferative endometrium) - Atypical hyperplasia (Presence of cytological abnormality) (EIN - Endometrial Intraepithelial Neoplasia) - Endometroid adenocarcinoma (Invasion into myometrium)
28
Endometrial adenocarcinoma
Most common cancer of female genital tract; 9,200 new cases/ 2.500 deaths/yr UK
29
History of Endometrial adenocarcinoma
Post menopausal bleeding, Intermenstrual bleeding, pain if late
30
Investigations
uss, biopsy, hysteroscopy
31
Staging of Endometrial adenocarcinoma
FIGO (1-4)
32
Treatment of Endometrial adenocarcinoma
``` Medical (progesterone), surgery (TAH - BSO), adjuvant therapy (chemo-radiotherapy) ```
33
Prognosis of Endometrial adenocarcinoma
Stage 1 = 90% 5 year survival | Stage 2-3 = <50%
34
Difference between Type 1 and Type 2 Endometrial adenocarcinoma
Type 1 (endometroid) Type 2 (serous) Incidence -75% of cases 25% of cases Age Pre or perimenopausal Post menopausal Pre-existing state endometrial hyperp Endometrial atrophy Mutations PTEN, Kras p53 e2 state E2, +ve E2 -ve Grades 1,2,3 3
35
PCOS
Endocrine disorder hyperandrogenism, menstrual abnormalities, polycystic ovaries 6-10% women (20-30% have polycystic ovaries)
36
investigations for PCOS
USS, fasting biochemical screen (dropin FSH, increase in LH, increase in testosteron, Increase in Dehydroepiandosterone), oral glucose tolerance test
37
Dx: Diagnosis of PCOS
Rotterdam criteria 2/3 of polycystic ovaries, hyperandrogenism (hirsuitsim/biochemical), irregular periods (over 35 days)
38
treatment for PCOS
Lifestyle - weight loss, medical (metformin, OCP, clomiphene (infertility), surgical (ovarian drilling)
39
Links to PCOS
infertility, endometrial hyperplasia/ adenocarcinoma
40
Gonadal failure
Hypergonadotrophic hypogonadism (primary failure of gonads)
41
Congenital causes of Gonadal failure
Turner's syndrome (XO), Klinefelter's syndrome (XXY)
42
Acquired causes of Gonadal failure
Infection, surgeru, chemo-radiotherapy, toxins/drugs
43
What does secondary failure of gonads result in
Hypogonadotrophic hypogonadism (hypothalamic/pituitary failure) resulting in Sheehan syndrome, pituitary tumours, brain injury PCOS
44
Presentation of gonadal failure
amenorrhoea/absent menarche; delayed puberty. decreased sex hormones, increase LH and FSH levels
45
Investigations for gonadal failure
Hormone profiling, karyotyping
46
Treatment for gonadal failure
Difficult - address cause | Hormone replacement therapy
47
Origin of ovarian neoplasms
Sex cord stromal tumours - granulosa cells, thecomas, fibrothecomas, Sertoli- Leydig cell tumours Germ cell tumours - teratomas, yolk sac tumours, embryonal carcinoma dysgerminomas) Surface epithelial tumours (serous, mucinous, endometroid, transitional cell, clear cell
48
Epithelial tumours
Most common group of ovarian neoplasms (90%) 3 major carcinoma histologic types: Serous (tubal) Mucinous (endocervical) Endometrioid (endometrium) Each type contains benign/ borderline/ malignant variants Benign tumours subclassified based on components; cystic (cystadenomas), fibrous (adenofibromas), cystic and fibrous (cystadenofibromas) Malignant epithelial tumours  cystadenocarcinomas
49
Germ cell tumours
15-20% all ovarian tumours Germinamatous and non -germinamatous
50
Germinamatous tumours
Dysgerminomas (differentiation - oogonia, malignant, chemosensitive)
51
Non- germinamatous tumours
``` Teratomas (differentiation towards multiple germ layers) Most mature (benign; 1% malignant transformation) ``` Yolk sac tumours (differentiation towards extraembryonic yolk sac, malignant, chemosensitive) Choriocarcinomas (differentiation - placenta, malignant, often unresponsive)
52
Treatment for germ cell tumours
surgery with or without chemotherapy
53
Sex cord stromal tumours
Rare; arise from ovarian stroma, which was derived from sex cord embryonic gonad Can generate cells from the opposite sex; Thecoma/ fibrothecoma/ fibroma Benign, thecomas and fibrothecomas produce E2 (also rarely androgens), fibromas hormonally inactive Comprised of spindle cells (plump spindle cells with lipid droplets = thecoma appearance) Meig’s syndrome = ovarian tumour, right sided hydrothorax, ascites Granulosa cell tumours Low grade malignant, produces E2 Sertoli-Leydig cell tumours Produces androgens; 10-25% malignant
54
ovarian cancer
2nd commonest cancer | ; >7,100 women >4,300 deaths/yr UK; 80% >50’s; 80-90% epithelial
55
Risk factors for ovarian cancer
FH, ↑age, PMH breast cancer, smoking, | E2-only HRT, Lynch II syndrome, obesity, nulliparity
56
Protective factors for ovarian cancer
OCP, breastfeeding, hysterectomy
57
History of ovarian cancer
non-specific symptoms; pain, bloating, weight loss, PV bleeding, urinary frequency, anorexia
58
staging of ovarian cancer
FIGO 1-4
59
treatment for ovarian cancer
Stage <1C epithelial tumours  TAH/BSO, omentectomy, appendectomy, lymphadenectomy & adjuvant chemo - chemo only in sensitive GCTs
60
prognosis for ovarian cancer
overall 5 years 43% survival
61
Ovarian metastatic tumours
Mullerian tumours ( most common) and Non-Mullerian tumours
62
Mullerian tumours
uterus, fallopian tube, pelvic peritoneum, contralateral ovary
63
Non-Müllerian tumours
Lymphatic/ haematogenous spread: GI tract: Large bowel, stomach (Krukenberg tumour), pancreatobiliary ``` Breast Melanoma Less commonly, kidney and lung Direct extension: bladder, rectal Metastatic tumours are confirmed histologically; prognosis is typically poor ```

Clinical Pathology (16 decks)

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