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GP, obstetrics, psych, paeds > O+G pathology > Flashcards

O+G pathology Flashcards

1
Q

what is the key histological description for endometrial clear cell carcinoma?

A

cytoplasmic clearing

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2
Q

what are some risk factors for developing endometrial cancer?

A

chronic anovulatory cycles nulliparity PCOS, obesity LYNCH SYNDROME and or other positive FMH of endometrial cancer unopposed E2 therapy

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3
Q

what are the 3 broad grades of epithelial ovarian neoplasms?

A

benign

borderline

malignant

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4
Q

which HPV subtypes are the ‘high risk’ subtypes?

A

16 and 18

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5
Q

describe vulvular lichen sclerosis

A

Analogue to balantitis XO

Can be associated with HPV –> differential VIN

Pruritic, dry scaly lesion

Autoimmune condition usually

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6
Q

what is the common name for leiomyoma?

A

fibroids

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7
Q

what HPV subtypes are associated with condyloma acuminatum?

A

HPV 6 or 11 (low risk subtypes)

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8
Q

what is the most common type of cervical cancer?

A

SCC

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9
Q

if you looked at the histology of leiomyosarcoma, what would you see?

A

dense spindled appearance of smooth muscle cells

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10
Q

what is the most common type of endometrial cancer?

A

endometrioid type

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11
Q

what is the pathology?

A

this is a cervical biopsy

on the left hand side there is full thickness atypia–> HSIL

right hand side = normal

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12
Q

what is the difference between ‘squamous intraepithelial lesions’ (SIL) and ‘intraepithelial lesions’ (IN suffix) when referring to lower genital tract neoplasia in women?

A

SIL refers to HPV related dysplasia whereas IN means the neoplastic change is NOT related to HPV infection

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13
Q

what does gestational trophoblastic disease refer to?

A

Gestational trophoblastic disease (GTD) describes a group of tumours that arise from the fetal trophoblast.

Tumour of the placenta due to abnormal conception of sperm and egg

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14
Q

what is the aim of cervical cytology?

A

to detect cervical changes at a pre-cancerous dysplasia stage

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15
Q

what are the features of dysplasic squamous epithelial cells on cervical cytology?

A

high nuclear to cytoplasmic ratio

enlarged dark nuclei

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16
Q

what is the hallmark histological feature of chronic endometritis?

A

plasma cells

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17
Q

what syndrome is associated with endometrial cancer?

A

lynch syndrome!!

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18
Q

what must you consider if you find malignant tumours in both ovaries?

A

metastatic cancer from elsewhere e.g. GIT, endometrium etc

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19
Q

what is the difference between the appearance of a VIN (vulval intraepithelial neoplasia) lesion and a vulval condyloma?

A

VIN is flat whereas a condyloma is not

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20
Q

what is the histological diagnostic criteria for endometriosis?

A
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21
Q

how might a woman with complete hyatidiform present?

A

vaginal bleeding

increased uterus size for dates

hyperemesis gravidarum +++

common in asian ethnicity

pre-eclampsia

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22
Q

what are the genetic risk factors for developing ovarian cancer?

A

BRCA 1 and BRCA 2

Lynch syndrome

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23
Q

what is choriocarcinoma, and how do we treat it?

A

choriocarcinoma is a type of invasive gestational trophoblastic disease

you can treat it effectively with chemotherapy such as methotrexate

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24
Q

what are the risk factors of a molar pregnancy?

A

previous molar pregnancies

asian background

extremes of age (less than 20, greater than 40 yrs)

nutritional deficiency

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25
Q

what is your management plan of a lady who has been diagnosed with a molar pregnancy?

A

Remove molar pregnancy

Monitor bHCG levels!! up to 6 months

encourage her to be on the GTN mole registry

encourage her to use contraception until bHCG normalise

If bHCG levels persists–> consider persistent trophoblastic disease.

This may indicate that the molar products may have embedded into other organs i.e. choriocarcinoma

26
Q

where do we normally see metastases for choriocarcinoma?

A

lung and ovaries

27
Q

What is the chromosomal differences between complete and partial molar pregnancy and their malignant potential

A

Complete molar pregnancy occurs as a result of fertilisation of an empty ovum with either two sperm or one that divides. The karyotype is generally 46XX (occasionally 46XY) and all of paternal origin.

Partial molar pregnancy results from the fertilisation of an ovum with two sperm or one that divides resulting in triploidy 69XXY, 69XXX or, rarely, 69XYY. (maternal and paternal) There is often a co-existing fetus that is prone to fetal death in utero and growth restriction.

Partial moles have a much lower malignant potential 2-4% whereas 20% chance complete moles becomes malignant

28
Q

what are the histopathological features of hyatidiform mole?

A

avascular hydropic (oedematous) chorionic villi

trophoblastic proliferation

29
Q

describe the transitional zone of the cervix?

A

zone of metaplasia as columnar epithelium of everted cervix becomes stratified squamous epithelium as it is exposed to the acidic environment of the vagina

30
Q

what is a condyloma?

A

papillomatous warty lesions of the cervix caused by HPV infection.

31
Q

describe the histological classification of cervical cancer?

A

CIN 1= low grade

CIN 2, CIN 3= high grade

32
Q

describe the changes to the future cervical screening program?

A

Starting from 2017, women will be screened every 5 years for cervical cancer rather than every 2 years. The clinician still needs to take cells from the cervix, but instead, will send the cells to a laboratory for liquid based cytology. This type of technology can also detect HPV infection and also screen for high risk genotypes, and is more sensitive at picking up early cervical changes.

Any woman with signs or symptoms suspicious of cervical pathology can be screened at any time.

Screening program will target women between 25-75yrs of age

33
Q

describe the process of a colposcopy?

A

A colposcopy is a procedure performed when a pap test result is abnormal. The clinician will use a special pair of binoculars/microscope to look at the cervix and analyse for any abnormal cervical change.

The procedure will involve the insertion of a speculum into the vagina to view the cervix, and a repeat pap smear. Acetic acid/vinegar is then applied, and then iodine as well to allow the clinician to differentiate between abnormal and normal cells of the cervix.

Depending whether the cells appear abnormal, a punch biopsy may be required

34
Q

a woman comes into gynae clinic for a colposcopy after having an abnormal pap smear. on colposcopy, the clinician determines that it is a low grade lesion, most likely CIN1. what is the management?

A

repeat cytology in 12 months

35
Q

what are the two types of excisional therapies used for cervical lesions (CIN 2,3)?

A

cone biopsy

loop wire excision (LEEP)

36
Q

what is a consideration of performing a cone biopsy on a young woman with CIN 2/3 cervical lesion?

A

increased risk of cervical incompetence

implications for future desire for pregnancy

37
Q

a woman with confirmed HSIL is treated. what is the management post HSIL treatment?

A

Perform follow up pap test and repeat colposcopy 4-6 months after treatment.

If negative, pap test and HPV test should be performed at 12 months post treatment, and then annually until both pap and HPV test are negative. At this point, the woman can go back to two-yearly screening (currently, this will change in 2017)

38
Q

a woman has a pap test and the results are sent off to LBC (liquid based cytology) as per new 2017 guidelines. The lab picks up HPV 16,18 infection and notifies you, her GP. What do you need to do now?

A

Refer her for a colposcopy regardless of the LBC results bc she has high risk HPV genotypes

39
Q

a woman comes in complaining of vulvar pain. what are your differentials?

A

vulvodynia

lichen planus

intimate partner violence/assault/trauma

bartholin duct abscess

cellulitis

herpes genitalis

aphthous ulcers on vulva

40
Q

what do we mean by ‘usual VIN’ and ‘differentiated’ VIN?

A

VIN usual type (HPV-related)

VIN differentiated (dermatosis-related).

41
Q

what are two cancers that we can find in the vulvar area?

A

SCC

extramammary Paget’s disease

42
Q

what are the two subtypes of endometrial cancer which have the worst prognosis?

A

papillary serous endometrial cancer

clear cell endometrial cancer

43
Q

what do we mean by a ‘chocolate cyst’ in gynaecology?

A

another name for endometrioma

which is a blood filled cyst found on the ovaries as a result of endometriosis

44
Q

what is uterine artery embolisation?

A

interventional radiologist uses catheter via femoral artery to deliver particles that block blood supply to the uterine artery–> used for treating large fibroids

45
Q

what does subserosal fibroids mean?

A

fibroids projecting into the peritoneal cavity

46
Q

why might GnRH agonists be used for fibroids? what is the main side effect of this drug?

A

reduces the size of fibroids prior to myomectomy

can help with symptoms and also make laparoscopy more likely

main side effect to consider- induces menopausal like state in the woman

47
Q

how do we biopsy endometrial lining?

A

hysteroscopy D and C usually

some countries use pipelles

48
Q

which lymph nodes may be involved in cervical cancer?

A

Lymphatic spread is first to the parametrial nodes lateral to the cervix, and then to the internal iliac, obturator and external iliac nodes. Spread then occurs to the common iliac nodes and paraaortic nodes.

49
Q

what are the clinical features/symptoms of complete hyatidiform mole?

A

Hyperemesis gravidarum +++

Larger for dates, soft uterus

Early onset preeclampsia

Hyperthyroidism

Vaginal blood loss

50
Q

how is partial mole usually diagnosed?

A

Silent miscarriage- molar pregnancy often diagnosed via histological analysis of passed products of conception

51
Q

how does untreated choriocarcinoma spread through the body?

A

Spread of the disease most frequently

occurs locally in the pelvis and by haematogenous

spread, notably affecting the liver, lungs and brain

52
Q

describe the process of colposcopy

A

Colposcopy is an examination of the cervix and lower genital tract with a low power, stereoscopic microscope with an attached light source.The cervix and vagina are cleaned of any blood and debris with normal saline, and, after inspecting the cervix and vagina, a dilute 3–5% solution of acetic acid is applied to the cervix. Acetic acid dehydrates the cells and causes a reversible coagulation of the nuclear proteins. Characteristic acetowhite epithelial changes will occur in cells rich in proteins such as dysplastic cells. Significant acetowhite features include intensity or colour tone, margins and surface contour, and vascular changes. A solution of Lugol’s iodine may be applied, being taken up by glycogen-rich cells and leaving dysplastic and immature cells as iodine negative

53
Q

how might we remove an endometrial polyp?

A

hysteroscopy and then resection of polyp with loop diathermy

54
Q

why are most solid ovarian masses removed even if they are benign e.g. dermoid cyst?

A

Risk of malignancy

Risk of ovarian torsion

55
Q

what can we do for a woman with known BRCA mutation to reduce her risk of developing ovarian cancer?

A

Surgical prophylaxis may be offered to high risk women with BRCA mutations- bilateral salpingoophrectomy

56
Q

how might we screen for ovarian cancer?

A

no effective screening test available

57
Q

what are some protective factors for ovarian cancer?

A

OCP use

breast-feeding

parity

58
Q

what is the difference between radical vs simple hysterectomy?

A

radical= removal of uterus, parametrium, cervix and upper part of the vagina

simple hysterectomy= removal of uterus and cervix

59
Q

describe the 4 stages of cervical cancer

A

Stage I - The cancer is found only in the cervix.
Stage II - The tumour has spread beyond the cervix and uterus to the vagina or other tissue next to the cervix (parametrium)
Stage III - The cancer has spread right out to the sidewall of the pelvis or has blocked a ureter (the tube carrying urine from the kidney to the bladder)
Stage IV - The cancer has spread to the bladder or rectum, or beyond the pelvis to other organs including the lungs, liver or bones.

60
Q

a lady has a colposcopy which shows grade 1a cervical cancer. what needs to be done?

A

cone biopsy. if cancer is within surgical margins then you can leave it as that, but if it extends past the margins then a hysterectomy and pelvic lymph node dissection is recommended.

other options that are fertility sparing = cone biopsy + pelvic lymphadenectomy or trachealectomy

GP, obstetrics, psych, paeds (55 decks)

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