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TRANSITION BLOCK 1 > O&G Pathology > Flashcards

O&G Pathology Flashcards

1
Q

What are the three possible types of endometrial hyperplasia?

A

Simple
Complex
Atypical (precursor of carcinoma)

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2
Q

Describe the difference in appearance between simple, complex and atypical hyperplasia

A

SIMPLE:

  • Glands and stroma
  • Dilated not crowded
  • Cytology = Normal

COMPLEX:

  • glands
  • crowded
  • Cytology = Normal

ATYPICAL:

  • glands
  • crowded
  • Cytology = Atypical
  • high N:C ratio
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3
Q

What are the precursor lesions to the main two types of endometrial carcinoma?

A

Endometrioid carcinoma = atypical hyperplasia

Serous carcinoma = serous intraepithelial carcinoma

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4
Q

What underlying conditions should you consider when a patient presents with endometrial carcinoma?

A
  • polycystic ovary syndrome

- Lynch syndrome (HNPCC)

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5
Q

What is thought to cause endomeTROID carcinomas?

A
  • unopposed oestrogen

- atypical hyperplasia

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6
Q

What is thought to cause SEROUS/CLEAR CELL endometrial carcinomas?

A
  • Not associated with unopposed oestrogen

- TP53 often mutated

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7
Q

Why does obesity cause an increased endometrial cancer risk?

A

Adipocytes = express aromatase (converts androgens to oestrogens)

Sex hormone-binding globulin levels = lower
=> level of free active hormone is higher

Level of insulin-binding globulins = reduced
=> free insulin levels = elevated
=> Insulins exert proliferative effect on endometrium like oestrogen

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8
Q

How do SEROUS/CLEAR CELL endometrial carcinomas usually spread?

A
  • along Fallopian tube mucosa and peritoneal surfaces

=> patients may present with extrauterine disease

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9
Q

Which type of endometrial carcinoma is more aggressive?

A

Serous/Clear cell

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10
Q

What characterises Serous endometrial carcinoma on histology?

A

complex papillary and/or glandular structure

+ diffuse, marked nuclear pleomorphism

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11
Q

How do clear cell endometrial carcinomas appear on histology?

A

Lots of “clear” cell spaces in comparison to other forms of cancer

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12
Q

Endometroid/Mucinous cancers are graded but Serous/Clear cell are not. TRUE/FALSE?

A

TRUE

- serous/ clear cell not formally graded

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13
Q

How are endometrial cancers graded?

A

Based on amouont of solid growth in tumour

Grade 1 5% or less solid growth
Grade 2 6-50% solid growth
Grade 3 >50% solid growth

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14
Q

How are endometrial cancers staged?

A

Stage I confined to endometrium
Stage II cervical stroma
Stage III (A = local spread, C = regional lymph nodes)
Stage IV bladder/bowel mucosa or distant mets

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15
Q

Endometrial tumours can also occur in the stroma. What are these called?

A

Endometrial Sarcomas
- usually high grade

can also get carcinosarcomas which are a mix of both

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16
Q

Give examples of tumours which can arise from the myometrium?

A

Leiomyomas (benign fibroids)

Leiomyosarcomas (rare, malignant)

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17
Q

How would patients usually present with a leiomyosarcoma?

A
  • age >50
  • abnormal vaginal bleeding
  • palpable pelvic mass
  • pelvic pain
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18
Q

Leiomyosarcomas have a poor prognosis even if confined to uterus at time of presentation. TRUE/FALSE?

A

TRUE

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19
Q

What phase is the endometrium in during each stage of the ovarian menstrual cycle?

A

Ovarian Follicular Phase = Endometrial Menstruation

Ovulation = Endometrial Proliferation

Ovarian Luteal Phase = Endometrial Secretory

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20
Q

The endometrial secretory phase ALWAYS lasts how many days?

A

14

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21
Q

Describe the histological appearance of the endometrium during the secretory phase

A
  • Increasing tortuosity

- Lumenal secretions

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22
Q

What may cause dysfunctional uterine bleeding in adolescence and early reproductive life?

A

Anovulatory cycles (PCOS)
Pregnancy/miscarriage
Endometritis
Bleeding disorders

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23
Q

What may cause DUB during reproductive age?

A 
Anovulatory cycles
Pregnancy/miscarriage
Endometritis
Bleeding disorders
Polyp
Fibroid
Adenomyosis
Hormone effects
Hyperplasia/Neoplasia: cervical, endometrial
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24
Q

What may cause Post-Menopausal DUB?

A
  • Atrophy
  • Polyp
  • Exogenous hormones: HRT, tamoxifen
  • Endometritis
  • Bleeding disorders

Hyperplasia
Endometrial carcinoma
Sarcoma

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25
Q

TVUS can measure endometrial thickness. What measurements would indicate a need for biopsy?

A

> 4mm in postmenopausal women
(>16mm in premenopausal)
= generally taken as an indication for biopsy

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26
Q

How can the endometrium be sampled?

A

Pipelle biopsy

Dilatation and curretage

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27
Q

What are the adv/disadv of Pipelle biopsy vs D+C?

A

Pipelle

  • no dilatation needed
  • no anaethesia
  • Outpatient procedure
  • safe
  • May only get a Limited sample

D+C

  • more thorough sampling method
  • however can miss 5% hyperplasias/cancers
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28
Q

A biopsy during which phase of the endometrial cycle is the least informative?

A

Menstrual phase

- endometrium is falling away therefore difficult to pick anything up on biopsy

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29
Q

What can be seen histologically if patients have anovulatory cycles?

A

Proliferation phase never moves into secretory as no ovulation has occurred
=> disordered proliferation begins to take place

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30
Q

What usually protects the endometrium from infection?

A
  • Cervical mucous plug

- Cyclical shedding of endometrium

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31
Q

What organisms can cause endometritis?

A

Neisseria
Chlamydia
TB
CMV/HSV

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32
Q

What causes of endometritis are non-infective?

A

IUD
Postpartum/Postabortal/Post curettage
Granulomatous (sarcoid, foreign body post ablation)
Associated with leiomyomata or polyps

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33
Q

How can you tell histologically if a patient has miscarried?

A

There will be chorionic villi in the sample (retained products of conception)

  • Foetal RBCs will be visible on sample
34
Q

What characterises a molar pregnancy on histology?

A

Swollen chorionic villi

35
Q

Which type of mole has a higher risk of progressing to a choriocarcinoma?

A

Complete Hydatidiform Mole

36
Q

What is the characteristic feature of adenomyosis on histology?

A

Endometrial glands and stroma within the myometrium

37
Q

What are the main types of cysts arising from the ovaries?

A 
Follicular e.g. polycystic ovaries
– Luteal
– Endometriotic
– Epithelial
– Mesothelial
38
Q

What causes the formation of a follicular cyst?

A
  • form when ovulation doesn’t occur

=> Follicle doesn’t rupture but grows into cyst

39
Q

Follicular cysts usually resolve. TRUE/FALSE?

A

TRUE - Usually resolve over a few months

40
Q

What is endometriosis?

A
  • Endometrial glands and stroma outside uterine body
41
Q

What sites does endometriosis normally present in?

A 
– Ovary (‘chocolate’ cyst)
– Pouch of Douglas
– Peritoneal surfaces, including uterus
– Cervix, vulva, vagina
– Bladder, bowel etc
42
Q

How does endometriosis look MACROscopically?

A

Peritoneal spots or nodules
Fibrous adhesions
Chocolate cysts

43
Q

Other than endometrial glands and stroma in the wrong place, how can endometriosis be identified microscopically?

A

Haemorrhage
inflammation
fibrosis

44
Q

What are the main complications of endometriosis?

A
  • Pain
  • Cysts
  • Adhesions
  • Infertility
  • Ectopic pregnancy
  • Malignancy (endometrioid carcinoma)
45
Q

How are epithelial ovarian tumours classified?

A

Benign - No cytological abnormalities, Does not invade stroma

Borderline - Cytological Abnormality but no stroma invasion

Malignant - Stromal invasion present

46
Q

What is the difference between high grade and low grade serous carcinoma?

A

Different precursor lesions

High grade:
- Serous TUBAL intraepithelial carcinoma
(most tubal in origin)

Low grade:
- Serous borderline tumour

47
Q

What type of ovarian cancers does endometriosis predispose to?

A

Endometrioid and Clear Cell carcinoma

48
Q

How is a primary diagnosis of ovarian cancer often made?

A
  • Ascitic fluid

- patients often present with ascites

49
Q

What is a Brenner Tumour? Is it normally benign, borderline or malignant?

A
  • tumour of transitional eptihelium

- usually BENIGN

50
Q

Most germ cell ovarian tumours are known as what?

A

Mature Teratomas

also called “dermoid cysts”

51
Q

What can be found in teratomas?

A

– contain all 3 layers of ectoderm, mesoderm and endoderm
– cystic, containing sebum and hair
– skin, respiratory epithelium, gut, fat common

52
Q

What other types of germ cell tumour can arise in the ovary?

A 
Immature teratoma
Dysgerminoma (young women/children)
Yolk sac tumour
Choriocarcinoma (due to molar preg.)
Mixed germ cell tumour
53
Q

What types of sex cord/stromal tumour may arise in the ovary?

A
  • Fibroma/Thecoma (Benign)
  • Granulosa cell tumour (all potentially malignant)
  • Sertoli-Leydig cell tumours (Rare)
54
Q

Metastases to the ovary most commonly come from where?

A

Stomach
Colon
Breast
Pancreas

55
Q

When must you suspect metastases to the ovary?

A

If bilateral tumour tissue appears

56
Q

Briefly describe Figo Ovarian Cancer Staging

A

1A - one ovary
1B - both ovaries

2A - uterus/fallopian tube
2B - intraperitoneal

3A - Retroperitoneal lymph node/microscopic beyond pelvis
3B Macroscopic metastasis beyond pelvis <2cm
3C Macroscopic peritoneal metastasis >2cm

4 Distant metastasis

57
Q

When should you consider a diagnosis of ectopic pregnancy?

A
  • female of reproductive age
  • amenorrhoea
  • acute hypotension
  • acute abdomen
58
Q

What is the transformation zone?

A
  • Squamo-columnar junction between ecto and endocervix
59
Q

What can physiologically change the position of the transformation zone?

A
  • menarche
  • pregnancy
  • menopause
60
Q

What can cause cervical erosion?

A
  • Exposure of endocervix to acid environment of vagina

=> physiological squamous metaplasia

61
Q

What HPV virus strains are most high risk for cervical cancer?

A

16 and 18

62
Q

Other than HPV, what makes the Squamocolumnar junction more vulnerable to develop cervical cancer?

A
  • age at first intercourse
  • long term use of oral contraceptives
  • non-use of barrier contraception
  • Smoking: 3 x risk
  • Immunosuppression
63
Q

What strains of HPV are responsible for genital warts?

A

6 and 11

64
Q

What is the normal time line between HPV and cancer?

A

HPV infection - High grade CIN
6 months - 3 years

High Grade CIN - Invasive Cancer
5 -20 years

65
Q

What is cervical intraepithelial neoplasia?

A
  • Precursor stage of cervical cancer
  • transformation zone.
  • Dysplasia
  • Asymptomatic but detected by cervical screening
66
Q

Describe the stages between normal squamous epithelium and neoplasia

A

Koilocytosis
CIN1
CIN2
CIN3

67
Q

How does CIN appear on histology?

A
  • Nuclear abnormalities
  • hyperchromasia
  • nucleocytoplasmic ratio
  • pleomorphism
  • Excess mitotic activity
68
Q

What is the difference between CIN I, II and III?

A

CIN I - Basal 1/3 of epithelium = abnormal cells
CIN II - Abnormal cells extend to middle 1/3
CIN III - Abnormal cells occupy full thickness of epithelium

69
Q

CIN III is the most likely to progress to invasion. TRUE/FALSE?

A

TRUE

>12%

70
Q

What are the symptoms of invasive cervical carcinoma?

A
  • Abnormal bleeding
  • Brownish or blood stained vaginal discharge
  • Contact bleeding – friable epithelium
  • Pelvic pain
  • Haematuria / urinary infections
  • Ureteric obstruction / renal failure
71
Q

Describe how invasive cervical carcinoma can spread

A

Local

  • uterine body
  • vagina
  • bladder
  • ureters
  • rectum

Lymphatic (pelvic and para-aortic nodes)

Haematogenous

  • liver
  • lungs
  • bone
72
Q

What is CGIN in comparison to CIN?

A

Cervical Glandular Intraepithelial Neoplasia (CGIN)

  • occurs from endocervical epithelium
  • harder to recognise than squamous
73
Q

What can CGIN progress to?

A

Endocervical Adenocarcinoma (glandular malignancy)

74
Q

What can predispose to endocervical adenocarcinoma?

A

Higher S.E. Class
Later onset of sexual activity
Smoking
HPV again (HPV18)

75
Q

Endocervical adenocarcinoma has a worse prognosis than squamous. TRUE/FALSE?

A

TRUE

76
Q

Where else can HPV cause intraepithelial neoplasia to occur?

A

Vulvar Intraepithelial Neoplasia, VIN
Vaginal Intraepithelial Neoplasia, VaIN
Anal Intraepithelial Neoplasia, AIN

77
Q

Describe the difference in presentation of vulvar intraepithelial neoplasia in young women vs older women.

A

Young women
- recurrent
=> causing treatment problems

Older women
- risk of progression to invasive squamous carcinoma.

78
Q

How is vulvar invasive squamous carcinoma treated?

A

radical vulvectomy

inguinal lymphadenectomy

79
Q

Describe the appearance of vulvar pagets disease

A

Crusting rash
Tumour cells in epidermis (contain mucin)
no underlying cancer
tumour arises from sweat gland in skin

80
Q

What other non-neoplastic epithelial disorders can occur in the vulva?

A

Lichen Sclerosis
Lichen planus
Psoriasis
Post-menopausal atrophy

81
Q

Vaginal melanoma may appear as a polyp. TRUE/FALSE?

A

TRUE

TRANSITION BLOCK 1 (4 decks)

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