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Pathology Flashcards

(85 cards)

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1
Q

what are the phases of the ovarian cycle

A

follicular phase
ovulation
luteal phase

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2
Q

what are the phases of the uterine cycle

A

menstrual phase
proliferative phase
secretory phase

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3
Q

what is the timeline for the phases of the uterine cycle

A 
proliferative = day 1 - 14
secretory = day 16 - 28
menstrual = day 1 - 3
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4
Q

what hormone is mainly present during the proliferative phase

A

oestrogen

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5
Q

what hormone is mainly present during the secretory phase

A

progesterone

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6
Q

what are causes of abnormal uterine bleeding [AUB] in the young

A

DUB usually due to anovulatory cycles

Pregnancy/miscarriage

Endometritis

Bleeding disorders

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7
Q

what are causes of abnormal uterine bleeding [AUB] in the perimenopause

A 
pregnancy/miscarriage 
DUB
endometritis 
leiomyoma [fibroid - smooth muscle tumour]
adenomyosis 
neoplasia [cervical, endometrial]
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8
Q

what are causes of abnormal uterine bleeding [AUB] in the post menopause

A 
Atrophy
Endometrial polyp
Exogenous hormones: HRT
Endometritis
Bleeding disorders

Sarcoma
Endometrial carcinoma

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9
Q

what endometrial thickness in post menopausal women is taken as an indication for biopsy

A

> 4mm

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10
Q

what endometrial thickness in pre-menopausal women is taken as an indication for biopsy

A

> 16 mm

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11
Q

what is the required history needed before taking a endometrium sample

A

Age

Date of LMP and length of cycle

Pattern of bleeding

Hormones

Recent pregnancy

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12
Q

what phase of the uterine cycle is least informative

A

menstrual phase

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13
Q

what is the definition of DUB

A

irregular uterine bleeding that reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining (no organic cause for bleeding)

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14
Q

what are most cases of DUB caused by

A

anovulatory cycles

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15
Q

what happens in anovulatory cycles

A

Corpus luteum does not form

Continued growth of functionalis layer

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16
Q

what are causes of an anovulatory cycle

A

PCOS
hypothalamic dysfunction
thyroid disorders
hyperprolactinaemia

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17
Q

what else can cause DUB

A

Luteal phase deficiency

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18
Q

what happens in luteal phase deficiency

A

insufficent progesterone or poor response by the endometrium to progesterone.

Abnormal follicular development (inadequate FSH/LH) – poor corpus luteum

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19
Q

what are organic causes of AUB

A 
endometritis 
polyp
miscarriage
adenomyosis 
leiomyoma
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20
Q

what are causes of endometritis

A

Neisseria, Chlamydia, TB, HSV
IUCD
post-partum
granulomatous

Chronic plasmacytic endometritis

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21
Q

what is endometritis associated with

A

leoimyomata

polyps

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22
Q

endometritis can either be chronic or acute - the presence of what indicated it is chronic

A

plasma cells in the stroma of the endometrium

i.e. Chronic plasmacytic endometritis

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23
Q

what is Chronic plasmacytic endometritis associated with

A

Pelvic inflammatory disease

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24
Q

what are features of endometrial polyps

A

common, almost always benign

usually asymptomatic

may present with bleeding or discharge

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25
when do polyps tend to develop
around and after menopause
26
what can present as a polyp that you need to be aware of
endometrial carcinoma
27
what is a molar pregnancy
non-viable fertilized egg implants in the uterus (or tube) either partial or complete
28
what type of disease is a molar pregnancy
gestational trophoblastic disease
29
what is the characteristics of a complete mole
caused by single or two sperm combining with an egg that had lost its DNA >>> only PATERNAL DNA is present
30
what is the characteristics of a partial mole
egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY (triploid). >>> have BOTH DNA
31
which moles have a higher risk of developing into choriocarcinoma
complete hydatidiform moles
32
what is adenomyosis
Endometrial glands and stroma within the myometrium
33
what are Sx of adenomyosis
menorrhagia/dysmenorrhoea
34
what is leiomyoma [fibroid]
Benign tumour of smooth muscle [found in other places than the uterus]
35
Sx of leiomyoma/fibroid
menorrhagia infertility pain
36
what is the growth of fibroids dependant on
oestrogen
37
what is the transformation zone [TZ] seen in the cervixq
Squamo-columnar junction between ectocervical (squamous) and endocervical (columnar) epithelia
38
what can alter the position of the TZ
menarche pregnancy menopause
39
what is cervical erosion
Exposure of delicate endocervical epithelium to acid environment of vagina
40
what does cervical erosion lead to
squamous metaplasia
41
what are Nabothian follicles/cyst
mucus-filled cyst on the surface of the cervix
42
what causes Nabothian follicles/cyst
caused when stratified squamous epithelium of the ectocervix (toward the vagina) grows over the simple columnar epithelium of the endocervix (toward the uterus)
43
what is inflammation of the cervix called
Cervicitis
44
what are Sx of cervicitis
often asymptomatic vaginal discharge urinary frequency dysuria intermenstrual/postcoital bleeding
45
what are the 2 time lines of cervicitis
non-specific acute | chronic inflammation
46
what can cause cervicitis
Chlamydia Trachomatis, HSV, gonorrhoeae, follicular cervicitis
47
what is follicular cervicitis also know as
Chronic Lymphofollicular Cervicitis
48
what is follicular cervicitis
inflammation of the sub epithelial reactive lymphoid follicles present in the cervix
49
what is a cervical polyp
localised inflammatory outgrowth
50
what HPV are associated with cervical cancer
HPV 16 and 18
51
what are risk factors for CIN/Cervical cancer
High risk HPV types Smoking Immunosuppression Vulnerability of SC Junction in early reproductive life - age at first intercourse - long term use of oral contraceptives - non-use of barrier contraception
52
what is the time line of progression from HPV infection to cancer
HPV infection → High grade CIN = 6 months - 3 years High Grade CIN → Invasive Cancer = 5 -20 years
53
what is cervical intraepithelial neoplasia (CIN)
Pre-invasive stage of cervical cancer
54
where does CIN occur
at transformation zone
55
Sx of CIN
asymptomatic
56
what causes CIN
dysplasia of squamous cells
57
what is koilocytosis
squamous epithelial cell that has undergone a number of structural changes, due to HPV infection
58
what are the degress of CIN
1. Normal squamous epithelium 2. Koilocytosis 3. CIN I 4. CIN II 5. CIN III
59
what are the histological changes seen in CIN
Nuclear abnormalities: - hyperchromasia - ↑ nucleocytoplasmic ratio - pleomorphism Excess mitotic activity above basal layers Delay in maturation/differentiation >> more immature basal cells seen
60
what is hyperchromasia
dark staining nuclei which is usually due to increased DNA content
61
what is the criteria for CIN I
Basal 1/3 of epithelium occupied by abnormal cells Raised numbers of mitotic figures in lower 1/3. Surface cells quite mature, but nuclei slightly abnormal.
62
what is the criteria for CIN II
Abnormal cells extend to middle 1/3. Mitoses in middle 1/3 Abnormal mitotic figures
63
what is the criteria for CIN III
Abnormal cells occupy full thickness of epithelium. Mitoses, often abnormal, in upper 1/3.
64
what makes up the vast majority of cervical tumours
invasive squamous carcinomas
65
why is invasive squamous carcinomas preventable
develops from pre-existing CIN | can be picked up in screening
66
staging of invasive squamous cervical cancer goes from stage 1 to 4 - what is stage 1 [A1, A2, B]
Stage 1 A1 - depth up to 3mm, width up to 7mm Stage 1 A2 - depth up to 5mm, width up to 7mm Low risk of lymph node metastases Stage 1B - confined to the cervix
67
staging of invasive squamous cervical cancer goes from stage 1 to 4 - what is stage 2
spread to adjacent organs (vagina, uterus)
68
staging of invasive squamous cervical cancer goes from stage 1 to 4 - what is stage 3
involvement of pelvic wall
69
staging of invasive squamous cervical cancer goes from stage 1 to 4 - what is stage 4
distant metastases or involvement of rectum or bladder
70
Sx of cervical cancer
abnormal bleeding [post coital/post menopausal/brownish or blood stained vaginal discharge/contact bleeding] pelvic pain haematuria/urinary infections ureteric obstruction/renal failure
71
what is the spread of squamous carcinoma of the cervix
Local → uterine body, vagina, bladder, ureters, rectum Lymphatic → early →pelvic, para-aortic nodes Haematogenous → late → liver, lungs, bone
72
what is Cervical Glandular Intraepithelial Neoplasia (CGIN)
the pre-invasive phase of endocervical adenocarinoma
73
where does CGIN originate from
endocervical epithelium
74
what is Endocervical Adenocarcinoma
5-25% of cervical cancers | worse prognosis that squamous carcinomas
75
what is the epidemiology of adenocarcinoma
Higher S.E. Class Later onset of sexual activity Smoking HPV = particularly HPV18.
76
what are the other HPV driven diseases that affect the female reproductive system
Vulvar Intraepithelial Neoplasia, VIN Vaginal Intraepithelial Neoplasia, VaIN Anal Intraepithelial Neoplasia, AIN
77
how does VIN present in young women
often multifocal, recurrent and persistent causing treatment problems.
78
how does VIN present in older women
greater risk of progression to invasive squamous carcinoma
79
what does VIN often occur with
CIN | VaIN
80
who normally gets Vulvar Invasive Squamous Carcinoma
usually elderly women | - can arise on normal tissue or VIN
81
where does vulvar invasive squamous carcinoma spread to
inguinal lymph nodes
82
Tx of vulvar invasive squamous carcinoma
radical vulvectomy inguinal lymphadenectomy
83
how does vulvar pagets disease present
crusting rash
84
what do tumour cells in the epidermis in vulvar pages disease contain
mucin
85
where does the tumour arise from in Pagets
sweat glands in the skins

Reproduction SB (30 decks)

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