Possible gynae causes for abdominal pain
- Mittleschmerz + rupture CL
- Ruptured ectopic
- Cx of ovarian cyst
- Acute salpingitis
- Ovarian tumour (rarely)
Ovarian tumours
= 80% benign
- Most commonly 20-45yo
- Most common Sx = abdominal pain / abdominal
enlargement
Classification of ovarian tumours
- Germ cell - mostly benign cystic teratoma
- Stromal - thecae / granulosa
- Surface epithelial -> most common
- Metastatic - most commonly tumours of
paramesonephric origin
Types of surface epithelial tumours
- Serous - most common
- Mucinous
- Endometroid (close resemblance to endometrial
tissue)
Peritoneal spread of ovarian tumours
- All serial surfaces are diffusely seeded w/ 0.5cm
nodules of tumour
Metastatic locations in ovarian malignancy
- Liver
- Lungs
- GI tract
- Opposite ovary (poor prognostic factor)
Endometriosis
= ectopic endometrial tissue, usually glands + stroma
Locations of endometriosis
In descending order of frequency:
1. Ovaries
- Uterine ligaments
- Rectovaginal septum
- Cul de sac
- Rectovaginal septum
- Large + small bowel / appendix
- Mucosa of cervix, vagina, f tubes
- Laparotomy scars
Theory of endometrial spread
- Metastatic
2. Metaplastic
Macro appearance of endometriosis
- Nodules of red/blue to yellow/brown appearance on
OR beneath the mucosal +/or serosal surface - Extensive disease -> organising haemorrhage ->
extensive fibrous adhesions
Micro appearance of endometriosis
- Straightforward - endometrial glands + stroma
HPV causing cervical Ca
16 + 18
HPV pathogenesis
- Infects immature basal cells
- Cervix is particularly vulnerable because of large areas of immature squamous metaplastic epithelium
- Replication of HPV occurs in mature SCCs -> manifests
as koilocytic atypic (nuclear atypic + cytoplasmic
perniculear halo) - Actives cell replication by interfering w/ p53 + Rb via
E6-7 toxins
Classification of premalignant cervical lesions
- LSIL = mild dysplasia, atypic confined to lower 1/3 of
epithelium, 10% progress to HSIL - HSIL = moderate dysplasia to CIS, 10% progress to Ca
Cervical Ca
- Most common type is SCC (80%)
- ~ age = 45yo
Macro appearance of cervical Ca
- Exophytic / infiltrative
Micro appearance of cervical Ca
- Nests / tongues of malignant squamous epithelium
- Can be keratinising or non-keratinising
Spread of cervical Ca
- Direct spread to involve contiguous tissues
- Local / distant Las are also involved
- Can spread to = liver, lung, bone (late)
Staging of cervical Ca
0 = HSIL
I = confined to cervix (95% 5yr)
- Ia - only on micro
- Ib - invasive Ca confined to cervix
II = extends beyond cervix but not the pelvic wall
(75% 5yr)
III = extends to pelvic wall, involves lower 1/3 of the
vagina (<50% 5yr)
IV = extends beyond the true pelvis OR involving
bladder / rectal mucosa (<50% 5yr)
Testicular Ca
- Uncommon
- 20-40yo
- 95% = germ cell
- Seminoma = 70%, NSGCT = 30%
Seminoma
- Arises from seminiferous tubules, relatively low grade
Metastatic spread of seminoma
- Usually LNs
- May involve lungs (cannonball mets)