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Pathology of the Female Reproductive Tract Part 1 Flashcards

1
Q

What type of epithelium is found in the vulva?

A

keratinizing squamous epithelium

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2
Q

What type of epithelium covers the vaginal mucosa?

A

non-keratinsing squamous epithelium

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3
Q

Which part of the vulva contains sweat and sebaceous glands?

A

Labia majora

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4
Q

Where are bartholin glands situated?

A

posterior part of the labia, either side of the bestibule

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5
Q

What are bartholin glands composed of?

A

acini lined by columnar mucous secreting cells

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6
Q

Where do bulbourethral glands open?

A

posterolaterally at the level of the hymen

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7
Q

Labia minora are devoid of adipose tissue
Labia minora has an epidermal rete ridge system
Labia minora contains elastic fibers

Which of these statements are true?

A

All
epidermal rete ridges are protective during childbirth and sexual interaction

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8
Q

Lymphatic drainage of the vulva

A

inguinal nodes then to external iliac nodes

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9
Q

As the vaginal opening is approached the ————- epithelium is reduced as mentioned above. This reduction continues to the —–, which is fibrous membrane between the vagina and vulva. Although the membrane itself is rarely intact (it can break from minor trauma) the external, vulval part of the hymen reflects the vulval microanatomy – that being —————- epithelium and the vaginal, inner part of the hymen reflects the vaginal microanatomy – that being ————–epithelium.

A
  • keratinised, stratified squamous epithelium is - hymen
  • keratinised stratified squamous epithelium -
    and non-keratinised, stratified, squamous
    epithelium.
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10
Q

Layers of the Vagina:

A
  • stratified squamous epithelial mucosa
  • sub-epithelial layer with elastic tissues +
    venules
  • fibromuscular layer with some skeletal
    muscle
  • tunic adventitia
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11
Q

Before puberty and after menopause epithelium thickness?

A
  • thin
  • during reproductive years, basal cell mitosis,
    superficial cells increase in size and number
    in response to glycogen, which peaks at
    ovulation
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12
Q

The vagina is a series of

A

mucosal folds

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13
Q

Microanatomy of the vulva and vagina

A

insert diagrams

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14
Q

Non-neoplastic epithelial disorders of the vulva are

A
  • disorders that cause hyperkeratosis
  • manifest as white areas on vulval skin
  • uncertain aetiology
  • 5% develop into squamous carcinoma
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15
Q

Squamous hyperplasia:
- what classification of neoplasia/
- causes?

A
  • non-neoplastic epithelial disorder
  • hyperkeratosis, irregular thickening of rete
    ridges, inflammation of the dermis
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16
Q

Linchen Sclerosis:
- what classification of reproductive
neoplasia?
- causes?

A
  • non-neoplastic epithelial disorders
  • hyperkeratosis, thinning and flattening of the
    rete ridges, oedema, hyalinzed connective
    tissue in the dermis
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17
Q

Neoplastic Epithelial Disorders of the Vulva:

A
  • associated with HPV
  • younger people
  • undifferentiated form = warty
  • differentiated form = Lichen’s Sclerosis
  • basaloid, warty, mixed type
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18
Q

Squamous Carcinoma of the Vulva:

A
  • predominantly elderly people
  • lymph node metastases common
  • grading as well differentiated, moderately
    differentiated and poorly differentiated (grade
    3)
  • nodal deposits larger than 5mm -> poor
    survival
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19
Q

Paget’s Disease of the Vulva:

A
  • mucin-containing adenocarcinoma cells in
    squamous epithelium
  • analogous to Paget’s disease of the breast
  • 25% underlying invasive adenocarcinoma
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20
Q

Basal Cell Carcinomas vs Malignant Melanomas of the Vulva:

A
  • curative
  • poor outcomes
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21
Q

Vaginal Adenosis:

A
  • uncommon
  • subepithelial connective tissue of the vagina
  • embryological development issue
  • change creates cells that are mucinous and
    cuboidal, hence more likley to undergo
    squamous metaplasia
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22
Q

Vaginal Intraepithelial Neoplasia:

A
  • analogous to cervical intraepithelial
    neoplasia
  • very rare
  • generally with both vulva and cervical lesions
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23
Q

Squamous Carcinoma of the Vagina:

A
  • rare
  • older people
  • similar to cervical squamous carcinoma,
    invades locally, radical surgery needed
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24
Q

Different Classifications of Neoplasia of the Vulva and Vagina:

A

Vulva:
- non-neoplastic epithelial disorders
- neoplastic epithelial disorders
- squamous carcinoma
- Paget’s disease
- others: basal cell carcinoma etc

Vagina:
- vaginal adenosis
- vaginal intraepithelial neoplasia
- squamous carcinoma

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25
Q

Microanatomy of the Uterus:

A

insert diagrams

  • uterus is muscular
  • consists of fundus, body, and cervix
  • layers of the uterus:
  • outer parametrium (epithelial cells)
  • middle myometrial layers (smooth muscles)
  • endometrium (simple columnar epithelium)
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26
Q

Endometrial Polyps:

A
  • common in peri/menopausal women
  • single/multiple
  • oestrogen stimulated endometrial reactions
  • often cystic with thick walled blood vessels
  • metaplasia is common + associated with
    inflammation
  • BENIGN -> can lead to neoplastic changes
27
Q

Endometrial Hyperplasia:

A
  • hyperoestrogenism and exposure to
    unopposed oestrogen eg in PCOS
  • classified into simple, complex and atypical
    hyperplasias
28
Q

Endometrial Hyperplasia: Simple Hyperplasia:

A
  • abnormal hyperplastic/metaplastic changes
  • dilation of glands + increased mitotic activity
  • no cellular atypia/risk of malignancy
29
Q

Endometrial Hyperplasia: Complex Hyperplasia:

A
  • focal rather than global
  • crowded glands
  • irregular branched glands
  • architectural abnormalities
  • non cytological abnormalities hence
    neoplastic change is low
30
Q

Endometrial Hyperplasia: Atypical Hyperplasia:

A
  • aka endometrial intraepithelial neoplasia
  • both architectural and cytological changes
  • nuclear polymorphism + cellular atypia
  • high risk of malignancy
31
Q

Endometrial Adenocarcinoma:

A
  • due to unopposed oestrogenic acitivity and
    atrophy of endometrium post-menopause
  • common invasion into myometrium
  • spreads lymphatically and venously to cervix,
    vagina and pelvis
  • two types:
    • endometroid adenocarcinoma
    • non-endometroid adenocarcinoma
32
Q

Endometroid Adenocarcinoma:

A
  • unopposed oestrogen stimulation
  • atypical hyperplasia
  • younger women + perimenopausal
  • prognosis is good
  • higher rates of molecular mutations with
    oestrogen and progesterone receptors than
    non-endometroid adenocarcinoma
33
Q

Non-endometroid Adenocarcinoma:

A
  • affects older women
  • not directly associated with oestrogen
    exposure
  • include clear cells, serous tumours
  • poor prognosis
  • p53 mutation
34
Q

Endometrial Stromal Sarcoma

A
  • rare
  • incidental finding on hysterectomy
  • low grade = locally, low mitotic activity,
    recurrence
  • high grade = malignant, invasion of
    myometrium, poor prognosis
35
Q

Endometrial Carcinosarcoma:

A
  • monoclonal origin
  • include endo/myometrial tissue
  • tissue foreign to the uterus
  • affects elderly people and are highly
    malignant
  • poor outcome
36
Q

Endometriosis:

A
  • presence of endometrial tissue outside the
    endometrium
  • undergo atypical change with potential
    associations including endometroid cancers
    of the ovary and endometroid
    adenocarinoma
37
Q

Myometrium: Neoplasias:

A
  • adenomyosis
  • uterine fibroids
38
Q

Adenomyosis:

A
  • endometrial tissue within the myometrium
  • aetiology uncertain
  • affects perimenopausal people
  • neoplastic changes is unusual
39
Q

Uterine fibroids:

A
  • most common benign tumours of the uterus
  • affect older people
  • aetiology is uncertain
  • associated with infertility
  • whorled appearance + large
  • oestrogen dependent
  • benign but neoplastic capability
40
Q

Fallopian Tube Cysts:

A
  • common and benign
  • fimbrial and paratubual cysts
  • lined by tubal-like epithelium
41
Q

Adenocarcinoma of the Fallopian Tube Epithelium:

A
  • rare
  • potential BRCA1 inheritance
  • spreads via lymphatics and peritoneum
  • poor outcomes
42
Q

Microanatomy of the Cervic:

A
  • cervix meets uterine body at the internal
    cervical os
  • cervix composed of stroma
  • ectocervix is continuous with vagina = non-
    keratinised, stratified, squamous epithelium
  • endocervix line lumen of the cervix = tall,
    columnar epithelium that secretes mucous
43
Q

Microanatomy of the Cervic:

A

insert diagrams

figure 1 = stroma
figure 2 = ecotocervix = non-keratinsing
stratified squamous
figure 3 = endocervix = tall columnar

44
Q

What meets at the squamocolumnar junction?

A

endocervical columnar epithelium and ectocervical squamous epithelium

usually located at the external cervical os between the cervix and the vagina

45
Q

The clitoris is analogous to

A
  • male penis
  • contains 2 ischiocavernosa, erectil tissue
  • pacinian nerve endings
46
Q

What does the endometrium consist of before puberty?

A

scanty, spindle-celled stroma

47
Q

During the reproductive years and under the influence of gonadotrophins the uterus is differentiated into

A

2 layers
- deep basal layer at junction of myometrium
- superficial functional layer, sensitive to
hormonal changes and undergoes the
menstrual cycle

48
Q

Secretory cells are found at which ends of the fallopian tubes?

A

uterine ends

smooth muscle content of the wall increases composed of inner circular and outer longitudinal layer

at the junction with the uterus a third muscular layer is added

49
Q

How do hormonal changes during puberty create a metaplastic environment in the cervical transformation zone?

A
  • hormonal changes driven by
    gonadotrophins
  • columnar cells of endocervix migrate into
    the ectocervix and are exposed to acidic
    pH in the vagina during reproductive years
  • ectropion transforms cell type through
    metaplasia as it heals, with squamous cells
    now overlying the ectropion
  • erosion of aligned crypts can also at this
    point form Nabothian cysts due to mucous
    trapping -> physiological cysts
  • metaplastic environment is an increased
    opportunity for pathology to arise
50
Q

What is the most common site for the carcinoma of the cervix?

A

the cervical transformation zone

51
Q

What is the most common cause of cervical cancer?

A

HPV (Human Papilloma Virus)

52
Q

What is the most important risk factor for cervical cancer and why?

A
  • sexual activity
  • increased likelihood of transmission of
    HPV
  • virus integration affects tumor suppressor
    p16 and p53
53
Q

What does Cervical Intraepithelial Neoplasia describe?

A

a spectrum of cervical disease up to the point of cervical cancer

54
Q

Cervical Intraepithelial Neoplasia Grading:

A
  • Grade 1,2,3
  • low grade to high grade
  • epithelial cytoplasmic maturation,
    abnormal nuclei
  • high grade = breaching the basement
    membrane
55
Q

Invasive Squamous Carcinoma of the Cervix:

A
  • small neoplastic foci
  • breach basement membrane of cervix
56
Q

Stages of Cervical Cancer:

A
  • 0-4

insert diagram

57
Q

Cervical Screening Program:

A
  • HPV testing + cervical cytology
  • Over 25, every three years
  • cells are tested for grade of dyskaryosis
    including disproportionate nuclear size,
    irregular shape
  • grades of dyskaryosis (CIN1-3) are not
    always linearly related to neoplasia
58
Q

A patient presents to their GP with a change to their vulva. The skin on the patient’s vulva has become thinner, with a white appearance and it is very itchy. If scratched it bleeds and this is very painful.

What is the likely diagnosis?

A

Lichen Sclerosis

59
Q

A patient presents to their GP with a change to their vulva. The skin on the patient’s vulva has become thinner, with a white appearance and it is very itchy. If scratched it bleeds and this is very painful.

  • Patient has Lichen Sclerosis

What is the patient at risk of?

A

Differentiated VIN (Vulval Intraepithelial Neoplasias) and Vulval Squamous Carcinoma

60
Q

A patient presents to their GP with postmenopausal bleeding for the last 3 months and abdominal bloating. The patient is referred to the gynaecology department at their local hospital and undergoes an endometrial biopsy. The biopsy shows both cytological and architectural changes with nuclear polymorphism and significant cellular atypia.

What is the likely diagnosis?

A
  • endometrial hyperplasia with atypia
61
Q

A patient presents to their GP with postmenopausal bleeding for the last 3 months and abdominal bloating. The patient is referred to the gynaecology department at their local hospital and undergoes an endometrial biopsy. The biopsy shows both cytological and architectural changes with nuclear polymorphism and significant cellular atypia.

  • endometrial hyperplasia with atypia

What is the patient at risk of?

A

Endometroid adenocarcinoma

62
Q

A patient presents to their local practice nurse for a smear test as part of the national cervical screening program. Cytology is obtained from the patient. The result is sent to the practice and the patient a few weeks later. The results shows borderline/ low grade CIN.

What is the main aim of the cervical screening program?

A

to detect pre-invasive disease in order to avoid neoplastic changes occurring

63
Q

A patient presents to their local practice nurse for a smear test as part of the national cervical screening program. Cytology is obtained from the patient. The result is sent to the practice and the patient a few weeks later. The results shows borderline/ low grade CIN.

What would be the next step in management of this patient?

A
  • HPV blood test
  • if positive, patient referred to colposcopy
    for further assessment
  • if negative, return to normal recall

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