Week 4 - Female Reproductive Pathology

Question 1

What type of epithelium lines the endocervix?

Answer 1

Columnar

Question 2

What type of epithelium lines the ectocervix?

Answer 2

Non-keratinising stratified squamous epithelium

Question 3

Where do most cervical neoplasia develop?

Answer 3

Transformation zone

Question 4

Which strains of HPV are prevalent in Scotland?

Answer 4

16

18

Question 5

Where are patients who have dyskaryosis suggestive of Cervical Intraepithelial Neoplasia on a cervical smear referred to?

Answer 5

Colposcopy clinic

Question 6

Who is eligible for cervical smear in Scotland?

Answer 6

Women aged 25-65
35-50 - 3 yearly
50-65 - five yearly

Question 7

Which strains of HPV does the vaccine protect against?

Answer 7

6, 11, 16, 18

Question 8

Describe the steps in a colposcopy

Answer 8

1. Cervix visualised
2. Washed with acetic acid
3. Application of iodine
4. Green light filter
5. Abnormal area can be biopsied or treatment performed at time

Question 9

How do early (E1-7) HPV genes cause cervical carcinoma?

Answer 9

Interact with intracellular molecules to interfere with cell proliferation machinery to replicate the virus

Question 10

How do late (L1-2) HPV genes cause cervical carcinoma?

Answer 10

Encode capsid proteins and disrupt cell cycle checkpoints

Question 11

What are the symptoms of cervical cancer?

Answer 11

Post-coital bleeding 
Intermenstrual bleeding 
Irregular vaginal bleeding 
Pain 
None?

Question 12

What commonly causes atrophic vaginitis?

Answer 12

Low oestrogen after menopause

Question 13

What are the symptoms of atrophic vaginitis?

Answer 13

Discomfort
Pain during intercourse
Bleeding

Question 14

Name 3 non-infective inflammations of the vulva

Answer 14

Lichen planus

Lichen sclerosus

Question 15

What proportion of vulval cancer is associated with HPV?

Answer 15

20%

Question 16

What are the 2 different forms of vulval SCC?

Answer 16

Associated with vulval intra-epithelial neoplasm

Associated with dermatoses

Question 17

Which embryonic structure do the gonads arise from?

Answer 17

Urogenital ridges

Question 18

Which embryonic structure do the genital ducts arise from?

Answer 18

Mesonephric and paramesonephric ducts

Question 19

Which ducts form female reproductive structures?

Answer 19

Paramesonephric i.e. Mullerian

Question 20

Which ducts form male reproductive structures?

Answer 20

Mesonephric i.e. Wolffian

Question 21

Which gene is responsible for sex determination?

Answer 21

SRY

Question 22

Which cells are present in the testes?

Answer 22

Leydig

Sertoli

Question 23

Why is testosterone essential for normal male development?

Answer 23

Stimulates development of mesonephric structures - without it, the ducts atrophy

Question 24

What causes the paramesonephric ducts to regress in males?

Answer 24

Sertoli cells produce Anti-Mullerian Hormone

Question 25

Which structures in males are formed from the urogenital sinus?

Answer 25

Bladder Prostate gland Bulbourethral gland Urethra

Question 26

Why do the mesonephric ducts regress in females?

Answer 26

They do not have testosterone

Question 27

What type of epithelium lines the fallopian tubes?

Answer 27

Ciliated columnar

Question 28

What are the symptoms of salpingitis?

Answer 28

``` Fever Lower abdominal pain Pelvic masses (if tubes distended with exudate or secretions) ```

Question 29

Give some examples of complications of salpingitis

Answer 29

``` Abscess Adhesions Obstruction of lumen Infertility Ectopic pregnancy ```

Question 30

What is the most common cancer of the fallopian tubes?

Answer 30

Papillary serous carcinoma

Question 31

What is Serous Tubal Intraepithelial Carcinoma?

Answer 31

Abnormal epithelium in distal fallopian tube that is limited by BM therefore in situ, however nuclear atypia clearly seen Likely precursor for high grade serous carcinoma

Question 32

What are the 3 types of non-neoplastic cysts?

Answer 32

Inclusion Follicular Luteal cysts

Question 33

What are the symptoms of PCOS?

Answer 33

Oligomenorrhoea Hirtuism Infertility Obsesity

Question 34

What are the hormonal changes seen in PCOS?

Answer 34

High androgens High LH Low FSH

Question 35

What causes the symptoms seen in PCOS?

Answer 35

Multiple cystic follicles in the ovaries over-produce androgens

Question 36

What is a potential complication of PCOS?

Answer 36

Type II diabetes

Question 37

What are the 3 types of cell that make up the normal ovary?

Answer 37

Epithelium Germ cells Stromal cells

Question 38

Name 2 risk factors for epithelial ovarian cancers

Answer 38

Nulliparity

Question 39

Name common mutations found in sporadic ovarian cancer

Answer 39

BRCA (9%) HER2 (35%) KRAS (30%) p53 (50%)

Question 40

Name 2 benign lesions of the ovarian epithelium

Answer 40

Cystadenoma | Cystadenofibroma

Question 41

Name the 5 types of ovarian carcinoma

Answer 41

``` High grade serous (70%) Endometrioid (10%) Clear-cell (10%) Low grade serous (5%) Mucinous (3%) ```

Question 42

Which mutations are seen in HGSC of the ovary?

Answer 42

p53 | BRCA1

Question 43

What age do women get malignant serous ovarian tumours?

Answer 43

45-60

Question 44

Which mutations are seen in LGSC?

Answer 44

BRAF | KRAS

Question 45

Which ovarian cancers arise from ovarian endometriosis?

Answer 45

Endometriod | Clear cell

Question 46

Where does HGSC of the ovary usually arise from?

Answer 46

Epithelial precursor lesions in the ovarian end of the Fallopian tubes

Question 47

What are Psammoma bodies?

Answer 47

Concentrically laminated calcified concretions commonly found in the papillae of serous tumours

Question 48

What type of disease can mimic primary ovarian mucinous carcnoma?

Answer 48

Metastatic cancer spread from the GI tract to the ovary

Question 49

How many mucinous ovarian tumours are malignant?

Answer 49

10%

Question 50

Which gene is involved in endometriod carcinomas?

Answer 50

PTEN tumour supressor gene

Question 51

What is a teratoma?

Answer 51

Tumour that contains tissues of all 3 germ cell layers

Question 52

What is a serious complication associated with a cystic teratoma?

Answer 52

Torsion