0501 - Female Urogenital Lesions Flashcards
What is the constant layer of epithelium from the renal calyces to the end of the urethra? Describe it.
Urothelium.
Stratified - 3-7 layers, with umbrella cells at the surface. No more than 7 layers!!!
Able to distend, and forms an impermeable barrier above basement membrane and lamina propria.
What are some non-neoplastic lesions of the ureter?
Congenital - diverticuli or duplication
Infection - secondary to vesico-uteric reflux
Inflammation - ureteritis cystica (cystic)
Deposits - Calculi, blood clots or fibrosis
What are some non-neoplastic lesions of the urinary bladder?
Congenital - Diverticulae, exstrophy
Infection - Schistosomiasis
Inflammation - Eosinophilic, drug-related, radiation, or idiopathic
Deposits - Within the lumen (lithiasis), within the wall (amyloid)
What are some non-neoplastic lesions of the urethra
Congenital - Hypospadias
Infection - Gonococcal, Chlamydia, E Coli
What is a standard approach to categorising urothelial neoplasms?
Flat or Papillary, and then benign of malignant
Flat - Benign is regeneration following inflammation, malignant is carcinoma in situ or urothelial carcinoma.
Papillary - benign is papilloma, malignant is papillary urothelial carcinoma. Between these is papillary urothelial neoplasm of unknown malignant potential.
Describe urothelial carcinoma in situ
Presentation - Asymptomatic or refractory UTI-like symptoms
Macro - Red, inflamed mucosa.
Micro - Classic features of malignancy, with more than 7 layers but no breach in the basement membrane.
Describe micro appearance of flat urothelial carcinoma
Can be low grade or high grade
Characterised by invasion - into lamina propria or muscularis propria respectively.
What is meant by papillary architecture?
A finger-like projection involving a fibrovascular core of blood vessels and connective tissue in the centre, surrounded by epithelium.
Physiologically normal only in the choroid plexus. Abnormal/tumour in other tissues.
Briefly describe the three forms of papillary urothelial neoplasms
Benign - papilloma. Papilla lined by normal urothelium, of normal thickness, orderly and organised with no mitoses.
Papillary neoplasm of unknown malignant potential - lined by abnormally thick (>7 layers) urothelium, in mild disarray with occasional mitoses.
Papillary urothelial carcinoma - lined by malignant urothelium, very chick with complete loss of organisation and several mitoses.
Any level can break off, leading to haematuria. Outside a UTI, any haematuria is abnormal and must be investigated.
Outline the normal histology of the fallopian tube.
Surrounding smooth muscle, with lumen containing plicae, leading to a folded appearance.
What are the major possible tumours of the fallopian tube?
Infection - Salpingitis - acute, chronic, granulomatous, foreign-body type.
Obstructive - Ectopic pregnancy, endometriosis, paratubal cyst
Benign neoplasm - Adenomatoid tumour
Malignant neoplasm - Primary or secondary carcinoma.
Briefly outline Salpingitis (aetiology, macro, micro, complications)
Aetiology - Infection (STI or post-instrumentation/pregnancy)
Macro - Adhesion and fusion of fimbriae, dilated tube filled with pus
Micro - Acute or chronic inflamation, plicae fused
Complications - Abscesses, ectopic pregnancy, infertility.
Briefly outline ectopic pregnancy (aetiology, macro, micro, treatment)
Aetiology - chronic salpingitis (fused plicae), congenital abnormalities, endometriosis
Macro - Dilated, haemorrhagic, +/- foetus
Micro - Chorionic villi
Treatment - Salpingectomy.
Describe the normal histology of the uterus.
Consists of endometrium and myometrium
Endometrium consists of glands and stroma - Glands grow from proliferative to secretory phase (ovulation)
Myometrium - smooth muscle.
Briefly outline the histology of endometrial carcinoma
Complex glandular and papillary architecture.
Glands are arranged back to back without normal stroma in between, and glands and papillae are lined by multiple layers of cells.
Cells show typical neoplastic changes (N:C ratio, nucleoli, pleomorphism).