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BSMS203 Gynae (Theme 3) > 1 & 2. Pathology of the female reproductive tract > Flashcards

1 & 2. Pathology of the female reproductive tract Flashcards

1
Q

Microscopic anatomy

A

Normal anatomy informs pathology

Microscopic changes in cells and tissues are translated into clinical disease

Neoplasms originate from cellular components of tissues

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2
Q

What kind of tissue are the vulva and vagins

A

Stratified squamous epithelium

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3
Q

Vagina at puberty

A

Oestrogen secreted by the ovary stimulates maturation of squamous epithelial cells
Glycogen is formed within mature squamous epithelial cells
Glycogen in cells shed from the surface is a substrate for vaginal anaerobic organisms (dominated by lactobacilli)
Lactobacilli produce lactic acid keeping vaginal pH below 4.5

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4
Q

Cervix parts

A

Ectocervix
Endocervix
Transformation zone

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5
Q

Ectocervix

A

stratified squamous epithelium

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6
Q

Endocervix

A

Single layer of tall, mucin producing columnar cells

The endocervix has a deceptively large surface area

Columnar epithelium lines tiny blind ending channels (‘clefts’)

These radiate out from the endocervical canal into the surrounding stroma

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7
Q

Squamo-columnar junction

A

The ectocervix is covered by stratified squamous epithelium
The endocervix is lined by columnar epithelium
The junction between the two is called the ‘squamo-columnar junction

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8
Q

Formation of the transformation zone

A

During puberty the cervix changes shape
The lips of the cervix grow
The distal end of the endocervix opens
Endocervical mucosa becomes exposed to the vaginal environment

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9
Q

Metaplasia in the vagina

A

The distal endocervical columnar epithelium is exposed to the acidic vaginal environment

It is not suited to this, so undergoes an adaptive change called metaplasia

Reserve cells in this area proliferate and mature to form squamous epithelium: This process is called squamous metaplasia

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10
Q

Metaplasia definition

A

a transformation of cell type from one kind of mature differentiated cell type to another kind of mature differentiated cell type

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11
Q

The transformation zone

A

Tissue from endocervical epithelium which has undergone metaplasia to become squamous like the ectocervix

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12
Q

What happens to the metaplastic squamous epithelium?

A

At first, the metaplastic squamous epithelium is thin and delicate (lots of proliferation & maturation is incomplete)

With time, the metaplastic epithelium comes to be as strong and well formed as that on the ectocervix

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13
Q

myometrium

A

bundles of smooth muscle, vasculature and nerves

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14
Q

Endometrium in proliferative phase

A
  1. Tubular glands
    1. Specialised stroma
    2. Blood vessels
      Mitoses in glands
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15
Q

Endometrium in secretory phase

A
  1. Cork screw glands
    1. Specialised stroma
    2. Blood vessels
      Secretions in glands
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16
Q

neoplasia

A

‘new growth’ – abnormal, uncoordinated and excessive cell growth.
persists following withdrawal of stimulus and associated with genetic alterations

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17
Q

Nomenclature of neoplasms

A

Different neoplasms have different behaviour
Accurate identification and naming therefore important for treating the patient

Neoplasms are classified according to their behaviour and histogenesis

Behaviour:  Benign or Malignant

Histogenesis: Recognising the cell of origin
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18
Q

behaviour of benign neoplasms

A

Benign:
Remains localised and doesn’t invade surrounding tissues
Generally grow slowly
Good resemblance of parent tissue

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19
Q

Consequences of benign neoplasms

A 
Pressure on adjacent tissue
Obstruction of lumen of a hollow organ
Hormone production
Transformation into a malignant neoplasm
Symptoms for the patient
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20
Q

Leiomyoma of the myometrium

A
  • A benign neoplasm of smooth muscle
    • Localised
    • Slow growing
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21
Q

benign neoplasms clinical problems

A 
Pressure on adjacent tissue
Bladder (frequency) Rectosigmoid (constipation)
Obstruction to lumen of a hollow organ
Adjacent (ureters) Blocking endocervix
Hormone production
? Erythropoietin producing polycythaemia
Transformation into a malignant neoplasm
Probably malignancy arises de novo

Abnormal uterine bleeding, pain

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22
Q

behaviour of malignant neoplasms

A

Invade into surrounding tissues
Spread via lymphatics to lymph nodes and blood vessels to other sites (metastasis)
Generally grow relatively quickly
Variable resemblance to parent tissue

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23
Q

How does malignant neoplastic tissue look different to normal tissue?

A

loss of differentiation

loss of cellular cohesion

enlarged irregular dark nuclei

increased numbers of mitoses

24
Q

Consequences of malignant neoplasms

A 
Destruction of adjacent tissue
Metastasis
Blood loss from ulcerated surfaces
Obstruction of a hollow viscera
Production of hormones
Weight loss and debility
Anxiety and pain
25
Q

Histogenesis of neoplasms

A

Classification by cell of origin
Determined by examining tissue under the microscope
Resemblance to parent tissue correlates with clinical behaviour

26
Q

Terminology of neoplasia

A

Neoplasms have the suffix – oma
Malignant epithelial tumours are carcinomas
Carcinomas are named for the epithelial cell type which they resemble
Carcinomas of glandular epithelium are called adenocarcinomas
Malignant stromal tumours are sarcomas

27
Q

carcinoma

A

Malignant epithelial tumours are carcinomas

Carcinomas are named for the epithelial cell type which they resemble

28
Q

Adenocarcinoma

A

Carcinomas of glandular epithelium

29
Q

sarcomas

A

malignant stromal tumours

30
Q

Squamous epithelium neoplasms

A

benign - squamous cell papilloma

malignant - squamous cell carcinoma

31
Q

Glandular epithilial neoplasms

A

benign - adenoma

malignant - adenocarcinoma

32
Q

Mesenchymal (stromal) cancer types

A

smooth muscle, striated muscle, adipose tissue, blood vessel, bone, cartilage

33
Q

smooth muscle cancers

A

leiomyoma (benign), leiomyosarcoma (malignant)

34
Q

striated muscle cancers

A

rhabdyomyoma (benign)

rhabdomyosarcoma (malignant)

35
Q

Adipose tissue cancers

A

lipoma (benign), liposarcoma (malignant)

36
Q

Blood vessel cancers

A

angioma (benign), angiosarcoma (malignant)

37
Q

Bone cancers

A

Osteoma (benign), osteosarcoma (malignant)

38
Q

Cartilage cancers

A

chondroma (benign), chondrosarcoma (malignant)

39
Q

malignant vulva tumours

A

squamous - squamous cell carcinoma

40
Q

malignant vagina tumours

A

squamous - squamous cell carcinoma

41
Q

malignant cervical tumour

A

squamous - squamous cell carcinoma

glandular - adenocarcinoma

42
Q

malignant endometrium tumour

A

glandular adenocarcinoma

stroma stromal sarcoma

43
Q

malignant myometrium tumour

A

sm muscle leiomyosarcoma

44
Q

Dysplasia

A

For some malignant neoplasms a ‘pre-malignant’ state is identified
This state is termed dysplasia
There is an accumulation of cells which look somewhat like malignant cells but do not invade the basement membrane
Dysplastic lesions may (but don’t always) progress to invasive malignancy
Recognising dysplastic lesions allows early treatment before invasion occurs

45
Q

Dysplasia definition

A

disordered growth and differentiation characterised by increased proliferation (more mitoses), atypia of cells and decreased differentiation

46
Q

Dysplasia terminology

A

Eg for the cervix:

Generic: Dysplasia
UK: Cervical intra-epithelial neoplasia (CIN)
US: Squamous intra-epithelial lesion (SIL)

47
Q

How is degree of dysplasia relevant?

A

The degree of dysplasia may predict the likelihood of developing invasive malignancy
Grade % progress to CIN3 % progress to SCC
CIN1 11 1
CIN2 22 5
CIN3 - 40

48
Q

Where does dysplasia often occur?

A

Dysplasia often occurs in sites where there is metaplasia

squamous metaplasia of the cervical transformation zone
squamous metaplasia of the bronchial epithelium
glandular metaplasia of the distal oesophagus

49
Q

Normal constituents of a smear test

A

Endocervical cells in endocervix
Squamous cells in ectocervix
metaplastic cells in transformation cells

50
Q

Normal cells vs dysplastic cells

A

Normal cells have a small nucleus and lots of cytoplasm

Dysplastic cells have a higher ratio of nuclear size to cytoplasmic volume, and the nuclei show the same features that we associate with malignancy

51
Q

Difference between dysplasia and carcinoma

A

The difference between dysplasia and carcinoma is invasion through the basement membrane

52
Q

What can cause CIN and cervical cancer?

A

human papillomavirus (HPV)

53
Q

Human papillomavirus

A

Human Papillomaviruses (HPVs) infect epithelium
Confined to local site of infection without viraemia
Over 130 HPV types, some of which infect the anogenital mucosa
Double stranded DNA virus 7.9Kbp

54
Q

High risk vs low risk HPVs

A

High Risk HPV 16,18,31,33,35,39,45,51,52,56,58,59,68

Low Risk HPV
6,11,40,42,43,44,54,61,72,81

55
Q

Strategies to prevent cervical cancer

A 
HPV Vaccination
Population based screening
Cervical sample cytology
Cervical sample HPV test
Colposcopy
Treatment of high grade dysplasia
Large Loop Excision of the Transformation Zone
56
Q

Endometrial cancer vs cervical cancer epidemiology

A

Cervical cancer is predominantly a disease of the developing world.
The incidence of cervical cancer has been declining in Europe. The reduction in incidence of cervical cancer has been paralleled by reduced mortality

Endometrial cancer is presently most common in North America and Europe

57
Q

What do seperate peaks in cervical cancer incidence indicate?

A

The separate peaks in cervical cancer incidence reflect a birth cohort effect

This happens when a group of people experience different circumstances to those born immediately before or after

An increase in cervical cancer incidence and mortality was seen in women reaching the age of sexual debut during WW1 and again in WW2

The incidence and mortality of cervical cancer in the UK have decreased, particularly since the early 1980s
In the UK this follows the introduction of the NHS cervical screening programme
A birth cohort effect exists, believed to reflect the different exposure to HPV at the time women reached the age of sexual debut
HPV vaccination is creating new birth cohorts

BSMS203 Gynae (Theme 3) (8 decks)

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