47 Disease of female genital system 2 Flashcards
What is endometriosis?
Ectopic endometrium causing bleeding int the tissues and fibrosis.
How does endometriosis present? (8).
25% are symptomatic. Dysmenorrhoea. Dyspareunia (pain on sex). Pelvic pain. Sub fertility. Pain on passing stool. Dysuria.
Epidemiology of endometriosis?
6-10% of women.
30 - 40 y/o.
What are the causes of acute endometritis? (3).
Histology?
Retained POC, prolonged rupture of membranes, complicated labour.
Neutrophils
What are the causes of chronic endometritis? (4).
Histology?
Pelvic inflammatory disease, retained gestational tissue, endometrial TB, IUCD infection.
Lymphocytes + plasma cells.
What are the symptoms of endometritis? (5).
Abdo/pelvic pain. Pyrexia. Discharge. Dysuria. Abnormal vaginal bleeding.
What is endometritis?
Inflammation of the endometrium.
What are endometrial polyps?
Sessile/polypoid estradiol (E2) dependant uterine overgrowths.
What are the symptoms of endometrial polyps? (5).
Often asymptomatic. Intermenstrual bleeding. Post menopausal bleeding. Dysmenorrhoea. Menorrhagia.
What is a leiomyomata?
Benign myometrial tumour with estradiol (E2)/progesterone (P4) dependent growth.
What are the risk factors for leiomyomata? (5).
Genetics. Nulliparity. Obesity. PCOS. Hypertension.
What are the symptoms of a leiomyomata? (4).
Often asymptomatic.
Menometrorrhagia (prolonged, heavy bleeds).
Subfertility/pregnancy problems.
Pressure symptoms.
What are the hormonal features of endometrial hyperplasia? (2).
Increased estradiol.
Decreased progesterone.
What are the symptoms of endometrial hyperplasia? (3).
Intermenstrual, postmenopausal or postcoital bleeding.
What are the risk factors for endometrial hyperplasia? (6).
Obesity. Exogenous estradiol. PCOS. Estradiol-producing tumours. Tamoxifen. HNPCC (PTEN mutations).
Type 1 endometroid endometrial carcinoma:
Incidence, age, type, mutations, E2 status.
75% of endometrial carcinoma. Pre-menopausal. Hyperplasia. PTEN, Kras. E2 +ve.
Type 2 serous endometrial carcinoma:
Incidence, age, type, mutations, E2 status.
25% of endometrial carcinoma. Post-menopausal. Atrophy. p53. E2 -ve.
What is polycystic ovary syndrome?
Complex endocrine disorder:
Hyperandrogenism.
Menstrual abnermalities.
Polycystic ovaries.
What hormonal changes are seen in PCOS?
Decreased FSH.
Increased LH, testosterone + DHEAS.
What are the rotterdam criteria?
Used for PCOS. 2/3 of:
Hyperandrogenism (hirsuitism/biochem).
Irregular periods >35 days.
Polycystic ovaries.
What is hypergonadotrophic hypogonadism?
Primary failure of the gonads.
What are the congenital causes of 1o gonadal failure in females? (2).
Turner syndrome (XO). Kleinfelter syndrome (XXY).
What is hypogonadotrophic hypogonadism?
Hypothalamic/pituitary failure leading to 2o gonadal failure.
What are the causes of 2o gonadal failure in females? (5).
Sheehan's syndrome. PCOS. Empty sella syndrome. Brain injury. Pituitary tumours.
How does gonadal failure present in females? (4).
Amenorrhoea/absent menarche.
Delayed puberty.
Decrease sex hormone levels.
± increase in LH/FSH levels.
What are the three origins of ovarian neoplasms?
Sex cord stromal tumours.
Germ cell tumours.
Surface epithelial stromal tumours.
What are the three types of serous epithelial neoplasms of the ovary?
Serous.
Mucinous.
Endometroid.
What is a malignant tumour of the ovarian epithelium called?
Cystadenocarcinoma.
What is a dysgerminoma?
Germinomatous tumour of the ovary. Malignant.
What are the three types of non-germinomatous tumours of the ovary?
Which is the only one that can be benign?
Teratomas (some are benign).
Yolk sac tumours.
Choriocarcinomas.
What does a teratoma differentiate towards?
Multiple germ layers.
If embryonal/foetal tissue present then malignant.
What does a choriocarcinoma differentiate towards? Malignant?
Placenta. Yes.
What are the three types of sex cord stomal tumours in females?
Thecoma/ fibrothecoma/ fibroma.
Granulosa cell tumour.
Sertoli-Leydig cell tumour.
What do thecomas, fibrothecomas and granulosa cell tumours produce?
Estradiol (E2).
What do sertoli-leydig cell tumours produce in females?
Androgens.
What are the risk factors for ovarian tumours? (6).
FH. Increasing age. PMH breast cancer. Smoking. E2-only HRT. Lynch II syndrome.
What are the protective factors for ovarian tumours? (3).
OCP.
Breastfeeding.
Hysterectomy.
Which tumours metastasise to the ovaries?
Mullerian tumours (uterus, fallopian, perineum).
GI, pancreatobiliary, breast, melanoma.
Bladder, rectal.
