6s: Gynaecological Pathology Flashcards

Question

What is another type of endometrial cancer?

Answer 1

endometrial stromal sarcoma

Answer 2

***Gestational Trophoblastic Disease** –* *a spectrum of tumours characterised by proliferation of trophoblastic tissue* * Types: * **Complete** (_2.5% = malignancy_; _10% = invasive moles_) and **partial** (_0% = malignancy_) mole * **Invasive** mole * **Choriocarcinoma**

Answer 3

* **Prevalence**: 1 in 1000 pregnancies * **Presentation**: * _Spontaneous abortion_ * USS – **snowstorm,** cluster of grapes * Very **high hCG** * Complete moles **may persist or recur** * Chromosomal abnormalities are important

Answer 4

**Complete** = empty egg fertilised by 2 sperm (or 1 which **duplicates** DNA) * 46 XY or 46 XX (paternal origin only) **Partial** = normal egg fertilised by 2 sperm (or 1 which **duplicates** DNA) * 69 XXX or 69 XXY (1x maternal and 2x paternal origin)

Answer 5

**Incidence**: 1 in 20,000-30,000 pregnancies * Rapidly invasive, widely metastasising (lung, vagina, brain, liver, kidney) * Responds well to chemotherapy * 50% arise in moles * 25% arise in previous abortion * 22% arise in normal pregnancy

Answer 6

***Endometriosis*** – *presence of endometrial tissue outside the uterus* **COMMON** - 10% of premenopausal women Pathogenesis * **Metaplasia of pelvic peritoneum** → implantation of endometrial tissue * Another theory suggests that it occurs due to **retrograde menstruation** (endometrial lining goes up the fallopian tubes and into the peritoneal cavity instead of out of the vagina) which then leads to implantation of this endometrial tissue at a site outside the uterus

Answer 7

Ectopic endometrial tissue is functional and bleeds at the time of menstruation → **pain, scarring and infertility** Associations: * **_Strongly_** → **clear cell** (mesonephroid/epithelial) ovarian cancer * Less strongly → **endometroid** (epithelial) ovarian cancer

Answer 8

* Follicular and luteal cysts * Endometriotic cyst

Answer 9

* 3-6% of women of reproductive age * Patients have **persistent anovulation** * Other features include **obesity and hirsutism/virilism**

Answer 10

* Nulliparity * Early menarche * Late menopause * **Genetic predisposition** (1%) * Infertility * Endometriosis * HRT * Inflammation (PID) * FHx ovarian/breast cancer

Answer 11

* Pregnancy * OCP

Answer 12

_Benign tumours_ * serous cystadenomas * mutinous cyst adenomas * cystadenofibromas * Brenner tumour _Epithelial_ = serous, mucinous, endometriosis, clear cell, transitional, mixed types * **70%** of all ovarian tumours * **95%** of all malignant tumours _Germ cell tumours_ = dysgerminoma, choriocarcinoma, teratoma, endodermal sinus tumours * age 15-21 AND 65-69 (bimodal peaks) _Sex cord tumours_ = granuloma cell tumour, fibroma, theca, sertoli-leydig cell * most common in **PMB women** * some subtypes in 25-30 year olds

Answer 13

TERATOMA (a germ cell tumour)

Answer 14

Type 1 ovarian carcinoma → LOW-GRADE: “Less Exciting, More Cancers” * Low-grade serous * Endometroid * Mucinous * Clear cell Low-grade, arise from **benign ovarian tumours** and **endometriosis** Present as large, stage 1 tumours **Mutations**: _K-Ras_, _BRAF_, _PI3KCA_, _Her2_, _PTEN_, _beta-catenin_ Type 2 ovarian carcinoma → HIGH GRADE, aggressive High-grade serous carcinomas NO precursor lesions **Mutations**: _p53_ (75% of cases), K-Ras, BRAF

Answer 15

MOST COMMON type, usually cystic, 30-50% bilateral ## Footnote benign = lined by bland epithelium borderline = more complex, atypical epithelial lining with papillae malignant = invasive with poor prognosis **psammoma**

Answer 16

10-20% ovarian tumours secrete mucin (epithelium resemble GI or endocervical epithelium)

Answer 17

* 10-24% of ovarian tumours * Associations: * Endometriosis (10-20% associated with endometriosis) * Endometrioid carcinoma co-existence in uterus * **Better prognosis than mucinous and serous**

Answer 18

_Strong association with endometriosis_ Called 'clear cell' because their cytoplasm is clear due to the presence of a lot of glycogen * Glycogen dissolves when the sample is processed for microscopy leaving an **empty space)**

Answer 19

**Fibromas** (arising from fibroblasts): * Benign * No endocrine production **Granulosa cell** tumour: * Variable behaviour * May produce oestrogen **Thecoma** (arising from thecal cells): * Benign * May secrete oestrogen (rarely secretes androgens) **Sertoli-Leydig Cell** Tumour * Variable behaviour * May be androgenic

Answer 20

* 20% of ovarian tumours; **95% are BENIGN** * Predominantly occur in **\<20 years** * Germ cell tumours are **classified on how they differentiate** **dysgerminoma, teratoma, choriocarcinoma, endodermal sinus tumour**

Answer 21

no differentiation

Answer 22

**_Mature_** Teratoma (most common type of germ cell tumour) * **Benign**; solid or cystic * Tissues all MATURE to adult-type tissues _(teeth and hair_ are very common) **_Immature_** Teratoma * Indicates presence of embryonic elements (most commonly _neural tissue_) * This is a **MALIGNANT** tumour that grows rapidly, penetrates the capsule and forms adhesions * Spreads within the peritoneal cavity * Metastasises to the lymph nodes, lungs, liver and other organs **_Mature Cystic_** Teratoma with _Malignant Transformation_: * Rare; most frequently SCC * Any type of the mature tissue within the teratoma can become malignant → so, it can give rise to carcinoid, thyroid cancer, BCC, melanoma etc.

Answer 23

trophoblastic cells (form placenta) → choriocarcinoma

Answer 24

extraembryonic tissues (e.g. amniotic sac) → endodermal sinus tumours

Answer 25

yolk sac tumour choriocarcinoma embryonal carcinoma

Answer 26

Krukenberg Tumour: * **Bilateral metastases** composed of _mucin-producing signet ring cells_ * Most often from _gastric or breast cancer_ Metastatic Colorectal Carcinoma * Ovaries are prone to metastatic spread of colorectal cancer

Answer 27

* Familial breast-ovarian cancer syndrome BRCA1 association * Site-specific ovarian cancer BRCA1 association * Cancer family syndrome (Lynch type II)

Answer 28

Lichen sclerosus (thinning epithelium with a layer of hyalinisation underneath) * This is sometimes associated with _epithelial dysplasia_ and development of _malignancy_ Papillary Hidradenoma (benign tumour) Malignant Tumours: * **_Squamous cell carcinoma_** (85%) – *risk factors…* * HPV or lichen sclerosus * VIN (vulval intraepithelial neoplasia) * _Invasive adenocarcinoma_ or _adenocarcinoma in situ_ (**Paget’s disease**) * Malignant melanoma * BCC

Answer 29

* Congenital anomalies (e.g. absence or atresia) * Tumours (RARE; 1%) * Carcinoma (squamous cell carcinoma) * Adenocarcinoma * Children of women with threatened abortion treated with diethyl stilbosterol → risk of clear cell carcinoma * Rhabdomyosarcoma