Anatomical Pathology - Female Genital Tract Flashcards
Major complication of ectopic preg
Haemorrhage
Ectopic pregnancy due to..
- Partial tubal obstruction (eg salpingitis)
2. Delayed pick up by fimbriae
Possible causes of endometriosis
Retrograde spread during menstruation Implantation (during C/S) Metaplasia Lymphatic spread Heamatogenous spread
Macroscopic characteristics of endometriosis
Chocolate cysts
Fibrosis (cyclical haemorrhage)
Microscopic characteristics of endometriosis
Endometrial glands + stroma
Fibrosis
Haemosiderin laden macrophages
Complications of endometriosis
Infertility
Adhesions
Intermittent intestinal obstruction
Some endometrial cancer
Complications of leiomyomas
Menstrual disturbances
Infertility
Repeated abortions
Obstetric complications
Possible locations of leiomyomas
Intramural
Subserosal
Submucosal
Possible macroscopic characteristics of squamous Ca Cx
Ulcerating
Exophitic
Nodular
Risk factors for squamous Ca Cx
Low SES Early sexual debut Multiple partners Smoking COC Immunosuppression STIs Long time since last pap smear
Causes of death in Ca Cx
Renal failure Haemorrhage Superadded infection Blood borne metastasis Iatrogenic (eg PE)
Stage 1A Ca Cx
Visible microscopically
Stage 1B Ca Cx
Visible macroscopically
1< 4cm
2> 4 cm
Stage 2A Ca Cx
Upper 2/3 vagina
Stage 2B Ca Cx
Parametrial involvement
Stage 3A Ca Cx
Lower 1/3 vagina
Stage 3B Ca Cx
Pelvic sidewall/ hydronephrosis/ non functional kidney
Stage 4A Ca Cx
Mucosa bladder / rectum
Stage 4B Ca Cx
Distant metastasis
Why cytology NB for Ca Cx
LSIL and HSIL can’t be seen macroscopically
Three sections on cytology report
Adequacy of smear
Epithelial cells changes
Organisms
What makes a Pap smear adequate
Endocervical cells present
Cells not obscured by blood/ exudate etc
Colposcopy looks at …
Margin of lesion
Color of lesion
Arrangement of superficial blood vessels
Rx CIN 1
Colposcopy
Rx CIN 2-3
LLETZ
If margins involved:
LLETZ
Cone biopsy
HysterectomyRx stage 1A1
Cone biopsy
Rx stage 1A2
Total abdo hysterectomy
Pelvic lymphadenectomy
Rx stage 1B
Radical hysterectomy
Pelvic lymphadenectomy
(Wertheim’s hysterectomy)
Rx stage 2 and above
Chemoradiation
Intracavitary brachytherapy
Type1 endometrial Ca pathogenesis
Unopposed oestrogen > endometrial hyperplasia > hyperplasia with atypia > carcinoma
Prognosis for endometrial Ca type 1
Good with surgery
Causes of unopposed oestrogen
Obesity
PCOS
HRT
Prognosis for type 2 endometrial Ca
Poor (chemo needed as tendency to metastasize)
Four types of endometrial cancer
Endometrial Ca
Carcinosarcoma
Endometrial stromal sarcoma
Gestational Trophoblastic disease
Two types of gestational Trophoblastic disease
Hyatidiform mole
Choriocarcinoma
Features of partial mole
Trophoblastic proliferation with normal villi
Triploid
Little malignant potential
Feature of complete mole
Molar tissue with no normal villi
Diploid (empty egg)
Malignant potential
Features of invasive mole
Molar tissue extends into parametrium
May metastasize
What is choriocarcinoma
Malignant tumour of cyto- and syncytio- trophoblasts without chorionic villi
Prognosis for choriocarcinoma
Good with chemo
