Benign Gynaecological Pathology Flashcards
Define pelvic inflammatory disease
Infection ascending from the vagina and cervix up to the uterus and fallopian tubes, leading to inflammation and the formation of adhesions
State the most common causes of pelvic inflammatory disease
UK: Chlamydia trachomatis, Neisseria gonorrhoea
ROW: Above plus TB, schisosomiasis
Describe the clinical features of pelvic inflammatory disease
Lower abdominal pain, dyspareunia, vaginal bleeding and discharge, fever, adnexal tenderness, cervical excitation
State at least 5 complications of pelvic inflammatory disease
Fitz-Hugh-Curtis syndrome, infertility, inc risk of ectopic pregnancy, intestinal obstruction, tubo-ovarian abscess, chronic pelvic pain, peritonitis, plical fusion
What is Fitz-Hugh-Curtis syndrome?
A rare complication of PID causing liver capsule inflammation leading to the creation of adhesions (violin string peri-hepatic adhesions)
Define endometriosis
The presence of endometrial glands or stroma in abnormal locations outside the uterus - e.g. ovaries, uterine ligaments
State the 3 aetiological theories of endometriosis
1: implantation from retrograde menstrual flow
2: metaplastic transformation of coelomic epithelial cells
3: vascular or lymphatic dissemination of endometrial cells
Describe the pathophysiology of endometriosis
Functional endometrial tissue outside of the uterus undergoes cyclical bleeding, leading to pain, scarring, and infertility
Describe the clinical features of endometriosis
Pelvic pain, dysmenorrhoea, deep dyspareunia, decreased fertility. On examination, vaginal tenderness, vaginal nodules, immobile and retroverted uterus in advanced disease
Describe the macroscopic appearance of endometriosis
Red-blue to brown nodules (powder burns) Chocolate cysts (endometriomas) in ovaries
Describe the microscopic appearance of endometriosis
Endometrial glands and stroma
Define adenomyosis
Presence of ectopic endometrial tissue deep within the myometrium
State the clinical features of adenomyosis
Heavy menstrual bleeding, dysmenorrhoea, deep dyspareunia. On examination, globular uterus
Define leiomyoma
Fibroid - a benign tumour of smooth muscle origin
State 3 possible locations for leiomyomas
Intramural, submucosal, subserosal
What % of women >35 have a leiomyoma
20%
Describe the macroscopic appearance of leiomyomas
Sharply circumscribed, discrete, round, firm, grey-white tumours of variable size
Describe the microscopic appearance of leiomyomas
Bundles of smooth muscle cells
State the clinical features of leiomyoma
Heavy menstrual bleeding, dysmenorrhoea, subfertility. Large leiomyomas may cause pressure effects (urinary frequency, tenesmus)
State the risks of leiomyoma during pregnancy
Red degeneration (haemorrhagic infarction, presenting with severe abdominal pain), post-partum torsion
Describe the histological appearance of the normal cervix
Outer cervix covered by squamous epithelium, endocervical canal lined by columnar epithelium - separated by squamocolumnar junction
Define the transformation zone
The area where columnar epithelium transforms into squamous cells
Define cervical intraepithelial neoplasia (CIN)
Dysplasia at the transformation zone as a result of infection by HPV 16, 18, or 33
Define CIN 1
Dysplasia confined to the lower 1/3 of the epithelium
Define CIN 2
Dysplasia confined to the lower 2/3 of the epithelium
Define CIN 3
Full thickness dysplasia with an intact basement membrane
What % of CIN 3 progresses to cervical cancer over 10 years?
30%
State at least 3 risk factors for cervical intraepithelial neoplasia
Early age at first intercourse, multiple partners, multiparity, smoking, HIV, immunosuppression
Define vulval intraepithelial neoplasia
Dysplasia of the normal squamous epithelium associated with HPV-16
State the two types of vulval intraepithelial neoplasia
Usual type, differentiated type
