Breast & Gynaecology Pathology Flashcards
What are the types of intraepithelial neoplasia?
Cervical intraepithelial neoplasia Cervical glandular intraepithelial neoplasia Vulval intraepithelial neoplasia Vaginal intraepithelial neoplasia Anal intraepithelial neoplasia
What happens if dysplasia is removed?
It is curative but if it is left, there is a chance of developing an invasive malignancy
HPV is what type of virus?
Double stranded DNA
What are the low risk HPVs?
6 and 11
40, 42, 43, 44, 53
What are the high risk HPVs?
16 and 18
31, 33, 35, 39, 58, 59
What are low risk and high risk HPVs associated with?
low risk= genital warts
high risk= pre-invasive and invasive diseases
What is a condylomata? What HPV is it associated with?
benign squamous neoplasm
6 and 11
Which HPVs are protected against in Gardasil?
6, 11, 16 and 18
Which HPVs are protected against in Cervarix?
16 and 18
What do high risk HPVs do in the cell?
upregulate E6 and E7 expression
What does E6 do? What does E7 do?
E6 inactivates p53
E7 binds to RB1 gene products
what does p53 do?
What does RB1 do?
p53 mediates apoptosis
RB1 is a tumour suppressor gene
What is the transformation zone?
An area of squamous metaplasia
Where is a CIN likely to develop?
Transformation zone
What is different about the transformation zone in post-menopausal women?
It is not easily excised via LLETZ
What is the pre-inasive stage of cervical SCC?
Cervical intraepithelial neoplasia
What is the aim of the cervical screening programme?
detection of CIN
When are women first invited for cervical screening?
25
Who is screened every 3 years and 5 years for cervical cancer?
3 years= 25-49
5 years= 50-64
What are the risk factors for cervical squamous cell carcinoma?
high risk HPVs multiple sexual partners young age at first intercourse low socioeconomic groups smoking immunosuppression
What is the precursor for cervical adenocarcinoma?
CGIN
How is cervical carcinoma staged?
FIGO
I- confined to cervix
II- invades uterus wall
III- extends to pelvic wall
IV- invades bladder or rectum
How deep are Stage IA2 tumours?
3-5mm
What types of vulvular intraepithelial neoplasia occurs in older women?
Differentiated
Is warty/basaloid VIN associated with HPV?
Yes
It is graded from 1-3
Lichen sclerosus is associated with
inflammatory dermatoses in those over 70 and there is a 15% chance of malignancy risk
Extra-mammary Paget’s disease is
an in situ adenocarcinoma of squamous mucosa
The most important prognostic factor in malignant melanoma is
Breslow thickness
How does malignant melanoma frequently spread?
via the urethra
What is endometriosis?
Ectopic endometrium around the body
How is endometriosis treated?
OCP
GnRH agonists
Progesterone antagonist
Ablation
Endometritis presents as
abdo pain
pyrexia
discharge
dysuria
What can cause endometritis?
Pelvic Inflammatory Disease
Endometrial TB
What are polypoid estradiol-dependent uterine overgrowths?
Endometrial polyps
How do endometrial polyps present?
Menorrhoagia
Dysmenorrhoea
What are leiomyomas?
Uterine fibroids
benign myometrial tumours
What are risk factors for uterine fibroids?
Genetics
Obesity
PCOS
HTN
What can uterine fibroids present as?
Menometorrhagia (Fe deficient anaemia)
Subfertility
The risk factors for endometrial hyperplasia are
obesity exogenous estradiol PCOS Tamoxifen HNPCC
What is a histological presentation of endometrial adenocarcinoma?
Invasion into the myometrium
What is the most common cancer of the female genital tract?
Endometrial carcinoma
What type of endometrical carcinoma presents in post-menopausal women?
Serous
What is the Rotterdam criteria?
Used to diagnose PCOS and requires 2/3 of:
polycystic ovaries on US hyperandrogenism irregular periods (>35 days)
How do you treat PCOS?
Weight loss
Metformin, OCP
Ovarian drilling
What does primary failure of gonads cause?
Hypergonadotropic hypogonadism
Hypergonadotropic hypogonadism can be caused by
Turner syndrome, Klinefelter’s syndrome
Infection, surgery and toxins
Secondary failure of the gonads is caused by
Hypothalamic/Pituitary failure
What does hypogonadotropic hypogonadism cause?
Sheehan syndrome
Pituitary tumours
Brain injury
How does gonadal failure present?
Amenorrhoea and absent menarche
Teratomas and yolk sac tumours are examples of
Germ cell tumours of the ovary
Sertoli-Leydig cell and thecomas are examples of
Sex-cord stromal tumours
CA125 is a marker for
ovarian cancer
What is Meig’s syndrome?
Ovarian tumour, right sided hydrothorax and ascites
What are protective factors for ovarian cancer?
OCP, breastfeeding and hysterectomy
Mullerian tumours of the ovary are commonly associated with
the uterus, fallopian tube, pelvic peritoneum and contralateral ovary
Which women are eligble for breast screening?
50-70
occurs every 3 years
What is the breast triple assessment?
Clinical examination
Radiological examination
Pathological examination
Fibrocytic changes normally affect
pre-menopausal women
What group are fibroadenomas most common in?
Afro-Caribbean women
What is a risk factor for breast cancer?
Oestrogens
What is commonly seen as microcalcifications on screening?
DCIS
How is breast cancer assessed?
Nottingham Grading System
What is the most common type of breast cancer?
Ductal
Trastuzumab targets
HER2
Tamoxifen is a
hormonally targeted therapy
What are the TORCH organisms?
Toxoplasmosis Other (syphilis, varicella-zoster, parvovirus B19) Rubella Cytomegalovirus (CMV) Herpes infections
They are some of the most common infections associated with congenital anomalies.
What are risk factors for puerperal endometritis?
C section
prolonged labour
multiple vaginal examinations
Pertussis is caused by
Bordatella pertussis
Impetigo can be caused by what organisms in childhood
S. aureus
S. pyogenes
Scarlet fever can be caused by
Group A beta-haemolytic streptococcus
