Cervical screening and pathology Flashcards
Metaplasia
replacement of one differentiated cell type with another, mature differentiated cell type
Dysplasia
abnormality of development or an epithelial anomaly of growth and differentiation
not invasive!
Neoplasia
New and abnormal development of cells that may be benign or malignant
Intraepithelial neoplasia = dysplasia (not invasive)
Invasiveneoplasia (neoplasm) = cancer
What could cause this mass in the myometrium
-
Benign Leiomioma see pic*
- benign SM tumours
- common
- Hormone receptive; regress following menopause -
Leimyosarcoma (invasive SM cancer)
- Malignant smooth muscle tumour
How can a benign leiomioma cause menorrhagia
If you get a sub-endometrial leiomioma you increase the surface area of the uterine cavity → increased bleeding and shedding.
Pain as uterus contracts around large fibroids
Whats the macroscopic difference between a leiomyosarcoma and a leiomyoma/fibroid
Leiomyoma: ovoid/round, circumscribed, solid creamy
Leiomyosarcoma: necrotic core/area, haemorragic areas, larger. It is heterogenous
Whats the microscopic description of a leiomyoma
Leiomyoma : collection of smooth muscle cells, arranged in a new growth formation (different to SM of uterus). Cigar shaped nuclei, and pink elongated cytoplasms.
cyclical abdominal pain indicates issues with?
Her period
Potential causes of painful heavy periods
Leimyoma (fibroids)
Endometriosis
Primary endometrial pathology
Leimyosarcoma unlikely
A chocolate (haemorrhagic) cyst of the ovary
What is endometriosis? What does it cause?
Endometrial tissue outside the lining of the uterus.
It responds to menstrual cycle hormones, leading to:
- pain
- cysts
- Tissue inflammation
- fibrosis
- infertility/ectopic pregnancy
- POTENTIALLY malignancy
What are the 3 things that need to be seen microscopically in order to diagnose endometriosis
- Endometrial glands
- Endmetrial stroma
- Changes in the surrounding tissue: fibrosis and/or haemocytic macrophages
What are you looking for macroscopically to diagnose Endometriosis
Cyst formation, many that are ‘chocolatey’ due to haemorrhage.
Changes the structure/function of normal tissues
What do we suspect from this?
-polycystic ovarian syndrome: underlying endocrine disorder cause her to be obese/infertile. Ovaries/follicule never ovulate so continued production of oestrogen.
This can cause excessive proliferation and shedding of the endometrium → heavy and irregular periods. (the irregularity makes you think she is not ovulating cyclically)
-leiomyoma
Age variation in a thickened endometrium?
-Postmenopausal: no oestrogen production so there shouldn’t be proliferating/shedding at all.
If there is this is a BAD SIGN,
How do you do a biopsy of the endometrium? What are the issues?
Pipelle Biopsy: little tube in uterus, suck out some endometrium. Not done under direct vision so can be incredibly difficult in obese patients.
D and C ‘Dilation and Curettage’: under direct vision in theatre under anaesthetic. Endometrium viewed and abnormal tissue scraped out.
What is this and what would it look like microscopically
Endometrial adenocarcinoma.
Shaggy, thickened, heterogenic, invading into the myometrium.
Glands proliferate and become increasingly crowded and complex
What can lead to too much eostrogen
- Obesity
- Exogenous oestrogen (HRT)
- Polycystic ovarian syndrome (PCOS)
- Hormone secreting tumours
- Early menarche, late menopause
- Nulliparity (pregnancy is a progestogenic state)
What sort of things is the cytologist looking for in the cervical smear specimen
- Nuclei:cytoplasm ratio
- Nuclei enlargement
- Nuclei variation
Is it normal, low grade dysplasia or high grade dysplasia
What happens if you have a smear, and see high-grade dysplastic lesion??
- Abnormal smears are refered to gynaecologist for colposcopy (examination of cervix with a specialised microscope).
- Cervix can be ‘painted’ with acetic acid to highlight abnoral areas
- A biopsy is taken of the suspicious areas and sent to the lab
What happens to the biopsy of the high-grade dysplastic region?
It is looked at microscopically (histology) and it is decided/confrimed what CIN stage the tissue is at.
CIN I: some cytoplasm still present, most of the issue down further below.
CIN III: Full thickness abnormality, lots of cytoplasm lost, darker nuclei
What is this? why is this so bad?
Cervical Cancer. Because of its anatomical location it can easily invade into important surrounding structures (rectum, bladder etc)
Mature Dermoid Cyst. Tries to recapitulate a human in the ovary.
What is a Mucinous Cystdenoa
Epithelial tumours of the ovaries
Serous Carcinoma
