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Clinical Pathology > Diseases of the female genital system 2 > Flashcards

Diseases of the female genital system 2 Flashcards

1
Q

What is endometriosis?

A

ectopic endometrium

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2
Q

What is the epidiemiology of endometriosis?

A

6-10% of women, 30 – 40yo

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3
Q

What are the clinical features of endometriosis?

A
  • 25% asymptomatic
  • dysmenorrhoea
  • dyspareunia
  • pelvic pain
  • subfertility
  • pain on passing stool
  • dysuria
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4
Q

What is the treatment for endometriosis?

A

Medical (COCP - GnRH agonists/antagonists, progesterone antagonists)

surgical (ablation/ TAH-BSO)

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5
Q

What other diseases is endometriosis linked to?

A
  • Ectopic pregnancy
  • ovarian cancer
  • IBD
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6
Q

What is endometritis?

A

Inflammation of the endometrium

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7
Q

What are the acute causes of endometritis?

A
  • Retained POC/placenta
  • prolonged ROM
  • complicated labour
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8
Q

What are the chronic causes of endometritis?

A
  • PID
  • retained gestational tissue
  • endometrial TB
  • IUCD infection
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9
Q

What is the difference in histology between acute and chronic endometritis?

A

Acute - neutrophils

Chronic - lymphocytes/plasma cells

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10
Q

What are the clinical features of endometritis?

A
  • Abdominal/pelvic pain
  • pyrexia
  • discharge
  • dysuria
  • abnormal vaginal bleeding
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11
Q

What is the treatment of endometritis?

A
  • Analgesia
  • abx
  • remove cause
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12
Q

What are endometrial polyps?

A

Sessile/polypoid E2-dependent uterine overgrowths

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13
Q

What are the clinical features of endometrial polyps?

A
  • Often asymptomatic
  • intermenstrual bleeding
  • post menopausal bleeding
  • menorrhagia, dysmenorrhoea
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14
Q

What is the treatment for endometrial polyps?

A
  • medical (P4/GnRH agonists)

- surgical (curettage)

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15
Q

What is leiomyomata?

A

Uterine fibroids - benign myometrial tumours with E2/P4-dependent growth

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16
Q

What is the epidemiology of leiomyomata?

A

~20% women 30-50’s

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17
Q

What are the risk factors for leiomyomata?

A
  • Genetics
  • nulliparity
  • obesity
  • PCOS
  • HTN
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18
Q

What are the clinical features of leiomyomata?

A
  • Often asymptomatic
  • menometrorrhagia (Fe def. anaemia)
  • subfertility/ pregnancy problems
  • pressure sx
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19
Q

What are the treatments for leiomyomata.

A
  • Medical (IUS/NSAIDs/OCP/P4/Fe2+);

- non-medical (artery embolization, ablation, TAH)

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20
Q

What is the prognosis for leiomyomata?

A
  • menopausal regression

- malignancy risk 0.01%

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21
Q

What is endometrial hyperplasia?

A

Excessive endometrial proliferation (increased E2, decreased P4)

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22
Q

What are the risk factors for endometrial hyperplasia?

A
  • obesity
  • exogenous E2
  • PCOS
  • E2-producing tumours
  • tamoxifen
  • HNPCC (PTEN mutations)
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23
Q

How is endometrial hyperplasia classified?

A
  • non-atypical hyperplasia (1-3% progress)

- atypical hyperplasia (23-48% are carcinoma on hysterectomy)

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24
Q

What are the symptoms of endometrial hyperplasia?

A

Abnormal bleeding - IMB/PCB/PMB

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25
Q

What is the treatment for endometrial hyperplasia?

A
  • medical (IUS, P4),

- surgical (TAH)

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26
Q

What is the prognosis for endometrial hyperplasia?

A
  • endometrial adenocarcinoma

- regression

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27
Q

What is the most common cancer of the female genital tract?

A

endometrial carcinoma

28
Q

What are the two types of endometrial carcinoma?

A
  • Type 1 - endometroid

- Type 2- serous

29
Q

What is the difference in epidemiology between serous and endometroid carcinoma?

A

Incidence

  • endometroid - 75% of cases
  • serous - 25% of cases

Age

  • endometroid - Pre/perimenopausal
  • serous - postmenopausal
30
Q

What mutations are found in endometroid carcinoma?

A

PTEN

Kras

31
Q

What mutations are found in serous carcinoma?

A

p53

32
Q

What is the E2 status of endometroid cancer?

A

E2 +ve

33
Q

What is the E2 status of serous cancer?

A

E2 -ve

34
Q

What are the grades of endometroid cancer?

A

Grades 1,2,3

35
Q

What are the grades of serous cancer?

A

3

36
Q

How is endometrial carcinoma staged?

A

FIGO (1 - 4)

37
Q

What are the treatments for endometrial cancer?

A
  • medical (P4), surgery (TAH-BSO), adjuvant therapy (chemo-/radiotherapy)
38
Q

What is the prognosis for endometrial cancer?

A
  • Stage 1 = 90% 5yr survival

- Stage 2-3 =

39
Q

What is polycystic ovary syndrome?

A

Complex endocrine disorder; hyperandrogenism, menstrual abnormalities and polycystic ovaries

40
Q

What is the epidemiology of polycystic ovary syndrome?

A

6-10% women (20-30% have polycystic ovaries)

41
Q

What investigations are performed for PCOS?

A
  • USS
  • fasting biochemical screen (↓FSH, ↑LH, ↑testosterone, ↑DHEAS )
  • OGTT
42
Q

How is PCOS diagnosed?

A

Rotterdam criteria 2/3 of:

  • polycystic ovaries
  • hyperandrogenism (hirsuitism/ biochemical)
  • irregular periods (>35 days)
43
Q

What are the treatments for polycystic ovary syndrome?

A
  • lifestyle (weight loss)
  • medical (metformin, OCP, clomiphene)
  • surgical (ovarian drilling)
44
Q

What other conditions are linked to PCOS?

A
  • infertility

- endometrial hyperplasia/ adenocarcinoma

45
Q

What is hypergonadotrophic hypogonadism?

A

Primary failure of gonads

46
Q

What are the congenital causes of hypergonadotrophic hypogonadism?

A
  • Turner syndrome (XO)

- Klinefelter’s syndrome (XXY)

47
Q

What are the acquired causes of hypergonadotrophic hypogonadism?

A
  • Infection
  • surgery
  • chemo-radiotherapy
  • toxins/drugs
48
Q

What is hypogonadothrophic hypogonadism?

A

Hypothalamic/ pituitary failure -> secondary failure of gonads

49
Q

What are the causes of hypogonadothrophic hypogonadism?

A
  • Sheehan’s syndrome
  • pituitary tumours
  • brain injury
  • empty sella syndrome
  • PCOS
50
Q

What is the presentation of hypogonadothrophic hypogonadism?

A
  • amenorrhoea/absent menarche; delayed puberty
  • decreased sex hormone levels +/-
  • increased LH and FSH levels
51
Q

What investigations are used in suspected hypogonadothrophic hypogonadism?

A
  • Hormonal profiling

- karyotyping

52
Q

What is the treatment for hypogonadothrophic hypogonadism?

A
  • Difficult - address cause

- HRT

53
Q

What are the origins of ovarian neoplasms?

A

Sex-cord stromal tumours

  • Granulosa cell thecomas
  • fibrothecomas
  • Sertoli-Leydig cell tumours

Surface epithelial stromal tumours

  • Serous
  • Mucinous
  • Endometroid
  • Transitional cell
  • Clear cell

Germ cell tumours

  • Teratomas
  • Yolk sac tumours
  • Dysgerminomas
54
Q

What is the most common group of epithelial neoplasms?

A

Epithelial tumours

55
Q

What are the three major histological types of epithelial ovarian tumours?

A
  • Serous (tubal)
  • Mucinous (endocervical)
  • Endometroid (endometrium)
56
Q

What are sex cord stromal tumours?

A
  • Rare; arise from ovarian stroma, which was derived from sex cord of embryonic gonad
  • Can generate cells from the opposite sex
57
Q

What are thecoma/ fibrothecoma/ fibromas?

A
  • Benign, thecomas and fibrothecomas produce E2 (also rarely androgens)
  • Fibromas hormonally inactive
  • Comprised of spindle cells (plump spindle cells with lipid droplets = thecoma appearance)
58
Q

What are granulosa cell tunours?

A

Low grade malignant, produces E2

59
Q

What are Sertoli-Leydig cell tumours?

A

Produces androgens; 10-25% malignant

60
Q

What is the 2nd commonest gynae cancer?

A

Ovarian cancer

61
Q

What are the risk factors for ovarian cancer?

A
  • Fx
  • ↑age
  • PMHx
  • breast cancer
  • smoking
  • E2-only HRT
  • Lynch II syndrome
  • obesity (weak)
  • nulliparity (weak)
62
Q

What are the protective factors for ovarian cancer?

A
  • OCP
  • breastfeeding
  • hysterectomy
63
Q

What is the typical history for ovarian cancer?

A
  • non-specific symptoms
  • pain
  • bloating
  • weight loss
  • PV bleeding
  • urinary frequency
  • anorexia
64
Q

What is the treatment for ovarian cancer?

A
  • Stage
65
Q

What is the prognosis for ovarian cancer?

A

Overall 5 years 43% survival

66
Q

What is the most common type of metastatic ovarian tumour and where do they spread from?

A

Mullerian

  • Uterus
  • Fallopian tube
  • Pelvic peritoneum
  • Contralateral ovary
67
Q

What are the site of spread for extra-mullerian tumours?

A

Lymphatic/ haematogenous spread:

  • GI tract: Large bowel, stomach
  • (Krukenberg tumour), pancreatobiliary
  • Breast
  • Melanoma
  • kidney
  • lung

Direct extension

  • bladder
  • rectal

Clinical Pathology (65 decks)

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