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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
What is the treatment for endometrial hyperplasia?
- medical (IUS, P4), | - surgical (TAH)
26
What is the prognosis for endometrial hyperplasia?
- endometrial adenocarcinoma | - regression
27
What is the most common cancer of the female genital tract?
endometrial carcinoma
28
What are the two types of endometrial carcinoma?
- Type 1 - endometroid | - Type 2- serous
29
What is the difference in epidemiology between serous and endometroid carcinoma?
Incidence - endometroid - 75% of cases - serous - 25% of cases Age - endometroid - Pre/perimenopausal - serous - postmenopausal
30
What mutations are found in endometroid carcinoma?
PTEN | Kras
31
What mutations are found in serous carcinoma?
p53
32
What is the E2 status of endometroid cancer?
E2 +ve
33
What is the E2 status of serous cancer?
E2 -ve
34
What are the grades of endometroid cancer?
Grades 1,2,3
35
What are the grades of serous cancer?
3
36
How is endometrial carcinoma staged?
FIGO (1 - 4)
37
What are the treatments for endometrial cancer?
- medical (P4), surgery (TAH-BSO), adjuvant therapy (chemo-/radiotherapy)
38
What is the prognosis for endometrial cancer?
- Stage 1 = 90% 5yr survival | - Stage 2-3 =
39
What is polycystic ovary syndrome?
Complex endocrine disorder; hyperandrogenism, menstrual abnormalities and polycystic ovaries
40
What is the epidemiology of polycystic ovary syndrome?
6-10% women (20-30% have polycystic ovaries)
41
What investigations are performed for PCOS?
- USS - fasting biochemical screen (↓FSH, ↑LH, ↑testosterone, ↑DHEAS ) - OGTT
42
How is PCOS diagnosed?
Rotterdam criteria 2/3 of: - polycystic ovaries - hyperandrogenism (hirsuitism/ biochemical) - irregular periods (>35 days)
43
What are the treatments for polycystic ovary syndrome?
- lifestyle (weight loss) - medical (metformin, OCP, clomiphene) - surgical (ovarian drilling)
44
What other conditions are linked to PCOS?
- infertility | - endometrial hyperplasia/ adenocarcinoma
45
What is hypergonadotrophic hypogonadism?
Primary failure of gonads
46
What are the congenital causes of hypergonadotrophic hypogonadism?
- Turner syndrome (XO) | - Klinefelter’s syndrome (XXY)
47
What are the acquired causes of hypergonadotrophic hypogonadism?
- Infection - surgery - chemo-radiotherapy - toxins/drugs
48
What is hypogonadothrophic hypogonadism?
Hypothalamic/ pituitary failure -> secondary failure of gonads
49
What are the causes of hypogonadothrophic hypogonadism?
- Sheehan’s syndrome - pituitary tumours - brain injury - empty sella syndrome - PCOS
50
What is the presentation of hypogonadothrophic hypogonadism?
- amenorrhoea/absent menarche; delayed puberty - decreased sex hormone levels +/- - increased LH and FSH levels
51
What investigations are used in suspected hypogonadothrophic hypogonadism?
- Hormonal profiling | - karyotyping
52
What is the treatment for hypogonadothrophic hypogonadism?
- Difficult - address cause | - HRT
53
What are the origins of ovarian neoplasms?
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
What is the most common group of epithelial neoplasms?
Epithelial tumours
55
What are the three major histological types of epithelial ovarian tumours?
- Serous (tubal) - Mucinous (endocervical) - Endometroid (endometrium)
56
What are sex cord stromal tumours?
- Rare; arise from ovarian stroma, which was derived from sex cord of embryonic gonad - Can generate cells from the opposite sex
57
What are thecoma/ fibrothecoma/ fibromas?
- 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
What are granulosa cell tunours?
Low grade malignant, produces E2
59
What are Sertoli-Leydig cell tumours?
Produces androgens; 10-25% malignant
60
What is the 2nd commonest gynae cancer?
Ovarian cancer
61
What are the risk factors for ovarian cancer?
- Fx - ↑age - PMHx - breast cancer - smoking - E2-only HRT - Lynch II syndrome - obesity (weak) - nulliparity (weak)
62
What are the protective factors for ovarian cancer?
- OCP - breastfeeding - hysterectomy
63
What is the typical history for ovarian cancer?
- non-specific symptoms - pain - bloating - weight loss - PV bleeding - urinary frequency - anorexia
64
What is the treatment for ovarian cancer?
- Stage
65
What is the prognosis for ovarian cancer?
Overall 5 years 43% survival
66
What is the most common type of metastatic ovarian tumour and where do they spread from?
Mullerian - Uterus - Fallopian tube - Pelvic peritoneum - Contralateral ovary
67
What are the site of spread for extra-mullerian tumours?
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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