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Year 2 Clinical Pathology > Disorders of the female genital tract 2: Uterus and Ovaries > Flashcards

Disorders of the female genital tract 2: Uterus and Ovaries Flashcards

1
Q

What is endometriosis?

A

Get ectopic endometrium which bleeds into tissues resulting in fibrosis

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2
Q

25% of women with endometriosis are asymptomatic, what 6 symptoms do some report?

A

1) Dysmenorrhoea
2) Dyspareunia (difficult or painful sexual intercourse)
3) Pelvic pain
4) Subfertility
5) Pain on passing stool
6) Dysuria

3

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3
Q

What investigation is carried out in suspected endometriosis?

A

Laparoscopy (a surgical procedure in which a fibre-optic instrument is inserted through the abdominal wall to view the organs in the abdomen)

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4
Q

There is both medical and surgical treatment for endometriosis, what is the medical treatment? 3

A

1) COCP (combined oral contraceptive pill)
2) GnRH agonist.antagonist (lower FSH and LH)
3) Progesterone antagonist

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5
Q

What is the possible surgical treatment for endometrosis?

A

1) Ablation

2) TAH-BSO (Total Abdominal Hysterectomy Bilateral Salpingo Oophorectomy)

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6
Q

What 3 other conditions has endometriosis been linked with?

A

1) Ectopic pregnancy
2) Ovarian cancer
3) IBD

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7
Q

What is endometritis and what 2 types can occur?

A

Inflammation of the endometrium

Can be acute or chronic

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8
Q

Give 2 causes of acute endometritis?

A

1) Retained POC/placenta

2) Complicated labour

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9
Q

What cell appears histologically in acute endometritis?

A

Neutrophils

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10
Q

Give 4 causes of chronic endometritis?

A

1) PID (pelvic inflammatory disease)
2) Retained gestational tissue
3) Endometrial TB
4) IUCD (intrauterine contraceptive device) infection

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11
Q

What cells appear histologically in chronic endometritis?

A

Lymphocytes and plasma cells

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12
Q

What are the 5 common symptoms of endometritis?

A

1) Abdominal/ pelvic pain
2) Pyrexia
3) Discharge
4) Dysuria
5) Abnormal vaginal bleeding

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13
Q

What are the 2 investigations in suspected endometriosis?

A

1) Biochemistry/ microbiology

2) USS

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14
Q

What are the 3 therapies for endometritis?

A

1) Analgesia
2) Abx
3) Remove cause

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15
Q

What are endometrial polyps?

A

Sessile/ polypoid oestrogen-dependent uterine overgrowths

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16
Q

Endometrial polyps are often asymptomatic but can cause what 4 symptoms?

A

1) Intermenstrual bleeding
2) Post menopausal bleeding
3) Menorrhagia
4) Dysmenorrhoe

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17
Q

What are the 2 main investigations in suspected endometrial polyps?

A

1) USS

2) Hysteroscopy (hysterscope inserted into vagina to examine cervix and inside of uterus)

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18
Q

What is the medical treatment for endometrial polyps?

A

Progesterone/ Gonadotropin agonists

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19
Q

What is the surgical treatment for endometrial polyps?

A

Curettage (scraping or scooping)

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20
Q

Can endometrial polyps be malignant?

A

Yes, but less than 1% are malignant

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21
Q

What is leiomyomata (uterine fibroids)?

A

Benign myometrial (smooth muscle) tumours with oestrogen/progesterone dependent growth

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22
Q

What are the 5 risk factors for developing leiomyomata?

A

1) Genetics
2) Nulliparity (never having children)
3) Obesity
4) PCOS (polycystic ovarian syndrome)
5) HTN (hypertension)

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23
Q

Leiomyomata is often asymptomatic, but what 3 symptoms are sometimes reported?

A

1) Menometrorrhagia (heavy, painful bleeding) - thus get Fe def anaemia
2) Subfertility/ pregnancy problems
3) Pressure symptoms

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24
Q

What are the 2 investigations in suspected leiomyomata?

A

1) Bimanual examination

2) USS

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25
Q

What are the 5 medical therapies for leiomyomata?

A

1) IUS
2) NSAIDs
3) OCP (oral contraceptive pill)
4) Progesterone
5) Iron

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26
Q

What are the 3 non medical therapies for leiomyomata?

A

1) Artery embolization
2) Ablation (surgical removal of body tissue)
3) TAH - total abdominal hysterectomy

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27
Q

What 2 things can leiomyomata lead to?

A

1) menopausal regression

2) malignancy risk 0.1%

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28
Q

What is endometrial hyperplasia?

A

Excessive endometrial proliferation (increased oestrogen and decreased progesterone)

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29
Q

What are the 6 risk factors for endometrial hyperplasia?

A

1) Obesity
2) Exogenous oestrogen
3) PCOS
4) Oestrogen producing tumours
5) Tamoxifen
6) HNPCC (PTEN mutations) - hereditary non polypoidal colorectal cancer

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30
Q

What are the 2 types of endometrial hyperplasia according to the WHO classification, how likely is each to become malignant?

A

1) Non-atypical hyperplasia (1-3% progress)

2) Atypical hyperplasia (23-48% are carcinoma on hysterectomy)

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31
Q

What is the main symptom of endometrial hyperplasia?

A

Abnormal bleeding (inter menstrual bleeding, post coital bleeding, post menopausal bleeding)

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32
Q

What are the 2 main investigations in suspected endometrial hyperplasia?

A

1) USS

2) Hysterectomy +/- biopsy

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33
Q

What are the 2 medical treatments for endometrial hyperplasia?

A

1) IUS

2) Progesterone

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34
Q

What is the surgical treatment for endometrial hyperplasia?

A

TAH - total abdominal hysterectomy

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35
Q

What type of cancer can endometrial hyperplasia progress to?

A

Endometroid adenocarcinoma

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36
Q

What are the 4 stages in the malignant progression of hyperplasia?

A

1) Normal
2) Non atypical hyperplasia
3) Atypical hyperplasia
4) Endometroid carcinoma

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37
Q

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

A

Endometrial carcinoma

38
Q

What are the 2 main symptoms of endometrial carcinoma?

A

1) Intermenstrual bleeding/ Post menopausal bleeding

2) Pain if late

39
Q

What are the 3 investigations in suspected endometrial carcinoma?

A

1) USS
2) Biopsy
3) Hysteroscopy

40
Q

What staging system is used for endometrial carcinoma?

A

FIGO staging system

41
Q

What are the 3 treatments for endometrial carcinoma?

A

1) Medical (progesterone)
2) Surgery - TAH
3) Adjuvant therapy - chemo/radio

42
Q

What is the 5 year survival for stage 1 endometrial carcinoma?

A

90%

43
Q

What is the 5 year survival for Stage 2/3 endometrial carcinoma?

A

-add-

44
Q

What are the 2 main types of endometrial carcinoma?

A

1) Endometroid

2) Serous

45
Q

What is the difference in age of incidence of endometroid and serous endometrial carcinoma?

A

Endometroid - Pre-/perimenopausal

Serous - post menopausal

46
Q

What is the pre existing state for endometroid and serous endometrial carcinoma?

A

Endometroid - Endometrial hyperplasia

Serous - Endometrial atrophy

47
Q

What 2 mutations are found in endometroid and 1 is found in serous endometrial carcinoma?

A

Endometroid - PTEN, Kras

Serous - P53

48
Q

What is the oestrogen status in endometroid and serous endometrial carcinoma?

A

Endometroid - Oestrogen positive

Serous - Oestrogen negative

49
Q

What grades are there for serous and endometroid endometrial carcinoma?

A

Endometroid - stages 1-3

Serous - always stage 3

50
Q

What is polycystic ovarian syndrome?

A

Complex endocrine disorder made up of hyperandrogenism, menstrual abnormalities and polycystic ovaries

51
Q

What are the 3 investigations in suspected PCOS?

A

1) USS
2) Fasting biochemical screen (decreased FSH, raised LH, testosterone and DHEAS)
3) OGTT (oral glucose tolerance test)

52
Q

What is the Rotterdam criteria for the diagnosis of PCOS?

A

2 out of 3 of:

1) Polycystic ovaries
2) Hyperandrogenism (hirsuitism/ biochemical)
3) Irregular periods (>35 days)

53
Q

What are the 3 treatments for PCOS?

A

1) Lifestyle - weight loss
2) medical - Metformin, OCP, clomiphene
3) Surgical - ovarian drilling

54
Q

What 2 other conditions has PCOS been linked to?

A

1) Infertility

2) Endometrial hyperplasia/ adenocarcinoma

55
Q

What are the 2 types of gonadal failure?

A

1) Hypergonadotrophic hypogonadism (primary failure of the gonads)
2) Hypogonadotrophic hypogonadism (hypothalamic/ pituitary failure leading to secondary failure of the gonads)

56
Q

What are the 2 congenital causes of primary hypogonadism?

A

1) Turner syndrome (XO)

2) Klinefelter syndrome (XXY)

57
Q

What are the 4 acquired causes of primary hypogonadism?

A

1) Infection
2) Surgery
3) Chemo-radiotherapy
4) Toxins/ drugs

58
Q

What are the 5 causes of secondary hypogonadism?

A

) Sheehan’s syndrome

2) Pituitary tumours
3) Brain injury
4) Empty sella syndrome
5) PCOS

59
Q

What are the 3 factors to the presentation of gonadal failure?

A

1) Amenorrhoea/ absent menarche
2) Delayed puberty
3) reduced sex hormone levels, +/- increased LH and FSH levels

60
Q

What are the 2 investigations necessary in suspected gonadal failure?

A

1) Hormonal profiling

2) Karyotyping

61
Q

What is the treatment for gonadal failure?

A

It is difficult - often address the cause if possible and use HRT

62
Q

What are the 3 types of ovarian neoplasms?

A

1) Surface epithelial stromal tumours (derived from the surface epithelium of the ovaries)
2) Germ cell tumours (come from the germ cells themselves)
3) Sex-cord stromal tumours (coming from the stroma of the ovary)

63
Q

What is the most common type of ovarian neoplasms (accounting for 90%)?

A

Surface epithelial stromal tumours

64
Q

What are the 3 major histological types of epithelial tumours?

A

1) Serous
2) Mucinous
3) Endometroid
(each type contains benign/ borderline /malignant variants)

65
Q

Benign ovarian epithelial tumours can be sub classified based on components, what are the 3 types?

A

1) Cystic (cystadenomas)
2) Fibrous (Adenofibromas)
3) Cystic and fibrous (cystadenofibromas)

66
Q

What is the term for a malignant ovarian epithelial tumours?

A

Cystadenocarcinoma

67
Q

Germ cell tumours account for what percentage of all ovarian tumours?

A

15-20% of all ovarian tumours

68
Q

What are the 2 main types of ovarian germ cell tumours?

A

1) Germinomatous

2) Non-germinomatous

69
Q

Name the 1 type of germinomatous and 3 types of non-germinomatous ovarian germ cell tumours?

A

Germinomatous: dysgerminomas

Non-germinomatous: teratomas, yolk sac tumours, choriocarcinomas

70
Q

What is a dysgerminoma, can it be treated?

A

Differentiation towards oogonia, malignant but responsive to chemo

71
Q

What is a teratoma?

A

Differentiation towards multiple germ layers

72
Q

What are the 2 types of teratomas?

A

1) Mature - benign, dermoid cyst (1% malignant transformation)
2) Immature - malignant, often contain embryonal/foetal tissue

73
Q

What are yolk sac tumours, can they be treated?

A

Differentiation towards extraembryonic yolk sac, malignant but responsive to chemo

74
Q

What are choriocarcinomas?

A

Differentiation towards placenta, malignant and often unresponsive to treatment

75
Q

What is the therapy for ovarian germ cell tumours?

A

Surgical +/- chemo +/- radio

76
Q

What are sex cord stromal tumours, where do they arise from, what is particularly unusual about it?

A

Rare - arise from ovarian stroma which was derived from the sex cord of embryonic gonad - can generate cells from the opposite sex

77
Q

What are the 3 types of sex cord stromal tumours, are they malignant or benign and what hormones does each produce?

A

1) Thecoma/ fibrothecoma/ fibroma - all benign, thecomas and fibrothecomas produce oestrogen, fribromas are hormonally inactive
2) Granulosa cell tumours are low grade malignant and produce oestrogen
3) Sertoli-Leydig cell tumours - 10-25% are malignant and they produce androgens

78
Q

What is the second commonest gynae cancer?

A

Ovarian

79
Q

What 3 things make up Meig’s syndrome?

A

1) Ovarian tumour
2) Right sided hydrothorax
3) Ascites

80
Q

What are the 8 risk factors for ovarian cancer?

A

1) FH
2) Increasing age
3) PMH breast cancer
4) Smoking
5) Oestrogen only HRT
6) Lynch II syndrome
7) Obesity
8) Nulliparity (having no children)

81
Q

What are 3 protective factors against ovarian cancer?

A

1) OCP
2) breastfeeding
3) Hysterectomy

82
Q

What are the 6 commonest symptoms of ovarian cancer?

A

(Non specific symptoms)

1) Pain
2) Bloating
3) Weight loss
4) PV bleeding
5) Urinary frequency
6) Anorexia

83
Q

What staging system is used in ovarian cancer?

A

FIGO staging system

84
Q

What is the treatment for sensitive germ cell ovarian tumours?

A

Chemo only

85
Q

What is the treatment for Stage

A

1) TAH/BSO
2) Omentectomy (Removal of some of omentum)
3) Appendectomy
4) Lymphadenectomy
5) Adjuvant chemotherapy

86
Q

What is the overall 5 year survival for ovarian cancer?

A

43%

87
Q

What are the 4 most common ovarian metastatic mullerian tumours?

A

1) Uterus
2) Fallopian tube
3) Pelvic peritoneum
4) Contralateral ovary

88
Q

What are the 2 most common ovarian metastatic extra mullerian tumours which spread by direct extension?

A

1) Bladder

2) rectal

89
Q

What are the 5 most common ovarian metastatic extra mullerian tumours which spread by lymphatic/haematogenous spread?

A

1) GI tract - large bowel, stomach
2) Krukenburg tumour - pancreatobiliary
3) Breast
4) Melanoma
5) Less commonly kidney and lung

90
Q

How are metastatic ovarian tumours confirmed, what is the prognosis?

A

They are confirmed histologically, prognosis is typically poor

Year 2 Clinical Pathology (64 decks)

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