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Pathology Test 3 > Female Genital Tract > Flashcards

Female Genital Tract Flashcards

1
Q

Endometrium

A

The endometrium of the uterus consists of glands and stroma which makes up the innermost lining of the uterus.

Estrogen:
- Causes Gland proliferation

Ovulation:
- occurs when ↑ progesterone → convert to secretory

If ovulation impaired”
- Estrogenic growth stimulus continues
- “Unopposed” by progesterone

Consequences:
- Dysfunctional bleeding
- Endometrial hyperplasia
- Possible progression to carcinoma

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2
Q

Causes of unopposed estrogen

A

Failure to ovulate:
- Older age
- Hormonal imbalances (e.g. polycystic ovary disorder)

Obesity:
- Fat cells convert androgens to estrogens

Medication:
- Estrogen replacement therapy without balancing progesterone
- Tamoxifen for breast cancer

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3
Q

ENDOMETRIAL HYPERPLASIA

A

An excess of estrogen relative to progestin, if sufficiently prolonged or marked can induce exaggerated endometrial proliferation hyperplasia which is an important precursor of endometrial carcinoma.

Proliferating Endometrium - we begin to more glands but also more dilated glands.

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4
Q

ENDOMETRIAL ADENOCARCINOMA

A

Most common malignancy of female genital tract

Usually postmenopausal

~85% associated with hyperestrinism

Cases not associated with estrogen more aggressive

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5
Q

LEIOMYOMA (“FIBROID”)

A

Benign tumors that arise from the smooth muscle cells in the myometrium are properly termed leiomyomas but because of their firmness often are referred to clinically as fibroids.
- Benign tumor of smooth muscle
- Very common
— 25% of women over 30 years

Symptoms
- Depend on size, location, and number
- Pain, bleeding, infertility
- May be asymptomatic

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6
Q

Types of Fibroids

A

Intramural

Submucosal

Subserosal

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7
Q

Endometriosis

A

Endometriosis is defined by the presence of endometrial glands and stroma in a location outside the uterus.
- Ectopic endometrial tissue
- Very common (10% of women)
- Estrogen dependent

Symptoms:
- Pelvic pain, often cyclical
- May be severe: nausea, insomnia, fatigue, depression
- Infertility

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8
Q

Endometriosis Etiology

A

Theories based on:

Deposition of endometrial (stem?) cells
- Retrograde menstruation?
- Circulating stem cells?
- Metaplastic transformation?

Survival and growth of seeded tissue
- Alterations in the biology of the ectopic tissue
- Host inflammatory response
- Genetic, epigenetic, and environmental influences

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9
Q

INFECTION (PELVIC INFLAMMATORY DISEASE)

A

Complications
- Pelvic pain
- Abscess
- Infertility
- Adhesions
- Ectopic pregnancy
- Hydrosalpinx (dilated fallopian tube)

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10
Q

ECTOPIC PREGNACY

A

Ectopic pregnancy is defined as the implantation of the fertilized ovum outside of the uterine corpus. Approximately 1% of pregnancies implant ectopically; the most common site is the fallopian tube.

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11
Q

Hydrosalpinx (dialted fallopian tube)

A

Dilated, thin walled Fallopian tube

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12
Q

Ovarian neoplasia

A

Epithelial
- 65-70% of cases
- Adults
- Majority benign
- Cancer in older

Germ cell
- 15-20% of cases
- Young (<25 yr)
- Similarities with testicular tumors

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13
Q

Benign Epithelial Ovarian Neoplasm

A

Lots of cysts that are thin walled - looks like soap bubbles

Cysts are lined by mucinous cystadenoma

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14
Q

Ovarian cancer

A

Many kinds of “ovarian cancer” (epithelial, germ cell, sex cord)

High grade serous carcinoma most common (epithelial differentiation)

Leading cause of death from gyn malignancy (>cervix or endometrium)

Often asymptomatic, or non-specific until late stage

No specific screening test

More likely to present at an advanced stage

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15
Q

Ovarian cancer - risk factors and protective factors

A

Risk factors
- Age
— (↑ post-menopausal)
- Genetics
— Personal history breast cancer
— Family history ovary & breast / colon cancer (BRCA / Lynch)
- Hormonal
— No children / late first pregnancy
— Estrogen therapy (w/o progestin)
- Endometriosis

Protective factors
- Progesterone effects:
— Early age of 1st pregnancy
— Breastfeeding
— Oral contraceptives
— Progesterone infused IUD

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16
Q

TUBAL VS OVARIAN ORIGIN OF OVARIAN CARCINOMAS

A

Tubal Origin (High grade serous carcinoma)
- Most common so-called “ovarian” cancer
- Tubal origin for HGSC a new concept
- Pre-cancerous changes in tube
- Strong p53 link; BRCA link in some

Ovarian Origin (Endometrioid, clear cell, mucinous, LG serous)
- Pre-cancerous changes in ovary
- From endometriosis or epithelial inclusions
- Often less aggressive than HGSC
- Different genetic mutations than HGSC

17
Q

OVARIAN CARCINOMAS - Outcome

A

Only 1/3 of cases confined to ovary

Surgery ± chemotherapy

5-year survival:
I: Confined to ovary – 90%
II: Pelvic spread – 70%
III: Lymph node or abdominal spread – 40%
IV: Distant metastasis – <20%

18
Q

VULVAR DISEASES

A

Non-neoplastic
- Infections (e.g. HPV)
- Various dermatologic conditions

Neoplastic
- Pre-cancerous changes
- Squamous cell carcinoma
- Other neoplasms (much less common)

19
Q

HUMAN PAPILLOMA VIRUS (HPV)

A

STI which infects squamous cells

Multiple HPV subtypes:
- Low risk strains (e.g. 6, 11):
— Condyloma (warts)

High risk strains (e.g.16, 18):
- Pre-cancerous changes

20
Q

Risk Factors - HUMAN PAPILLOMA VIRUS (HPV)

A

Behavioral based
- Young age of first intercourse
- Multiple sexual partners
- Unprotected intercourse
- Smoking

Biological based
- Host factors
— Immune response, etc.
- Viral factors
— HPV type, viral load, etc.
- Weakened immune system

21
Q

VULVAR CONDYLOMA ACCUMINATUM

A

Genital warts

HPV-6 and HPV-11

Usually multiple

Recurrence common

30-50% associated cervical infection

22
Q

VULVAR INTRAEPITHELIAL NEOPLASIA (VIN)

A
  • Mostly squamous cell carcinoma
  • Preceded by pre-cancerous changes

HPV associated (high risk viral strains)
- Younger age
- Multifocal disease
- Recurrent

Non-HPV (p53 mutation)
- Older age
- Solitary lesions
- Linked to chronic inflammatory lesions
- Higher risk of progression to invasion

23
Q

SQUAMOUS CELL CARCINOMA

A

There appear to be two distinct forms of vulvar squamous cell carcinomas that differ in pathogenesis and course.

  1. The less common form is related to high-risk HPV strains and occurs in middle-aged women, particularly cigarette smokers. This form is often preceded by precancerous changes in the epithelium termed vulvar intraepithelial neoplasia (VIN).
  2. A second form of squamous carcinoma occurs in older women, sometimes following a long history of reactive epithelial changes, principally lichen sclerosus. It is preceded by a subtle lesion, differentiated vulvar intraepithelial neoplasia (dVIN). If left untreated it may give rise to HPV negative, well-differentiated, keratinizing squamous cell carcinoma.
24
Q

CERVIX

A

The cervix is a cylinder-shaped neck of tissue that connects the vagina and uterus. Located at the lowermost portion of the uterus, the cervix also is the site of one of the most common cancers in women worldwide

Transformation zone
- During development, the columnar mucus-secreting epithelium of the endocervix is joined to the squamous epithelial covering of the exocervix at the cervical os.
- During puberty, some columnar epithelium become visible on the exocervix and these exposed columnar cells, eventually undergo squamous metaplasia, forming a region called the transformation zone, where tumours most commonly arise.

25
Q

CERVICAL NEOPLASIA

A

HPV infection in 99% of cases
- Most HPV infections transient
- Persistence in 10%
- High risk HPV can integrate into host genome and drive cancer development

Cervical neoplasia preventable
- HPV vaccine
- Condom use
- Regular screening (pap smear)

26
Q

Pap Test - CERVICAL NEOPLASIA

A
  • Transformation zone sampled
  • Most lesions pre-cancerous for years
  • Allows for early detection
  • Simple, inexpensive
  • High specificity, lower sensitivity
  • HPV DNA analysis can help guide management

Colposcopy clinic if:
- High grade squamous atypia
- Persistent atypia
- Atypical glandular lesions

Cervical biopsy to establish diagnosis

Squamous cell carcinoma (90%)

Often asymptomatic; may have post-coital spotting

Conservative treatment if minimal depth of invasion

27
Q

Treatment Options - CERVICAL NEOPLASIA

A

Cone biopsy

Hysterectomy

Radiation

Pathology Test 3 (6 decks)

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