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Female Pathology Flashcards

1
Q

What type of epithelium lines the Fallopian tubes?

A

Ciliated columnar epithelium

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2
Q

What organisms commonly cause salpingitis?

A 
Chlamydia trochomatis 
Mycoplasma
Coliforms
Streptococci
Staphylococci
Neisseria gonorrhoeae
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3
Q

What are symptoms of salpingitis?

A

Fever
Lower abdomen/pelvic pain
Pelvic masses if tubes distended with exudate/secretions

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4
Q

What complications are associated with salpingitis?

A

Adherence of tube to ovary (tube-ovarian abscess)

Adhesions involving tubal plicae - increased risk of tubal ectopic pregnancy

Damage/obstruction of tubal lumen - infertility

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5
Q

What is the most common type of primary adenocarcinoma affecting the Fallopian tubes?

A

Papillary serous carcinoma

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6
Q

What mutation are Fallopian tube carcinomas associated with?

A

BRCA1

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7
Q

Describe STIC (serous tubal intraepithelial carcinoma)

A

Abnormal epithelium in distal fallopian tube
Limited by basement membrane
Likely precursor for high grade serous carcinoma
p53 mutation may be involved

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8
Q

Give three non-neoplastic cysts that are found in the ovaries

A

Inclusion cysts
Follicular cysts
Luteal cysts

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9
Q

What hormone levels are associated with polycystic ovarian syndrome?

A

High LH

Low FSH

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10
Q

Describe the cysts found in polycystic ovarian syndrome

A

Cysts are lined by granulose cells with a hypertrophic and hyperplastic luteinized theca interna

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11
Q

What are the there cell types that can result in ovarian neoplasms?

A

Surface (coelomic) epithelium
Germ cells
Stromal cells/sex cord

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12
Q

What risk factors are associated with the development of ovarian neoplasms?

A

Nulliparity
Family History
Prolonged OCP use may reduce risk

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13
Q

If a KRAS mutation is present in ovarian cancer, what type of ovarian carcinoma is it likely to be?

A

Mucinous cystadenocarcinoma

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14
Q

If HER2 is overexpressed in an ovarian cancer, what is the prognosis like?

A

Poor

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15
Q

What type of ovarian cancers are associated with p53 mutations?

A

High grade serous adenocarcinoma (related to STIC)

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16
Q

What are the 5 subtypes of surface epithelium ovarian carcinomas?

A
  1. High grade serous (70%)
  2. Endometrioid (10%)
  3. Clear cell (10%)
  4. Low grade serous (5%)
  5. Mucinous (3%)
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17
Q

What are the two ways that malignant epithelial tumours can be described?

A

Cystic (cystadenocarcinoma)

Solid (adenocarcinoma)

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18
Q

What are the two types of benign ovarian surface epithelium lesions?

A

Cystic (cystadenoma)

Solid stromal component (cystadenofibroma)

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19
Q

What mutations are associated with High Grade Serous Carcinoma? What is the effect of this?

A

p53 and BRCA1

Inability to repair dsDNA –> chromosomal instability –> genomic chaos

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20
Q

What mutations are associated with Low Grade Serous Carcinoma?

A

BRAF

KRAS

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21
Q

What age do women usually present with benign serous ovarian tumours?

A

30-40y

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22
Q

What age do women usually present with malignant serous ovarian tumours

A

45-65y

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23
Q

What are psammoma bodies?

A

Concentrically laminated calcified concentrations which are common in the papillae of serous tumours in general

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24
Q

What are Krukenberg tumours?

A

Mucinous tumour that metastases bilaterally to the ovaries from the GI tract

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25
How are ovarian endometriod carcinomas microscopically characterised?
Neoplastic tubular glands
26
What proportion of women with ovarian endometriod carcinoma also have endometrial carcinoma?
15-20%
27
What tumour suppressor gene is lost in ovarian endometriod carcinoma?
PTEN
28
What is ovarian clear cell carcinoma associated with?
Endometriosis
29
What are 95% of ovarian germ cell tumours?
Mature cystic teratomas
30
What are 5% of ovarian germ cell tumours?
Immature cystic teratomas
31
What type of ovarian germ cell tumour is more aggressive?
Immature cystic teratoma
32
What hormone is secured by granulose and theca cell tumours?
Oestrogen
33
In what age group do granulose cell tumours usually occur?
Post-menopausal women
34
What is the triad of Meig's syndrome?
Ovarian fibroma Ascites Pleural effusion
35
What is a Brenner Tumour?
Uncommon mixed surface epithelial-stromal tumour
36
Prior to puberty, what epithelium covers the ectocervix?
Non-keratising stratified squamous epithelium
37
Prior to puberty, what epithelium covers the endocervix?
Columnar epithelium
38
At what site of the cervix do most cervical neoplasms develop?
Transformational zone (site of squamous metaplasia)
39
What HPV strains are associated with the development of cervical cancer?
16 and 18
40
During cervical cytology, what is indicative of CIN?
Presence of dyskaryosis
41
What is the screening programme for cervical cancer?
Women between 25 and 65 25-50: every 3 years 50-65: every 5 years
42
If on cervical cytology there are borderline nuclear abnormalities, what is the next step?
Repeat in 6/12 If 3 borderline results --> colposcopy
43
If on cervical cytology there is low grade dyskaryosis, what is the next step?
Repeat in 6/12 If 2 --> colposcopy
44
If on cervical cytology there is high grade dyskaryosis, what is the next step?
Colposcopy
45
If on cervical cytology there is glandular abnormality, what is the next step?
Colposcopy
46
If on cervical cytology there are features suggestive of invasion, what is the next step?
Urgent colposcopy
47
What do early genes of HPV do?
E1 to E7 Interact with intracellular molecules to interfere with cell proliferation machinery to replicate the virus
48
What do late genes of HPV do?
L1 and L2 Encode capsid proteins which cause disruption of the cell cycle checkpoints May contribute to accumulation of oncogenic mutations and carcinogenesis
49
From 2020, what mode will cervical screening take?
Screening for HPV If positive --> cytology
50
Describe coloposcopy
``` Cervix is visualised Washed with acetic acid Application of iodine Green light filter Abnormal area can be biopsied or treatment performed ```
51
Describe the features of CIN 2
2/3 of epithelium involved Nuclear enlargement with dense hyperchromasia Course chromatin clumping
52
Describe the features of CIN 3
Full thickness involvement of the epithelium
53
What are the two methods of treating CIN?
LETZ | Post Cold Coagulation
54
What complications are associated with treating CIN?
Immediate: pain, haemorrhage Delayed: secondary haemorrhage, infection, cervical stenosis
55
What metaplastic change can endocervical glandular epithelium undergo?
Cervical glandular intraepithelial neoplasia (cGIN)
56
What symptoms are associated with cervical cancer?
``` Post coital bleeding Intermenstrual bleeding Irregular vaginal bleeding Pain None ```
57
What condition affecting the vagina is caused by low oestrogen levels following the menopause?
Atrophic vaginitis
58
What symptoms are associated with atrophic vaginitis?
Discomfort, dyspareunia, bleeding | Cysts and polyps not uncommon
59
What infections may involve the vagina?
Bacterial vaginosis Thrush - candida Trichomonas vaginalis Actinomyces
60
What are actinomyces always associated with?
IUD
61
Describe vulval cancer associated with VIN (HPV Infection)
Occurs in women <60 Associated with CIN on cervix Related to HPV 16/18 Warty or basaxoid cancers
62
Describe vulval cancer associated with dermatoses
Older women >60 Well differentiated and keritanising Not associated with HPV or VIN Adjacent squamous hyperplasia and/or lichen sclerosus common

MBChB (14 decks)

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