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MBChB > Female Pathology > Flashcards

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
Q

How are ovarian endometriod carcinomas microscopically characterised?

A

Neoplastic tubular glands

26
Q

What proportion of women with ovarian endometriod carcinoma also have endometrial carcinoma?

A

15-20%

27
Q

What tumour suppressor gene is lost in ovarian endometriod carcinoma?

A

PTEN

28
Q

What is ovarian clear cell carcinoma associated with?

A

Endometriosis

29
Q

What are 95% of ovarian germ cell tumours?

A

Mature cystic teratomas

30
Q

What are 5% of ovarian germ cell tumours?

A

Immature cystic teratomas

31
Q

What type of ovarian germ cell tumour is more aggressive?

A

Immature cystic teratoma

32
Q

What hormone is secured by granulose and theca cell tumours?

A

Oestrogen

33
Q

In what age group do granulose cell tumours usually occur?

A

Post-menopausal women

34
Q

What is the triad of Meig’s syndrome?

A

Ovarian fibroma
Ascites
Pleural effusion

35
Q

What is a Brenner Tumour?

A

Uncommon mixed surface epithelial-stromal tumour

36
Q

Prior to puberty, what epithelium covers the ectocervix?

A

Non-keratising stratified squamous epithelium

37
Q

Prior to puberty, what epithelium covers the endocervix?

A

Columnar epithelium

38
Q

At what site of the cervix do most cervical neoplasms develop?

A

Transformational zone (site of squamous metaplasia)

39
Q

What HPV strains are associated with the development of cervical cancer?

A

16 and 18

40
Q

During cervical cytology, what is indicative of CIN?

A

Presence of dyskaryosis

41
Q

What is the screening programme for cervical cancer?

A

Women between 25 and 65

25-50: every 3 years
50-65: every 5 years

42
Q

If on cervical cytology there are borderline nuclear abnormalities, what is the next step?

A

Repeat in 6/12

If 3 borderline results –> colposcopy

43
Q

If on cervical cytology there is low grade dyskaryosis, what is the next step?

A

Repeat in 6/12

If 2 –> colposcopy

44
Q

If on cervical cytology there is high grade dyskaryosis, what is the next step?

A

Colposcopy

45
Q

If on cervical cytology there is glandular abnormality, what is the next step?

A

Colposcopy

46
Q

If on cervical cytology there are features suggestive of invasion, what is the next step?

A

Urgent colposcopy

47
Q

What do early genes of HPV do?

A

E1 to E7

Interact with intracellular molecules to interfere with cell proliferation machinery to replicate the virus

48
Q

What do late genes of HPV do?

A

L1 and L2

Encode capsid proteins which cause disruption of the cell cycle checkpoints

May contribute to accumulation of oncogenic mutations and carcinogenesis

49
Q

From 2020, what mode will cervical screening take?

A

Screening for HPV

If positive –> cytology

50
Q

Describe coloposcopy

A 
Cervix is visualised
Washed with acetic acid 
Application of iodine
Green light filter
Abnormal area can be biopsied or treatment performed
51
Q

Describe the features of CIN 2

A

2/3 of epithelium involved
Nuclear enlargement with dense hyperchromasia
Course chromatin clumping

52
Q

Describe the features of CIN 3

A

Full thickness involvement of the epithelium

53
Q

What are the two methods of treating CIN?

A

LETZ

Post Cold Coagulation

54
Q

What complications are associated with treating CIN?

A

Immediate: pain, haemorrhage
Delayed: secondary haemorrhage, infection, cervical stenosis

55
Q

What metaplastic change can endocervical glandular epithelium undergo?

A

Cervical glandular intraepithelial neoplasia (cGIN)

56
Q

What symptoms are associated with cervical cancer?

A 
Post coital bleeding
Intermenstrual bleeding
Irregular vaginal bleeding 
Pain
None
57
Q

What condition affecting the vagina is caused by low oestrogen levels following the menopause?

A

Atrophic vaginitis

58
Q

What symptoms are associated with atrophic vaginitis?

A

Discomfort, dyspareunia, bleeding

Cysts and polyps not uncommon

59
Q

What infections may involve the vagina?

A

Bacterial vaginosis
Thrush - candida
Trichomonas vaginalis
Actinomyces

60
Q

What are actinomyces always associated with?

A

IUD

61
Q

Describe vulval cancer associated with VIN (HPV Infection)

A

Occurs in women <60
Associated with CIN on cervix
Related to HPV 16/18
Warty or basaxoid cancers

62
Q

Describe vulval cancer associated with dermatoses

A

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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