Female Reproductive Pathology 2

Question 1

What are the most common cause of congenital uterine abnormalities?

Answer 1

Mullerian malformations

Question 2

What are mullerian malformations associated with?

Answer 2

Abnormalities or renal and axial skeleton systems

Question 3

What is the most common type of vulval cancer?

Answer 3

Squamous cell carcinoma which develops at edges of labia majora/minora

Question 4

What do most vulval cancers develop from?

Answer 4

Vulvar intraepithelial neoplasia

Question 5

What are the 2 types of squamous cell vulvar cancer?

Answer 5

HPV associated - seen in young people

Vulvar dystrophy (e.g. lichen sclerosus) associated - seen in older women

Question 6

What are the features of vulval squamous hyperplasia?

Answer 6

Hyperkeratosis
Irregular thickening of ridges
Some neoplastic potential

Question 7

What are the characteristics of Lichen Sclerosis?

Answer 7

Hyperkeratosis and flattening of ridges 
Oedema in connective tissue 
White patches - 'leukoplakia'
Pruitis
Some neoplastic potential

Question 8

What are the two types of endometrial adenocarcinoma?

Answer 8

Endometriod

Non-endometriod

Question 9

What are the features of endometriod endometrial adenocarcinoma?

Answer 9

Related to unopposed oestrogen

Associated with atypical hyperplasia and polycystic ovary syndrome

Question 10

What are the features of non-endometriod endometrial adenocarcinoma?

Answer 10

Affects elderly, post-menopausal women

p53 often mutated

Question 11

What are some rarer types of endometrial tumour?

Answer 11

Endometrial stromal sarcoma

Malignant mixed Mullein tumour

Question 12

What is adenomyosis?

Answer 12

Benign disease of the uterus due to the presence of ectopic endometrial glands and stroma within the myometrial hyperplasia

Question 13

What are the features of a myometrial leiomyoma?

Answer 13

Benign smooth muscle tumour
Can be intramural, submucosal and subserosal
Common
Associated with dysmenorrhoea and infertility

Question 14

What is endometriosis?

Answer 14

The presence of endometrial glands and stroma outside the uterine body

Question 15

What are the consequences of endometriosis?

Answer 15

Pelvic inflammation
Infertility
Pain

Question 16

What are small ovarian cysts a cause for concern?

Answer 16

When patient is pre-pubertal, post-menopausal, pregnant or the mean diabetes is >3cm

Question 17

How may people with polycystic ovary disease present?

Answer 17

Hirsutism
Acne
Hair loss
Menstrual disturbance
Infertility 
Obesity

Question 18

How do you get polycystic ovary disease?

Answer 18

Familial/ hereditary

Multifactorial and polygenic

Question 19

What is the treatment of PCOS?

Answer 19

Combined oral contraceptive pill

Question 20

What are the complications of PCOS?

Answer 20

Risk of endometrial hyperplasia and adenocarcinoma due prolonged stimulation of uterine cells by oestrogen (progesterone absent)

Question 21

What are the symptoms of metastatic ovarian cancer?

Answer 21

Pleural effusion
Ascites
Weight loss
Fatigue

Question 22

What is a dysgerminoma?

Answer 22

Undifferentiated tumour found in young women

Counterpart to male seminoma

Question 23

What is a teratoma?

Answer 23

Tumour that contains all three germ cell layers
Mature cystic teratomas common (benign)
Immature (malignant) uncommon

Question 24

Describe yolk sac tumours

Answer 24

Young women (<30)
Produces alpha fetoprotein
Highly malignant but treatable

Question 25

What is a fibroma?

Answer 25

Benign tumour of ovary that may produce oestrogen, causing uterine bleeding

Question 26

Where do metastatic ovarian tumours commonly originate from?

Answer 26

Stomach Colon Breast Pancreas

Question 27

Who are at risk of molar pregnancies?

Answer 27

Women under 16 and over 45 | Asian women

Question 28

What is a complete hydatidiform mole?

Answer 28

Develops when 1 or 2 sperm cells fertilise an egg that contains no nucleus or DNA More invasive potential that partial

Question 29

What is a partial hydatidiform mole?

Answer 29

2 sperm fertilise a normal egg | Tumours contain some foetal tissue mixed with trophoblastic tissue

Question 30

What is an invasive hydatidiform mole?

Answer 30

A mole that has grown into the myometrium

Question 31

What are the risk factors for invasive mole formation?

Answer 31

Long time between LMP and treatment for mole Uterus has become very large Woman >40 years Woman has had gestational trophoblastic disease in past

Question 32

Why do women with hydatidiform moles have high hCG levels?

Answer 32

Excessive amount of trophoblastic tissue which secretes hCG

Question 33

How can choriocarcinoma develop?

Answer 33

Molar pregnancy Abortion (spontaneous or intential) Tubal pregnancy Normal pregnancy

Question 34

Describe non-gestational choriocarcinomas

Answer 34

Can develop in men and women Can be in ovaries, testicles, chest, abdomen Often mixed with other cancers forming mixed germ cell tumour Less favourable prognosis

Question 35

What is gestational trophoblastic disease?

Answer 35

Group of pregnancy related tumours

Question 36

What is the worry with ectopic pregnancy?

Answer 36

The uterine tube could rupture causing fatal haemorrhage

Question 37

What is the mean age women develop Cervical Intraepithelial Neoplasia?

Answer 37

25-30 years

Question 38

How many cases of LSIL become more sinister?

Answer 38

6% progress to HSIL | 1% become invasive cancer

Question 39

What are some possible complications of cervical cancer spread to surrounding areas?

Answer 39

Ureteral compression resulting in hydroureter, hydronephrosis and renal failure If bladder and rectum involved, fistula may develop

Question 40

Which nodes are involved n lymphatic spread of cervical cancer?

Answer 40

Paracervical Hypogastric External iliac

Question 41

What is a red flag for breast cancer in over 50s?

Answer 41

Unilateral changes in nipple including discharge

Question 42

What is the typical presentation of endometriosis?

Answer 42

Chronic pelvic pain Pain during sex Dysmenorrhoea Rectal pain on defecation

Question 43

What is the gold standard test for endometriosis?

Answer 43

Gynaecological laparoscopy

Question 44

What is the common presentation of Wilm's tumour?

Answer 44

Asymptomatic abdominal mass with insidious growth