Female Reproductive Pathology 2 Flashcards
What are the important features of Mullerian malformations?
- associated with abnormalities of the renal and axial skeleton systems
- have functioning ovaries and age-appropriate external genitalia
- after onset of puberty, usually present with menstrual disorders
- late presentations usually with infertility and obstetric complications
What are the important features of vulval cancers?
- majority is squamous cell carcinomas
- usually develop from pre-cancerous, preinvasive areas called vulval intraepithelial neoplasia
- 2 subtypes;
- associated with HPV - younger women
- associated with chronic vulval skin changes (vulval dystrophy) and lichen sclerosus - older women
Describe some vulval epithelial disorders
- squamous hyperplasia: hyperkeratosis, irregular thickening of ridges, neoplastic potential
- lichen sclerosus: hyperkeratosis, flattening of ridges, oedema in connective tissue and chronic inflammation, neoplastic potential
Describe the clinical appearance of lichen sclerosus (vulval dystrophy) and its treatment
- sometimes white patches called leukoplakia
- causes itching (pruritis)
- picking the skin makes it worse (excoriation)
- treated with potent topical corticosteroids
What is the main presenting symptom of endometrial cancer?
post-menopausal bleeding
Describe some abnormalities of the myometrium
- adenomyosis: endometrial glands and stroma present within the myometrium, causes menorrhagia/dysmenorrhoea
- smooth muscle tumours: leiomyoma/fibroid (common and associated with menorrhagia and infertility) and leiomyosarcoma
What is endometriosis and its complications?
- endometrial glands and stroma present outside the uterine body
complications:
- pelvic inflammation
- infertility
- pain
What are the possible sites of endometriosis?
- ovary (chocolate cyst)
- pouch of Douglas
- peritoneal surfaces, including uterus
- cervix, vulva, vagina
- bladder bowel etc.
Where can ovarian cysts originate from?
Can be:
- mesothelial
- epithelial
- follicular
- luteal
- endometriotic
Describe a possible clinical presentation of polycystic ovary syndrome
- hyperadrogenism
- hirsutism (growing dark/coarse hair in male pattern)
- acne
- alopecia
- menstrual disturbance
- infertility
- obesity
What are the long term complications of polycystic ovary syndrome?
- type 2 diabetes
- dyslipidaemia
- hypertension
- cardiovascular disease
- endometrial carcinoma
What are some treatment options for PCOS?
- combined contraceptive pill for
- contraception
- to prevent development of endometrial hyperplasia and cancer
- suppress excessive androgen secretion to control acne and hirsutism
- alternative treatment can be the Mirena intrauterine system (the coil)
How would you describe an ovarian neoplasm?
- solid or cystic
- benign or malignant
- classification:
- epithelial (90%)
- germ cell
- sex cord/stromal
- metastatic
- miscellaneous
What are different types of epithelial ovarian tumours?
- benign
- borderline (cytological abnormalities with no stromal invasion)
- malignant (stromal invasion)
What are the symptoms of ovarian cancer?
- non-specific GI symptoms (bloating/indigestion/)
- gradually increasing abdominal distension
- increasing size of tumour causes pressure effects (chronic abdo, pelvic, back pain; increases urinary frequency/urgency; constipation/altered bowel habits; leg swelling/DVT/PE)
- abnormal vaginal bleeding
- metastatic symptoms: ascites, pleural effusion, weightloss, fatigue
