Female Reproductive Pathology 2 Flashcards
Describe some features of mullarian malformations
- Associated with renal and axial skeletal system abnormalities but tend to have functioning ovaries and age-appropriate external genitalia. Therefore these disorders don’t tend to be picked up until after the onset of puberty
How can congenital uterine anomalies be picked up?
- Heterosalpingogram,
- MRI,
- Hysteroscope
Name some examples of congenital uterine anomalies
- uterus didelphys,
- Uterus bicornis bicollis,
- Uterus bicornis unicollis,
- Uterus unicoris,
- Uterus unicornis with rudimentary horn,
- Uterus septus
What is the precancerous growth for vulval cancers?
Vulval intraepithelial neoplasias
What are the two subtypes of squamous cell vulval cancer and their features
One is more common in younger women and tends to be associated with HPV. The other occurs more often in older women and is associated with chronic vulval skin changes called vulval dystrophy including lichen sclerosus
Name two vulval epithelial disorders and their features
Squamous hyperplasia - Hyperkeratosis, irregular thickening of ridges (some neoplastic potential)
- Lichen sclerosus - Hyperkeratosis flattening of ridges, oedema in connective tissue with chronic inflammation (some neoplastic potential)
What are symptoms and treatment of lichen sclerosus?
It causes pruritis (itching) which is made worse by itching. Treated with potent tropical corticosteroids and follow ups as it does have neoplastic potential.
What is endometrial cancer and what is the most common symptom?
It is a common oestrogen-dependant cancer which tends to affect older women. It typically presents with postmenopausal bleeding so any postmenopausal bleeding is malignant until proven otherwise.
Name two abnormalities of the myometrium and their features
Adenomyosis (endometrial glands and stroma within myometrium causing menorrhagia/dysmenorrhoea)
Smooth muscle tumours (leiomyoma - fibroids associated with menorrhagia and infertility, these can grow to be very large and can compress bladder/rectum, and leiomyosarcomas)
What is endometriosis and what are its common sites?
- It is endometrial glands and stroma outside the uterine body. Common sites for growth are ovaries, pouch of dougles, peritoneal surfaces, cervix, vulva, vagina, bladder and bowel.
What can endometriosis cause?
Pelvic inflammation, infertility and pain (painful periods, painful sex, pain when moving bowels or passing urine)
What can ovarian cycts arise from?
- Mesothelial,
- Epithelial,
- Follicular,
- Luteal,
- Endometriotic
When should ovarian cysts be considered abnormal?
If patient is pre-pubertal, post-menopausal, pregnant of the mean diameter is larger than 3cm
How do women with polycystic ovary syndrome present?
With symptoms of hyperandrogenism (hirsutism, acne and alopecia and weight gain)
What are possible long term associations of polycystic ovary syndrome?
Type 2 diabetes mellitus, dyslipidaemia, hypertension, cardiovascular disease and endometrial carcinoma (risk of cancer is due to unopposed actions of oestrogen in absence of progesterone)
What can be involved in the management of polycystic ovary syndrome?
- Combined oral contraceptive pill or mirena intrauterine system; for contraception, protection against endometrial hyperplasia and cancer and to supress excessive androgen secretion.
What should make you consider a endometrial biopsy and/or hysteroscopy?
Thickened endometrium in an amenorrhoeic/oligomenorrhoeic women or in the presence of an endometrial polyp.
What are the classifications of ovarian neoplasms?
Epithelial (90%),
- Sex-cord/stromal,
- Metastatic,
- Miscellaneous
What are ovarian cancer symptoms?
- Non-specific GI symptoms such as bloating or indigestion.
- Chronic abdominal, pelvic or back pain,
- Urinary symptoms
- Leg swelling and DVT/PE due to pressure on pelvic veins.
- Abnormal vaginal bleeding,
- Symptoms of metastatic disease,
- Torsion, rupture or infection of tumour
What is the management of ovarian cancer?
- Surgical treatment which is generally total abdominal hysterctomy and bilateral salpingo-oophorectomy, infracolic omentectomy, pelvic and para-aortic LN sampling, peritoneal biopsies ect.
- Intraperitoneal chemotherapy is good as tumours tend to be radioresistant.
- Biological immunotherapy
What are hydatidiform moles/molar pregnancy
Cancers resulting from overproduction of tissue that is supposed to develop into placenta. Therefore they have high amounts of hCG
What is a complete hydatidiform mole?
When 1 or 2 sperm cells fertilize an egg that contains no nucleus so all genetic material comes from the father.
What is a partial hydatidiform mole?
When 2 sperm cells fertilise a normal egg (triploid)
What is an invasive hydatidiform mole?
Tumour that has grown into the muscle layer of the uterus.
What are choriocarcinomas?
Malignant form of gestational trophoblastic disease
What are ectopic pregnancies and their complications
Implantation of a pregnancy outside of the endometrial cavity (most commonly fallopian tube). It can cause catastrophic intra-abdominal haemorrhage
