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Repro > Gyn Path 2 & Cervical Cancer CPC > Flashcards

Gyn Path 2 & Cervical Cancer CPC Flashcards

1
Q

What is cause of endometrial hyperplasia?

A

Unopposed estrogen

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2
Q

What is clinical presentation of endometrial hyperplasia? When does it typically present?

A

Presents with abnormal bleeding during perimenopausal years

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3
Q

What are risk factors for endometrial hyperplasia? Big list

A

Tamxoifen, ovarian lesions (PCOS), obesity, HTN, diabetes, nulliparity, early age menarche, late menopause, cigarette smoking

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4
Q

What are protective factors for endometrial hyperlasia? (4)

A

Progesterone: large number of births, old age at first birth, long birth period, short premenopausal delivery-free period

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5
Q

What is gross appearance of endometrial hyperplasia?

A

Fleshy diffuse endometrium processes

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6
Q

What are histological features of hyperplasia (general)?

A

Increase in glands
Irregularities in gland shape and size
Mitotic activity

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7
Q

What are classifications of endometrial hyperplasia? What is risk for each for transformation?

A

Simple without atypia=1%
Complex without atypic=8%
Simple with atypia=3%
Complex with atypia=29%

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8
Q

What makes hyperplasia complex?

A

Amount of stroma, complexity of glands

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9
Q

Describe histological changes for:

  1. Simple hyperplasia without atypia
  2. Complex hyperplasia without atypia
  3. Complex hyperplasia with atypia
A

Simple/no atypia: more glands and they are of variable size…but nuclei are normal
Complex/no atypia: increased glands that are branching, decreased stroma but nuclei are still normal
Complex/atypia: Lots of glands, branching, little stroma, nuclei are large, speckled with prominent nucleoli

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10
Q

What is risk of cancer if hysterectomy performed immediately after diagnosis of hyperplasia?

A

Does not change! May be due to undetected carcinoma when hysterectomy performed

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11
Q

How do you distinguish endometrial hyperplasia from carcinoma? (4)

A

Myometrial invasion
Desmoplastic response: more fibrotic infiltrate of glands
Cribriform blands–confluent glands
Extensive papillary pattern

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12
Q

What is most common malignant tumor of female genital tract? What are risk factors?

A

Endometrial carcinoma– the risk factors are the same as for endometrial hyperplasia

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13
Q

What is the breakdown of type 1 vs. type 2 endometrial carcinomas?

A

Type 1: 80%

Type 2: 20%

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14
Q

What are the differences between type I and type II endometrial carcinoma?

A 
Grade, Indolent vs. aggressive
PTEN/K-Ras/MSI vs. P53
Cell type 
Precursor: hyperplasia vs. intraepithelial carcinoma 
Estrogen dependence 
Pre/perimenopausal vs. postmenopausal
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15
Q

What is the gross appearance of Endometrial carcinoma?

A

Polypoid, invasion of myometrium

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16
Q

Describe the histological appearance of type I endometrial carcinoma

A

Confluent proliferation of glandular epithelium

Increased nuclei size, decreased stroma, mitoses, branching, chromatin

17
Q

Describe the histological appearance of serous type II endometrial carcinoma: glands and cells

A

Complex papillae or irregular gaping glands

Cells: nuclear atypic, macronuclei, abnormal mitoses, psammoma bodies (calcifications)

18
Q

How can you detect type II endometrial carcinoma using IHC?

A

Stain for p53 to detect intraepithelial carcinoma

19
Q

Describe the histological appearance of clear cell type II carcinoma

A

Clear vacuolated cytoplasm

Markedly atypical nuclei

20
Q

How is endometrial carcinoma staged?

A

I: confined to uterus (endometrium, less than half of myometrium, more than half)
II: cervical involvement
III: serosa, adnexa, vaginal/pelvic lymph nodes
IV: bowel/bladder/distant

21
Q

What is the prognosis for endometrial cancer? Is it worse for any specific group?

A

Overall: 75-80%
Localized: 90% survival
Prognosis is significantly worse for african americans

22
Q

What are the types of cervical cancer? What is their frequency?

A

80% squamous
15% adenocarcinoma
5% other

23
Q

What are symptoms/signs of cervical cancer? (2)

A

Abnormal vaginal bleeding

Post-coital bleeding

24
Q

What are risk factors for cervical cancer? (5)

A 
HPV infection (16/18)
Multiple sexual partners
Cigarette smoking
Early sex
Immunosuppression
25
Q

What is screening for cervical cancer? Describe recommendations

A

20-29: Get pap smear every 3 years
30-65: Co-test every 5 years
Older: Don’t do anything if they’ve all been negative

26
Q

What are oncogenic types of HPV? Why? What are types associated with condylomata?

A

16/18: contain E6/E7 genes that cause cellular transformation (p53,RB, instability)
6/11: condylomata

27
Q

What is progression course for cervical cancer?

A

First LSIL or CINI (which can regress)

Then HSIL/CINIII, which over years progresses to squamous carcinoma

28
Q

Where is site of first neoplastic lesions? How is looked at?

A

The squamocolumnar junction (transformation zone)

Look at it using pap smear

29
Q

What are differences between US and worldwide regarding cervical cancer rates? Why?

A

All about screening–
10 deaths/day in US, 11th most common cancer in women, 2nd most common among women 20–39

Worldwide much worse–3rd cause of cancer deaths in women…disproportionately affecting underserved

30
Q

Describe gross appearance of cervical cancer (2)

A

Can be fungating obliterative tumor

Can also cause barrel cervix

31
Q

Describe stages of cervical cancer, treatment and corresponding prognosis

A

I: just cervix–>hysterectomy or XRT (above 84%)
II: upper vagina/parametrium–>hysterectomy or chemo/XRT (65-75%)
III: Lower vagina/pelvic wall: chemo/XRT (36%)
IV: distant mets, bladder–>chemo/XRT (13%)

32
Q

What is biggest risk factor for cervical cancer in US?

A

Not being screened

33
Q

What are koilocytes?

A

The bad things on pap smears– may have darker/bigger nuclei with a perinuclear halo

34
Q

What are risk factors for progression of cervical lesions?

A

Age, HPV type, smoking, multiparty, condom/OCP use, chlamydia

35
Q

What do you look for on colposcopy?

A

Can you visualize squamocolumnar junction? Satisfactory or nah

Acetowhite changes: density, thickness, punctuations, peeling, bleeding

36
Q

Treatment for HSIL?

A

Excision/ablatement

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