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gynae 1 Flashcards

1
Q

State the location where you can find:
a) Herpes
b) Molluscum
c) HPV
d) Chlamydia
e) N. Gonorhoaeae
f) Candida
g) Trichomonas

A

a) Vulva
b) Vulva
c) Anywhere in the female genital tract
d) Vagina, Cervix, Corpus, Adnexa
e) Anywhere in the female genital tract (but presentation differs)
f) Vulva
g) Vagina

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2
Q

How does HPV present?

A

Genital warts
Intraepithelial neoplasia
Invasive Carcinoma

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3
Q

How does chlamydia trachomatis present?

A

Follicular cervicitis
Endometritis
Salpingo-oophoritis

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4
Q

How does Gonorrhoaea present?

A

Vulva - Skene gland adenitis
Vagina - Vaginitis in children
Cervix - Cervicitis
Corpus & Adnexa - Acute endometrotos and salpingitis

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5
Q

In the female genital tract, how does the following appear?
a) Bacteria
b) Protozoa
c) Fungi
d) Virus

A

a) Purulent Discharge
b) Thin, greenish, yellow bubbly discharge
c) Patchy, white adherent exudate
d) Vesical fluid, multinucleate giant cells

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6
Q

How does Pelvic Inflammatory DIsease present? What are complications of PID?

A

Pelvic Pain
Adnexal tenderness
Fever and vaginal discharge

Peritonitis
Adhesions
Bacteraemia
Tubal Pregnancy (due to strictures)
Infertility

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7
Q

What are pathologies of the vulva?

A
  1. Bartholin Cyst
    - Barthonlin duct obstruction, leading to accumulation of secretions in the gland, leading to infection
  2. Non-neoplastic Epithelial Disorders
    - Lichen Sclerosus
    – Autoimmune, leading to atrophy of external genitalia within the vulva region
    – Produces some discoloration
    – Epithelium is thinned, dermis shows sclerotic sclerosis and inflammation
    - Lichen Simplex Chronicus
    – secondary to chronic pruritis
    – epithelium is hyperplastic (hyperkeratosis, thickened epidermis)
  3. Neoplasms
    - Benign: Hidradenoma, Condylomas
    - Malignant: VIN (secondary to HPV), SCC, Paget’s
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8
Q

What is vulva-paget disease?

A

An insitu carcinoma of primitive epithelial progenito cells

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9
Q

How can you identify vulva-paget disease?

A

Low Molecular Weight Cytokeratin Stain (CK7)
Redness of the Vulva

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10
Q

What is the pathogenesis of HPV-related vulvar malignancy?

A

Infection by HPV, producing florid papillomatosis throughout the entire vulva epithelium

Epithelium is thrown into papillary processes – dysplastic changes in epithelium

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11
Q

A key clinical feature of HPV-related Vulva Carcinoma?

A

Condylomata Acminata

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12
Q

How does non HPV-related Vulva Carcinoma develop?

A

Background of lichen sclerosus or squamous cell hyperplasia from differentiated vulvar intraepithelial neoplasia (VIN)

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13
Q

How does squamous cell carcinoma of the vulva present?

A

Keratinisation/Keratin Pearls
Intercellular Bridges
Pavemented appearance

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14
Q

What are the 4 broad categories of vaginal pathologies?

A
  1. Congenital Abnormalities
  2. Vaginal Intraepithelial Neoplasia (VAIN)
  3. Adenocarcinoma
  4. Embryonal Rhabomyosarcom
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15
Q

Explain a congenital abnormality of the vagina.

A

Agenesis of the vagina or septum formation
(mullerian duct does not fuse properly)

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16
Q

What are histological features of clear cell adenocarcinoma of the vagina?

A

Vacuolated Tumour Cells in Clusters and Gland-like structures

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17
Q

What is a precursor for Clear Cell Adenocarcinoma?

A

Vaginal Adenosis

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18
Q

Who does Clear Cell Adenocarcinoma occur to.

A

Young women (15-20yo) whose mothers treated with DES during pregnancy

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19
Q

How does embryonal rhabdomyosarcoma present?

A

Grape-like clusters

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20
Q

Who does embryonal rhabdomyosarcoma occur to?

A

Infants & Children

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21
Q

How to treat embryonal rhabdomyosarcoma?

A

Surgery & Chemotherapy

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22
Q

REVISE: What is the type of epithelium for the endocervix, external os, and ectocervix?

A

a) Columnar Epithelium
b) Squamocolumnar Junction
c) Stratified Squamous Epithelium

23
Q

Grading for cervical neoplasms (what type of displasia = what type of CIN)

A

Mild Dysplasia - CIN I
Moderate Dysplasia = CIN II
Severe Dysplasia = CIN III
Carcinoma In Situ = CIN III

24
Q

What are 4 key risk factors for cervical neoplasia?

A
  1. Multiple Sexual Partners
  2. Male partner with multiple previous sexual partners
  3. Certain HLA and viral subtypes
  4. Genital Infections (chlamydia)
25
Q

What is the pathogenesis of HPV and its link to cervical cancer

A

HPV 16 & 18: 16 esp associated with amplificaton of 3q
Cell cycle regulation disrupted by viral oncogenes
- E6 –> p53
- E7 00> RB

26
Q

Histological features of a HPV infection

A
  1. Multinucleation
    2, Perinuclear Haloes
  2. Crinkled Nuclei
  3. Koilocytosis - CIN I
  4. IHC stain can identify HPV DNA
27
Q

What are two main tests for cervical cancer?

A
  1. PAP Smear
  2. HPV Test
28
Q

What is the pathogenesis of cervical neoplasia?

A

HPV Infection
Progression to cervical intraepithelial neoplasia (CIN)
Invasion

29
Q

What is the gross appearance of carcinoma of cervix? Symptoms?

A

Fungating, Ulcerating, Infiltrative

Intermenstrual Bleed, Post menopausal blled, dysparaunia

30
Q

Types of cervix carcinoma?

A
  1. Squamous Cell Carcinoma (75-90%)
    - Large Cell non keratinising
    - Large cell keratinising
    - small cell
  2. Adenocarcinomas, Adenopsquamous Carcinomas, Undifferentiated (10-25%)
31
Q

For stage 1,2,3,4, cervical carcinoma, where do the invade?

A

1 - cervix
2 - upper vagina or parametrium
3 - pelvic wall or lower vagina
4 - rectum/bladder, extra pelvic

32
Q

What are 4 pathologies of the endometrium?

A
  1. Polyps
  2. Hyperplasia
  3. Carcinoma
  4. Stromal neoplasms
33
Q

Define Endometrial Hyperplasia

A

Increase in number of glands relative to stroma

34
Q

Cause of endometrial hyperplasia

A

Unopposed estrogen stimulation

35
Q

The two subtypes of endometrial hyperplasia are?

A

Atypical (Complex) and Non-Atypical (Simple)

36
Q

Histological features of simple hyperplasia of endometrium. Progress to adenocarcinoma?

A

Cystic hyperplasia: Proliferative, irregularly dilated glands. No

37
Q

Histological features of complex hyperplasia of endometrium. Progress to adenocarcinoma?

A

Glandular crowding and irregular shape, epithelial stratification. High risk of cancer

38
Q

Mutation in complex hyperplasia of endometrium?

A

Loss of PTEn

39
Q

What are the two types of endometrial carcinomas? What are the causes behind them.

A

Type 1: Prolonged Estrogen Stimulation
- Endometrial hyperplasia
- Ovarian Estrogen Secreting Tumours
- ERT
Type 2: No Association with Estrogen
- p53 mutation
- poorly differentiated serous type
- poor prognosis

40
Q

Clinical & Histological Features of Endometrial Carcinoma?

A
  1. Abnormal Bleeding
  2. Intermenstrual Bleeding

Squamous Metaplasia, Invasion into underlying smooth muscle

41
Q

Where does endometrial carcinomas invade, based on their stage?

A

1 - Corpus
2 - Corpus & Cervix
3 - Pelvis
4 - Beyond pelvis

42
Q

What are pathologies of the smooth muscle region of the endometrium?

A

Leiomyoma
Leiomyosarcoma

43
Q

Locations of leiomyoma?

A

Subserosal, Submucosal, Intraural, Pedunculated

44
Q

Symptoms of leiomyomas?

A
  1. Abnormal Bleeding
  2. Bladder Compression
  3. Sudden Pain
  4. Infertility
  5. Spontaneous Abortion
  6. Most asymptomatic
45
Q

Progestins and pregnancy may cause rapid increase in size and hemorrhagic degeneration ‘red degeneration’

A

pls note

46
Q

What histological features can be seen in leiomyosarcomas?

A
  1. Increased mitosis
  2. Necrosis
  3. Atypia
47
Q

What are stromal neoplasms of the endometrium called? What is rhe progression of it?

A

Endometrial Stromal Neoplasms.

Becomes a sarcoma once invades vessel

48
Q

What are the symptoms of endometriosis?

A

Dysmenorrhea, Pelvic Pain, Infertility

49
Q

Risk of Endometriosis?

A

Precursor to endometrioid and clear cell carcinoma

50
Q

What is adenomyosis

A

Ectopic endometrial deposits in the myometrium, with accompanying overgrowth of muscle and connective tissue

51
Q

Describe the two forms of adenomyosis

A

Diffuse (commoner)
- deposits confined to inner myometrium
- foci of endometrium often brown in colour
Localised
- resembling fibroid but with brownish foci

52
Q

Histological features of adenomyosis?

A

1/ Trabaculation
2. Subcystic changes
3. Hemorrhage
4. Endometrial tissue, tubular glands and endometrial stroma between muscle bundles

53
Q

What are causes of abnormal bleeding?

A

Gynae (3 decks)

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