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Pathology > Gynae histopath > Flashcards

Gynae histopath Flashcards

1
Q

What is PID?

A

Infection ascedning from cervix/vag to uterus & tubes (endometritis & salpingitis) causing inflammation and fomration of adhesions

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2
Q

Most common causative organisms for PID in UK? (2)

A

Chlamydia Trachomatis
Neisseria gonorrhea
in other places TB & schisto are common

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3
Q

Clinical presentation of PID (6)

A 
Lower abdo pain, fevers, chills
Dyspareunia
Vaginal bleeding/ discharge
adnexal tenderness
Cervical excitation
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4
Q

Complications of PID (6)

A 
Infertility
Sepsis
Fitz-hugh-curtis syndrome - peri hepatic adhesions (RUQ pain)
Plical fusion
increased risk of ectopic
chronic pelvic pain
tubo-ovarian abscess
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5
Q

What is endometriosis?

A

Presence of endometrial glands/ stroma outside the uterus

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6
Q

Common places for endometriosis? (4)

A

POD
ovaries
uterine ligament
rectovaginal septum

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7
Q

Clinical features of endometriosis? (5)

A

pelvic pain, dysmennorhhea, reduced fertility, deep dyspareunia
Nodules/ tenderness in vag/posterior fornix/uterus ;
immobile uterus which is retroverted in advanced disease

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8
Q

What is adenomyosis?

A

Presence of endometrial tissue in the myometrium

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9
Q

Clinical features of adenomyosis (4)

A

Deep dyspareunia, menorrhagia, dysmenorrhea, globular uterus

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10
Q

What is a leiomyoma (fibroid)?

A

benign tumour of SM origin

(most common tumour of the female genital tract) 20% of women > 35 will have

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11
Q

3 sites where fibroids can be found

A

Submucosal
Intra mural
Subserosal
oestrogen dependent - enlarge during pregnancy, regress during menopause

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12
Q

Macroscopic appearance of fibroids (4)

A

Round, discrete, firm, gray/ white tumours of variable size

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13
Q

Microscopic appearance of fibroids (1)

A

Bundles of SM cells

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14
Q

Clinical features of fibroids (5)

A

Reduced fertility
Menorrhagia
dysmenorrhea
pressure symptoms - urgency/freq or tenesmus
Red degeneration of fibroids in pregnancy

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15
Q

What % of women with PMB will have a malignancy?

A

10% - PMB is endometrial cancer unless proven otherwise

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16
Q

Endometrial cancer is subdivided into which types?

A

Endometroid (80%) & non-endometroid (20%)

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17
Q

Pathophysiology of endometrioid endometrial cancer? (2)

A

Related to oestrogen excess
Peri-menopausal women
these are mainly adenocarcinomas (85%) but can show squamous differentiation

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18
Q

Risk factors for endometroid cancer? (7)

A

Oestrogen excess - obesity, anovulatory amenorrhoea (e.g. PCOS), nulliparity, early menarche, late menopause, tamoxifen
Also DM & HTN

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19
Q

Subtypes of non-endometroid endometrial cancer (3)

A

Serous
Papillary
clear cell

20
Q

Pathophysiology of non-endometroid endometrial cancer

A

Unrelated to oestrogen excess; usually in elderly women with endometrial atrophy

21
Q

Normally what type of cells make up the vulva? i.e. normal vulval histology

A

Squamous epithelium

22
Q

VIN pathology (similar to CIN)

A

Dysplasia of epithelium - associated with HPV
graded VIN I, II & III
but progression to invasive disease is lower than for CIN (5%)

23
Q

Vulval carcinoma arises from (2) (mainly squamous cell carcinoma)

A

VIN

or other skin abnormality e.g. Paget’s of vulva

24
Q

Ovarian carcinomas - 3 types

A

Epithelial
Germ cell
Sex-cord/ stroma

25
Q

Subtypes of ovarian epithelial carcinomas (4)(70%)

A 
Serous
Mucinous
Clear cell
Endometriod 
these are derived from the epithelium that covers the ovary. THey can be benign, borderline, or malignant serous
26
Q

Characterisitics of serous epithelial ovarian carcinoma (2)

A

Most common
Psammoma bodies
mimics tubular epithelium - so columnar

27
Q

Characterisitcs of mucinous ovarian carcinomas (2)

A

Mucin secreting cells - similar to those of endocervical mucosa
Or intestinal type metastatic from appendix in some cases causing PSEUDOMYXOMA PERITONEI (fills peritoneal cavity with mucin - compression of organs and scarring)
No Psammoma bodies

28
Q

Characteristics of endometriod ovarian carcinomas (1)

A

Mimics endometrium - form tubular glands

29
Q

Characteristics of Clear cell ovarian carcionmas (2)

A

Abundant clear cytoplasm - IC glycogen

HOBNAIL appearance

30
Q

Subtypes of germ cell ovarian carcinomas: (3) (20%)

A

Teratoma
Dysgerminoma
Choriocarcinoma
Derived from germ cells (produce gametes). Usually benign in adults, MALIGNANT in children

31
Q

Characterisitcs of a dysgerminoma (1)

A

Female counterpart of testicular seminoma

32
Q

Characteristics of ovarian Teratoma (4)

A

Can be ecto, meso or endo - mostly ecto
Mature teratomas (dermoid cyst): benign; usually cystic
e.g. bone, hair, teeth etc.
Immature teratomas - MALIGNANT - usually SOLID
Contain immature embroyonal tissue

33
Q

Characteristics of choriocarcinoma (1)

A

Secretes hCG

34
Q

Subtypes of Sex cord/ stroma tumours (10%)

A

Fibroma - from cells of ovarian stroma
Granulosa-thecal cell tumours
Sertoli-leydig tumour

35
Q

Characteristics of ovarian fibromas (2)

A

No hormone production

V. Osmotically active > cause ascites + pleural effusion = MEIG’S syndrome

36
Q

Characteristics of granulosa-theca cell tumours (3)

A

Produce Oestrogen:
Look for oestrogenic effects: in children precocious puberty, irregular menses, breast enlargement, endometrial/ breast cancer

37
Q

Characteristics of Sertoli-Leydig cell tumours (3)

A

Secrete androgens:

Look for defeminsation: breast atrophy, virilisation (hirsuitism, deepened voice, enlarged clit)

38
Q

Describe the normal cervix histology (3)

A

Outer cervix = squamous epithelium
Endo cervical canal = columnar glandular epithelium
Junction between them is the squamous columnar junction (SCJ) AKA transition zone - susceptible to malignancy

39
Q

what is CIN? (1)

A

Dysplasia at the TZ due to HPV 16/18 infection

40
Q

Grading of CIN on cytology (3)

A

Graded mild, moderate or severe dyskaryosis on cytology.

41
Q

Grading of CIN on histology (3)

A

CIN 1 - dysplasia confined to lower third of epithelium
CIN 2 - dysplasia lower 2/3rds
CIN 3 - Full thickness of epithelium - but BM intact

60- 90% of CIN 1 reverts to normal in 2 yrs , 30% of CIN 3 goes to cervical cancer over 10 yrs

42
Q

Risk factors for CIN (4)

A 
Early age at 1st intercourse
Multiple partners
multiparity
smoking
HIV/ immunosuppression
43
Q

What is CGIN? How to treat it?

A

Cervical glandular intraepithelial neoplasia - less common + harder to diagnose on cytology
Treatment requires excision of entire endocervix (this can compromise fertility)

44
Q

Cervical carcinoma usually arises from what? (1)

A

CIN

45
Q

Types of Cervical carcinoma (2)

A 
Mostly squamous (70/80 %) 
20% adenocarcinomas, adenosquamous & others
46
Q

What marks the change between CIN & Cervical cancer?

A

invasion of BM

47
Q

Clinical features of cervical carcinoma (4) (majority of lesions benign - staged using FIGO)

A

PCB, IMB, PMB, discharge, pain

Pathology (20 decks)

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