Gynae Pathology Flashcards
What do you call inflammation or infection of the fallopian tube?
Salpingitis
Name three infections of the female genital tract that cause discomfort but no serious complications
Candida
Trichomonas vaginalis
Gardnerella
Name four infections of the female genital tract with serious complications
Chlamydia - infertility
Gonorrhoea - infertility
Mycoplasma - spontaneous abortion and chorioamnionitis
HPV - cancer
What increases the chance of getting a candida infection?
Diabetes mellitus, oral contraceptives, pregnancy
What type of organism is trich?
Protazoan
What is gardnerella?
Gram -ve bacillus which causes vaginitis
Which organism can cause spontaneous abortion and chorioamnitis?
Myoplasma genitalium
Name three organisms causing PID due to ascending from lower genital tract
Gonorrhoea
Chlamydia
Enteric bacteria
Name four other organisms causing PID
Staph
Strep
Coliform bacteria
Clostridium difficile
Deep tissue layer invovlement
Start at uterus and spread by lymph nodes
Secondary to abortion
Complications of PID
Infertility
Peritonitis
Bacteremia/sepsis
Intestinal obstruction due to adhesions
List some complications of salpingitis
Ectopic pregnancy
Hydrosalpinx
Tuboovarian abscess
Peritonitis
Adhesions to the ovary
Infertility
Plical fusion
What is the second most common type of cancer in women worldwide?
Cervical cancer
List sites of ectopic pregnancies. Which site is most common?
Peritoneum
Abdomen
Tubal - 95 percent
Ovarian
Epidemiology of cervical cancer
Mean age: 45-50 years old
RF for cervical cancer
HPV
Smoking
Multiple partners
Immunosuppression
Sexual activity from an early age
Which are low risk HPVs?
6 and 11
They cause genital and oral warts
High risk HPVs
16 and 18
Low and high grade cervical dysplasia
Name the parts of the cervix, and what type of cells line these.
Mucinous epithelium lines the endocervix
Stratified epithelium lines the ectocervix
Transitional zone in the middle
What do you call it when some of the cells become cancerous? Explain this
Cervical intraepithelial neoplasia
This is where the cells have acquired some genetic and phenotypical changes, but haven’t invaded past the basement membrane yet
Which type of epithelium is more commonly involved in intraepithelial neoplasia of the cervix?
CIN (squamous) < CGIN (glandular)
What is the prognosis of squamous or adenocarcinomas dependent on?
Tumour type
Tumour grade
Tumour stage - FIGO staging I-IV
Lymphovascular space invasion
What are the two modes of existence of HPV?
Latent or productive phase
Explain the pathogenesis of cancer from HPV
HPV is a DNA virus which encodes two proteins which inactivate tumour suppressor genes.
E6 suppresses p53 (proliferation)
E7 suppresses Rb (apoptosis)
Both interfere with apoptosis and allow uncontrolled proliferation.
In some cases, the body can eliminate HPV within how many years?
2 years
Screening program for cervical cancer
25-49 - every 3 years
50-64 - every 5 years
When is the HPV vaccine given?
Aged 12-13 girls and boys
Second dose 6 to 24 months after 1st dose
List three types of cancers which are screened for
Bowel
Breast
Cervical
Causes of endometrial hyperplasia
PCOS
Perimenopause (oestrogen)
Persistent anovulation
Ovarian granulosa cell tumours
Oestrogen therapy
Endometrial carcinoma
Epidemiology of endometrial cancer
Most common gynae cancer in global north
RF for endometrial cancer
Obesity
Diabetes mellitus
Nulliparity
Excessive oestrogen stimulation
List some histological subtypes of endometrial cancer
Endometrioid
Serous
Clear cell
Squamous
Mesonephric
Mucinous
Carcinosarcoma
Mixed cell
Undifferentiated
Most common histological subtype of endometrial cancer
Endometrioid - atypical endometrial hyperplasia
Oestrogen dependent
High and low grade
Compare endometriod endometrial cancer with clear cell carcinoma and serous carcinoma
Clear cell and serous are:
Less common
Older, postmenopausal women
No precursor / not oestrogen dependent
High grade, stage
Whereas endometriod cancer is
More common
Any age
Oestrogen dependent
Low and high grade
Occurs through multiple gene mutations
What mutations are seen in serous cell carcinoma?
P53 (90 percent)
P13KCA mutations in 15 percent of Her-2 amplification
What mutations are seen in clear cell carcinoma?
PTEN
CTNNB1
Her-2 amplificaiton
FIGO staging for endometrial cancer - what are the main things they look for?
Stage 1 - confined to CORPUS uteri
Stage 2 - invades cervical stroma
Stage 3 - local or regional spread
Stage 4 - bladder/bowel/distant invasion
