Gynae Pathology

Question 1

identify this and how to describe it

Answer 1

lichen sclerosus
- atrophic plaques
- intense puritus (itch)

Question 2

who is lichen sclerosus usually found in, and where

Answer 2

post menopausal women at the anogenital area

Question 3

what could lichen sclerosus lead to? (one malignant, and one worse rash)

Answer 3

• chronic inflammatory disease
• chronic scratching leads to lichen simplex chronicus
• could lead to** squamous cell carcinoma**

Question 4

what is this condition, and what is it caused by?

Answer 4

vaginal agenesis (no vagina)
- due to lack of mullerian duct development

Question 5

what pathology of the fallopian tubes is here and what does it arise from

Answer 5

hyatids of morgagni (paratubual cyst)
arises from remants of the mullerian duct

Question 6

identify this pathology and some causes of it

(there is fluid in the fallopian tubes)

Answer 6

hydrosalpinx
(fluid filled fallopian tube)

PID and endometriosis

Question 7

what organisms cause PID

Answer 7

1.** chlamydia trachomatis **
2. neisseria gonorrhoea

Question 8

hydrosalpinx vs pyosalpinx

Answer 8

fluid filled vs pus filled

Question 9

what are inflammed fallopian tubes called?

Answer 9

salpingitis

salpinx~ :tube
itis:inflammation

Question 10

Answer 10

isthmus
interstitum
inter –> in the middle of (it is the connection between the fallopian tube and the womb)

Question 11

what condition is more likely in women with IUDs?

Answer 11

actinomyotic salpingitis
- caused by actinomyces israeelii
- shows gram + organism

Question 12

what is the most common ovarian mass in young women?

Answer 12

follicular cysts

Question 13

what are follicular cysts caused by?

Answer 13

graffian follicle fails to rupture
= continues to grow
= develops into large cysts with granulosa cells

Question 14

how does hyperinsulinema lead to hyperplasia and hyperpigementation?

Answer 14

insulin resistance
= more IGF-1 produced
= increased melanocyte and keratinocyte proliferation
= hyperplasia and hyperpigmentation

Question 15

what are multiple follicular cysts also known as?

Answer 15

polycystic ovary syndrome

Question 16

what are corpus lutheal cysts caused by?

Answer 16

build up of fluid in corpus lutheum
= enlargement of CL
= produce excess progestrone
= delay mences
= menstrual irregularities

Question 17

what are the 3 layers of the uterine wall?

Answer 17

(inner)
endometrium
MYOmetrium
PERImetrium
(outer)

Question 18

what cells is the endometrium lining made out of?

Answer 18

simple columnar epithelium (contains microvilli to push the egg around)

Question 19

what is the most common benign tumour of the endometrium

Answer 19

endometrial hyperplasia

1. COMPLEX hyperplasia (with atypia)
2. SIMPLE hyperplasia (no atypia)

Question 20

what is the histological presentation of complex vs simple hyperplasia?

Answer 20

COMPLEX: (high risk of carcinoma)
- glandular crowding
- epithelial stratification
- loss of PTEN gene

SIMPLE: (low risk of carcinoma)
- dilated glands

Question 21

fibroids vs cysts

Answer 21

fibroids: uterus
cysts: ovaries

Question 22

what is the most common UTERINE neoplasm in young women?

Answer 22

leiomyoma

Question 23

which carcinoma does endometriosis increase the risk of, and why?

Answer 23

clear cell carcinoma

endometriosis
= ectopic endometrial tissue
= chronic inflammation
= increase risk of mutations
= CCC

Question 24

why does obesity increase the risk of PCOS?

Answer 24

obesity
= increase adipose tissue
= increase peripheral estrogen
= PCOS risk increases

Question 25

what is this pathology

Answer 25

adenomyosis

Question 26

what is adenomyosis characterised by?

Answer 26

hyperplasia of endometrial basal layer
= etopic endometrial deposits in the myometrium

Question 27

what types of adenomyosis are there, and which one is more common?

Answer 27

diffuse and localised type

diffuse adenomyosis is more common

Question 28

what is the most common neoplasm (tumour) of the fallopian tube, and how to describe it?

Answer 28

adenomaTOID tumour

it is a tumour of the visceral mesothelial layer
= usually asymptomatic

Question 29

**low yield

what are the histological findings of adenomaTOID tumours?

Answer 29

1. tubular spaces of varying sizes
2. flattened cells in desmoplastic stroma (desmoplastic = formation of fibrous tissue)

Question 30

what does endometriosis affecting the fallopian tubes result in?

Answer 30

salpingitis isthmica nodosa + hydrosalpinx
= increased probability of infertility

salpingitis = inflammation of the fallopian tubes
isthmica = at the isthmus
nodosa = formation of nodules

Question 31

what is the most common type of ovarian tumour?

Answer 31

epithelial ovarian tumours

Question 32

**think of the ovary as a grape

1. epithelial (skin)
   2.sex cord/ stromal (flesh)
2. germ cell (seed)

What possible neoplasms can occur at these 3 levels?

Answer 32

epithelium:
1. cystadenoma - mucinous and serous (benign, borderline or malignant)
2. brenner tumour
3. Clear cell carcinoma

4. Endometrioid carcinoma

stroma
1. ovarian fibroma
2. thecoma
3. stertoli-leydig cell tumour
4. Granulosa cell tumor

germ cell:
1. teratoma
2. Dysgerminoma
3.yolk sac tumor
4. Choriocarcinoma