Gynaecological and breast pathology Flashcards
Pathology of HPV infection in cervix
koilocytosis
Diagnosis of CA cervix
Colposcopy
Screening for CA cervix (inclusion criteria, site, reporting system)
Pap smear + reflex HPV test
Inclusion: 21~65y female
Site: transformation zone
Reporting system: Bethesda system
Endometrial sampling methods (4)
Pipelle endometrial aspirator
Vabra aspiration
Dilataion & curettage
Hysteroscopic-guide biopsy
Pathology of endometrial hyperplasia (↑ … ratio)
↑ gland to stroma ratio
MC carcinoma in female genital tract
endometrial carcinoma
Which type of endometrial carcinoma resembles normal endometrium? Which type has the worst prognosis?
Endometrioid
Serous
Staging for endometrial carcinoma
FIGO staging
MC gynaecological tumour
uterine leiomyoma/ fibroids
Which ovarian germ cell tumour is…
(a) benign?
(b) most malignant?
(c) 2nd most malignant?
(a) Mature teratoma
(b) Dysgerminoma
(c) Yolk sac tumour
MC site of ectopic pregnancy
fallopian tube
MC cause of placental choriocarcinoma
complete mole
Tumour with synctiotrophoblast and cytotrophoblast
Placental choriocarcinoma
MC soft & firm breast lump in young and old female respectively
Soft: fibrocystic changes
Young & Hard: Fibroadenoma
Old & Hard: Carcinoma
MC mastalgia cause
fibrocystic changes
Yellow / green nipple discharge DDx (2)
infection, ductal ectasia
Bloody nipple discharge DDx (3)
fibrocystic changes, intraductal papilloma, carcinoma
Triple assessment for breast
Clinical assessment
Radiological assessment: USG or mammogram (>35y)
Pathological assessment: core needle biopsy
Inflammatory diseases of breast (1+3)
Acute: mastitis
Chronic: ductal ectasia, fat necrosis, idiopathic granulomatous mastitis
Risk factors for mastitis (3)
post-partum nursing, ↑ viscosity of milk, trauma
Benign epithelial lesions at breast (1+3+2)
Non-proliferative: fibrocystic changes
Proliferative without atypia:
- usual ductal hyperplasia
- sclerosing adenosis (↑ CA risk)
- intraductal papilloma (↑ CA risk)
Proliferative with atypia (4x risk of CA)
- atypical lobular hyperplasia
- atypical ductal hyperplasia
Pathogenesis of fibrocystic changes
exaggeration of cyclic breast change related to menstrual cycle
- simple cysts (lining cells often undergo apocrine metaplasia)
- apocrine secretions may calcify
- cysts rupture –> chronic inflammation & fibrosis
CA breast: DCIS vs LCIS
(presentation, invasion risk, mammography, HG pathology, management)
unifocal; multifocal
same breast; bilateral breasts
pleomorphic microcalcification; /
comedo, pleomorphic cells
BCS + RT, tamoxifen; surveillance / bilateral total mastectomy
Which invasive breast carcinoma is not palpable?
invasive lobular carcinoma
Genetics for CA breast (4)
BRCA1/2, TP53, PTEN, STK11
Adjuvent therapy regimen for CA breast
- Hormonal therapy if ER+ or PR+
- Targeted therapy if HER2+
- Cytotoxics if HER2+ or Ki67 high
- chemotherapy for high risk cancers
Gene-based assay for risk scores of CA breast
Oncotype DX
Hormonal therapy for CA breast
Tamoxifen (SERM — selective estrogen receptor modulator)
Anastrozole (aromatase inhibitor)
Describe koilocyte (3)
enlarged smudged nuclei
perinuclear cytoplasmic halo
condensed cytoplasmic borders
IHC subtypes / molecular classes of CA breast (4)
Luminal A (HR+/Ki67 low)
Luminal B (HR+/Ki67 high)
HER-2 positive (HR-/HER2+)
Triple negative (HR-/HER2-)
Carcinogenesis of HPV infection
↑ oncoprotein E6, E7 –> bind to and degrade p53 & pRb (tumour suppressors)
