Gynaecological and Breast Pathology Flashcards
1
Q
What is screening
A
The process of identifying people who appear healthy but may be at an increased risk of disease or condition
2
Q
What is the main aim of breast screening
A
To reduce mortality from breast cancer
3
Q
Who is screened in the breast screening programme
A
50-70 years
Invited every 3 years
Mammography main tool
4
Q
What is the breast triple assessment
A
Clinical examination (history, physical) Radiological examination (ultrasound, mammography) Pathological examination (core cut biopsy, FNAC)
5
Q
How are the areas of breast triple assessment scored
A
P1, R1, B1: Normal P2, R2, B2: benign lesion P3, R3, B3: Atypical P4, R4, B4: Atypical, prob-malignant P5, R5, B5: malignant
6
Q
Who are the members of the breast MDT
A
Surgeons Oncologists Radiologists Pathologists Specialist nursing team Research nurses Genetic counsellors
7
Q
What are the synonyms of fibrocystic change
A
Fibrocystic disease Fibrous mastopathy Mammary dysplasia Schimmelbusch's disease Chronic cystic mastitis
8
Q
What is fibrocystic change
A
Generally affects pre-menopausal women
Usually B/L and multifocal
Risk of FCC development is increased in women with hyperestogenism
No increased risk of subsequent carcinoma development
A constellation of benign, hormonally mediated breast changes including cyst formation, stroll fibrosis and mild epithelial hyperplasia without atypic
Symptoms cease 1-2 years following menopause
9
Q
How does fibrocystic change present
A
Lumpy, premenstrually painful breasts
10
Q
What is fibroadenoma
A
Common
Women 20-30 years
More common in Afro-caribbean women
Mobile, painless, well defined breast lump
11
Q
How are fibroadenoma’s treated
A
Surgical excision
12
Q
What is DCIS
A
Ductal carcinoma in situ
A malignant clonal proliferation of cells within breast parenchymal structures
No evidence of invasion
A precursor of invasive carcinoma
Most commonly identified as microcalifications on screening
Pure DCIS cannot produce metastasis
Can progress to invasion if left
13
Q
What are the risk factors for breast cancer
A
Linked to oestrogen
Increased with early menarche, late menopause, obesity in postmenopausal women, OCP’s and normal therapy for menopause, alcohol
14
Q
What should a path report tell about malignancy
A
In situ or invasive Type Grade Size Vascular invasion Nodal status Relationship to margins Molecular marker status
15
Q
What are the main types of breast carcinoma
A
Ductal (75%) Lobular (12%) Tubular/cribriform (3%) Medullary (3%) Mucoid (2%) Metaplastic (1%) Others (4%)
16
Q
What are the key prognostic factors
A
Tumour grade
Tumour size
Nodal status
17
Q
What is the Nottingham Prognostic index
A
Grade + nodal status + 0.2 x tumour size
- 4 or less : good (80%+ 16 year survival)
- 41-5.4: moderate (46%)
- 41 +: poor (10%)
18
Q
What is CIN
A
Cervical intraepithelial neoplasia
Dysplasia
Leads to squamous cell carcinoma
19
Q
What is CGIN
A
cervical glandular intraepithelial neoplasia
Dysplasia
Leads to adenocarcinoma
20
Q
What is VIN
A
Vulval intraepithelial neoplasia
Dysplasia
21
Q
What is VaIN
A
Vaginal intraepithelial neoplasia
Dysplasia
22
Q
What is AIN
A
Anal intraepithelial neoplasia
Dysplasia
23
Q
What is dysplasia
A
Earliest morphological manifestation of multistage process of neoplasia
Cytological features of malignancy but no invasion
Removal is curative, if left then significant chance of developing invasive malignancy
24
Q
What are the results of low risk HPV
A
Types: 6, 11
Lower genital tract warts (condylomata: benign squamous neoplasms), low grade INs
Very rare in malignant lesions
25
What are the results of high risk HPV
Types: 16, 18, 31, 33
| High grade INs and invasive carcinomas
26
What are the HPV vaccines
Gardasil (HPV 6,11, 16,18)
| Cervarix (HPV 16, 18)
27
What part of the cervix is vulnerable to the oncogenic effects of HPV
Transformation zone
28
What are the characteristics of CIN I
Regression 60%
Persistence 30%
Progression to CIN III 10%
Progression to invasion 1%
29
What are the characteristics of CIN II
Regression 40%
Persistence 40%
Progression to CIN III 20%
Progression to invasion 5%
30
What are the characteristics of CIN III
Regression 33%
Persistence ~56%
Progression to invasion 20-70%
31
What makes a good screening test
```
High sensitivity and specificity
Not harmful
Not too expensive
Acceptable to population
Define pre-invasive stage long enough to allow intervention
Simple successful treatment
Not a test for cancer
```
32
How are smear tests triaged
HPV triage
33
What is LLETZ
Large loop excision of the transformation zone
34
What are the FIGO staging of cervical carcinoma
I: Confined to cervix
II: Invades beyond uterus, not to pelvic side wall
III: Extends to pelvic wall, lower 1/3 vagina, hydronephrosis
IV: Invades bladder or rectum or outside pelvis
35
What are the treatments for each stage of cervical carcinoma
IA1, IA2: No need for radical treatment, complete excision with LLETZ
IB, IIA, IIB: Consider radical therapy with surgery or chemo or radiotherapy
III, IV: Consider palliative care, chemotherapy
36
What are the characteristics of Vulval squamous cell carcinoma
```
Associated with VIN
Associated with inflammatory dermatoses
Eroded plaque or ulcer
Spreads locally to involve:
-Vagina and distal urethra
-Ipsilateral inguinal LNs
Contralateral inguinal LNs, deep iliofemoral LNs
```
37
What is endometriosis
Presence of endometrial tissue at sites other than the endometrium
38
How do patients with endometriosis present
```
25% asymptomatic
Dysmenorrhoea
Dyspareunia
Pelvic pain
Subfertility
Pain on passing stool
Dysuria
```
39
How is endometriosis diagnosed
Laparoscopy
40
How is endometriosis treated
Medically (COCP, GnRH agonists/antagonists, progesterone antagonists)
Surgically (ablation/ TAH-BSO)
41
What are some linked issues with endometriosis
Ectopic pregnancy
Ovarian cancer
IBD
42
What is endometritis
Inflammation of the endometrium
43
How do patients with endometritis present
```
Abdominal/pelvic pain
Pyrexia
Discharge
Dysuria
Abnormal vaginal bleeding
```
44
How is endometritis diagnosed
Biochemistry/microbiology
| USS
45
How is endometritis treated
Analgesia
Antibiotics
Remove cause
46
How do patients with endometrial polyps present
Often asymptomatic
Intermenstrual/ post menopausal bleeding
Menorrhagia
Dysmenorrhoea
47
How is endometrial polyps diagnosed
USS
| Hysteroscopy
48
How is endometrial polyps treated
medical (P4/GnRH agonists), surgical (curettage)
49
What is endometrial hyperplasia
Excessive endometrial proliferation
50
What are the risk factors for endometrial hyperplasia
```
Obesity
Exogenous E2
PCOS
E2-producing tumours
Tamoxifen
HNPCC (PTEN mutations)
```
51
What are the types of endometrial hyperplasia
simple non-atypical, simple atypical
| Complex non-atypical, complex atypical
52
What is the history for endometrial hyperplasia
Abnormal bleeding
53
How is endometrial hyperplasia diagnosed
USS
Hysteroscopy
Biopsy
54
How is endometrial hyperplasia diagnosed
Medical (IUS,P4)
| Surgical (TAH)
55
What is the prognosis for endometrial hyperplasia
Endometrial adenocarcinoma
| or regression
56
What is the malignant progression of hyperplasia
Normal - Non-atypical hyperplasia - Atypical hyperplasia - Endometrioid adenocarcinoma
57
What is polycystic ovary syndrome
Endocrine disorder
Hyperandrogenism
Menstrual abnormalities
Polycystic ovaries
58
How is PCOS investigated
USS
Fasting biochemical screen (↓FSH, ↑LH, ↑testosterone, ↑DHEAS)
OGTT
59
How is PCOS treated
Lifestyle (weight loss)
Medical (metformin, OCP, clomiphene)
Surgical (ovarian drilling)
60
What are linked issues with PCOS
Infertility
Endometrial hyperplasia
Adenocarcinoma
61
What is endometrial adenocarcinoma history
PMB/IMB, pain if late
62
How is endometrial adenocarcinoma investigated
USS
Biopsy
Hysteroscopy
63
How is endometrial adenocarcinoma treated
Medical (P4)
Surgery (TAH-BSO)
Adjuvant therapy (chemo-radiotherapy)
64
What is the prognosis for endometrial adenocarcinoma
Stage 1: 90% 5 yr survival
| Stage 2-3: <50% 5 yr survival
65
What are epithelial tumours
```
Most common group of ovarian neoplasms
3 major carcinoma histological types:
Serous (tubal)
Mucinous (endocervical)
Endometrioid (endometrium)
Each type contains benign/ borderline/ malignant variants
```
66
How are the benign epithelial tumours classes
Based on components
Cystic (cystadenomas)
Fibrous (adenofibromas)
Cystic and fibrous (cystadenofibromas)
67
How are malignant epithelial tumours named
Cystadenocarcinoma
68
What are germ cell tumours
15-20% of all ovarian tumours
Types:
Germinomatous:
- Dysgerminomas (malignant, chemosensitive)
Non-germinatous:
-Teratomas (differentiation towards multiple germ layers)
-Yolk sac tumours (differentiation towards extra embryonic yolk sac, malignant, chemosensitive)
-Choriocarcinomas (differentiation- placenta, malignant, often unresponsive
69
How are germ cell tumours treated
Surgical
Chemo
Radiotherapy
70
What are sex cord stroll tumours
Can generate cells from the opposite sex:
Thecoma/fibrothecoma/fibroma:
-Benign thecomas and fibrothecomas produce E2, fibromas hormonally inactive
-Comprised of spindle cells
-Meig's syndrome:ovarian tumour, right sided hydrothorax, ascites
Granulosa cell tumours:
-low grade malignant, produces E2
Sertoli-Leydig cell tumours:
-Produce androgens, 10-25% malignant
71
What is ovarian cancer risk factors
: FH, ↑age, PMH breast cancer, smoking,
| E2-only HRT, Lynch II syndrome, obesity, nulliparity
72
What are protective factors for ovarian cancer
OCP, breastfeeding, hysterectomy
73
What are the ways ovarian cancer patients present
Non-specific symptoms:
- Pain
- Bloating
- Weight loss
- PV bleeding
- Urinary frequency
- Anorexia
74
What are the treatments of ovarian cancer
Stage <1C epithelial tumours TAH/BSO, omentectomy, appendectomy, lymphadenectomy & adjuvant chemo - chemo only in sensitive GCTs
75
What are leiomyoma
Uterine fibroids
| Benign smooth muscle tumours of the myometrium
76
What is the history of leiomyoma
Often asymptomatic menorrhagia
| Subfertility/pregnancy problems
77
How is leiomyoma diagnosed
Bimanual examination
| USS
78
How is leiomyoma treated
Medical (IUS/NSAIDs/OCP/P4/Fe2+); non-medical (artery embolization, ablation, TAH)
79
What can happen as a result of infection in pregnancy
- miscarriage
- congenital anomalies
- fetal hydrops
- fetal death
- preterm delivery
- preterm rupture of the membranes
80
What is the key message to give mothers during antenatal counselling to avoid infections
Avoid exposure to infection during pregnancy
| Get vaccinations so maternal antibodies can cross the placenta and give passive immunity to the foetus
81
What should the mother be screened for early stage in pregnancy
Hepatitis B
| HIV
82
What are the in utero infections which can be transmitted from mother to baby
```
TORCH
Toxoplasmosis
Others (syphilis, HIV, Coxsackie virus, Hep B, Varicella-zoster)
Rubella
Cytomegalovirus disease
Herpes simplex disease
```
83
What are the potential foetal consequences of TORCH infections
```
Abortion
Stillbirth
Prematurity
IUGR
Congenital malformations (microcephaly, intracranial calcifications)
```
84
What are the managements of intra-amniotic infections
Intrapartum antimicrobials and delivery of the foetus
| Antimicrobials should be administered at the time of diagnosis not after delivery
85
What are the clinical features of puerperal endometritis
```
Fever (38.5C in first 24 h post delivery or >38.0 for 4 hours, 24 h+ after delivery), no other apparent cause identified
Uterine tenderness
Purulent, foul-smelling lochia
Increased white cell count
General malaise, abdominal pain
```
86
What is early onset neonatal sepsis
Within 72 hours
A major cause of mortality and morbidity in new-born babies
High mortality, particularly in premature and low birth weight babies
Death in 1 in 4 babies who develop it, even when given antibiotics
87
What is the most common bacterial infection
Streptococcal pneumoniae
88
What are the upper respiratory tract infections in children
Common cold
Acute tonsillitis
Acute otitis media
89
What is a sore throat
Any various inflammations of the tonsils, pharynx, or larynx characterised by pain in swallowing
90
What causes a sore throat
Viral (70-80%)
| Group A beta-haemolytic streptococcus (20-30%)
91
How does a patient with otitis media present
```
Unusual irritability
Difficulty sleeping
Tugging or pulling at one or both ears
Fever
Fluid draining from the ear
Loss of balance
Unresponsiveness to quiet sound or other signs of hearing difficulty
```
92
What is otitis media
Inflammation of middle ear
93
What are the Lower respiratory tract infections
Pneumonia
Acute bronchitis
Bronchiolitis
94
What is bronchiolitis
Inflammation of bronchioles/small airways in children younger than 2 years
A seasonal viral illness characterised by fever, nasal discharge and dry, wheezy cough.
On examination there are fine inspiratory crackles and/ or high-pitched expiratory wheeze
95
What are the causes of bronchiolitis
```
Respiratory Syncytial Virus (RSV)
Metapneumovirus
Adenovirus
Para-influenza virus
Influenza
Rhinovirus
```
96
What is the clinical picture of LRTI
Acute febrile illness, possibly preceded by typical viral URTI
Breathlessness
Irritability
Poor feeding
Sleeplessness
Cough, chest, abdominal pain in older patients
Audible wheezing is rare but can occur
97
How does meningitis present in children
```
Fever
Irritability
Lethargy
Poor feeding
High pitched cry
Bulging AF
Convulsions
Opisthotonus
```
98
How does meningococcemia present
```
Fever
Non-specific malaise
Lethargy
Vomiting
Meningism
Resp distress
Irritability
Seizures
Maculopapular rash common early in disease
Petechial rash seen in 50-60%
```
99
What are the symptoms of UTI
Older children:
Dysuria, frequency, urgency, small-volume voids, lower abdominal pain
Younger children:
Nonspecific symptoms
Fever, irritability, vomiting, poor appetite
