Gynaecological pathology

Question 1

Common causes of PID

Answer 1

Chlamydia trocho and N Gonorrhoea = most common in uk

others = TB, schistosomiosis

Question 2

how will PID present

Answer 2

lower abdo pain, dyspareunia, vaginal bleeding/discharge, fever, tenderness, cervical excitation

Question 3

complications of PID

Answer 3

peritonitis, bacteremia, adhesions -> intestinal obs, ectopic preg, infertility

Question 4

histo findings in endometriosis

Answer 4

powder burns - red/brown nodules

chocolate cysts in ovaries (endometriomas)

Question 5

what adenomyosis

Answer 5

presence of ectopic endomet tissue in myometrium

Question 6

how will adenomyosis present

Answer 6

heavy menstrual bleeding, dysmenorrhagia, deep dyspareunia, globular uterus

Question 7

histo of leiomyoma

Answer 7

(fibroid)

sharply circumscribed discrete bundles of smooth muscle cells (grey-white tumours)

Question 8

first diagnosis for post menopausal bleeding

Answer 8

endometrial carcinoma till proven otherwise

Question 9

types of endometrial carcinoma

Answer 9

T1 (85%) - endometriod

T2 (15%) - non endometriod - serous carcinoma/clear cell carcinoma

Question 10

associations and risk factors for endometriod carcinoma

Answer 10

related to oestrogen excess
RF = oestrogen, Dm ,HTN
asso with atypical endometrial hyperplasia

Question 11

what mut is associated with endometriod carcinoma

Answer 11

PTEN

Question 12

epidemiology of non endometriod carcinoma

Answer 12

unrelated to oestrogen excess

older women with endomet hyperplasia

Question 13

what is associated with VIN and how many progress to invasive disease

Answer 13

asso with HPV-16

<5% progress

Question 14

types of ovarian carcinoma

Answer 14

70% = epithelial
20% = germ cell
sex cord stromal tumours
metastatic tumours

Question 15

types of epithelial ovarian carcinomas and defining features

Answer 15

most common = serous cystadenoma - psammoma bodies
mucinous cystadenoma - mucin sec cells, K-Ras mut
endometrial tumours - form tubular glands, endomet is RF
clear cell tumour - clear cytoplasm, strong asso with endomet, hobnail appearance

Question 16

types of germ cell ovarian tumour

Answer 16

dysgermioma
teratoma - most common ov tumour in young women
choriocarcinoma - malig , sec hcG

Question 17

histo of mature teratoma

Answer 17

mature teratoma = benign dermoid cyst. tissue differentiates into mature tissue (teeth hair etc)

Question 18

histo of immature teratoma

Answer 18

malig, solid, contains immature embryonic tissue

Question 19

types of sex cord stromal tumours

Answer 19

fibroma - benign, non sec
granulosa-thecal cell tumour - prod E2
sertoli leydig cell tumour - sec androgens

Question 20

common metastatic ovarian tumour

Answer 20

krukenberg tumour - mets from gastric/breasyt cancer

signet ring cells

Question 21

staging for ovarian cancer

Answer 21

1 = lim to ov
2 = lim to pelvis
3 = lim to abdo (+LN mets)
4 = distant mets outside abdo cavity

Question 22

typical age range for cervical carcinoma

Answer 22

45-50

Question 23

risk factors for cervical carcinoma

Answer 23

HPV exposure (16 and 18) 
cocp, lots of sexual partners, non barrier contraception

Question 24

what are the types of cervical carcinomas

Answer 24

70-80% = sq cell carcinoma 
20 = adenocarcinoma

Question 25

staging for cervical carcinoma

Answer 25

0 = CIN 
1 = lim to cervix
2 = extended beyond uterus
3 = extends to pelvic wall/lower 1/3 of vagina
4 = extension beyond pelvis

Question 26

epithelial changes in the cervix

Answer 26

cervix = sq epi
squamocolumnar junc
endocervical canal= columnar glandular epi

Question 27

what is the transformation zone

Answer 27

area in cervix when columnar epi transforms to squamous cells

Question 28

how is CIn staged

Answer 28

1 = lower 1/3 of epi
2 = lower 2/3
3 = full thickness but BM intact

Question 29

when does CIN become cervical cancer

Answer 29

when it breaks through the Basement membrane

Question 30

progression of CIN

Answer 30

60-90% CIN1 will revert to normal

30% CIN3 prog to cancer

Question 31

what are the risk factors for CIN

Answer 31

early first sex
multi partners
HIV
immunocomp
multiparity