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YR5 Histopathology > Gynaecological Pathology > Flashcards

Gynaecological Pathology Flashcards

1
Q

Describe the gynaecological tract from the outside in

A

Vulva

Vagina

Cervix

Uterine body

Fallopian tube

Ovaries

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2
Q

Name 2 forms of congenital anomalies in gynaecology

A

Duplication

Agenesis

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3
Q

What is the term for inflammation in each part of the Gynaecological Tract?

A

Vulva: vulvitis

Vagina: vaginitis

Cervix: cervicitis

Endometrium: endometritis

Fallopian tube: salpingitis

Ovary: oopheritis

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4
Q

Name 3 infections of the female genital tract that cause discomfort but no serious complications. What causes are each associated with?

A

Candida: DM, OCP + pregnancy enhance development of infection.

Trichomonas vaginalis: Protozoan.

Gardenerella: Gram -ve bacillus causes vaginitis

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5
Q

Name 4 infections of the female genital tract that can have serious complications.

A

Chlamydia: Major cause of infertility.

Gonorrhoea: Major cause of infertility.

Mycoplasma: Spontaneous abortion + chorioamnionitis.

HPV: Implicated in cancer.

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6
Q

What is PID?

A

general term for infection of the female upper genital tract, inc. womb, fallopian tubes + ovaries.

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7
Q

How do gonococci, chlamydia and enteric bacteria cause PID?

A

Usually starts from the lower genital tract + spreads upward via mucosal surface.

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8
Q

How do staph, strep, coliform bacteria and clostridium perfringens cause PID?

A

Secondary to abortion.

Usually start from the uterus + spread by lymphatics + blood vessels upwards.

Deep tissue layer involvement.

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9
Q

List 4 complications associated with PID

A

Peritonitis

Bacteraemia

Intestinal obstruction due to adhesions

Infertility (due to adhesions)

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10
Q

What is the sequence of events with salpingitis?

A

Usually direct ascent from the vagina.

Depending on severity + tx may result in resolution or complications.

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11
Q

List 7 complications associated with salpingitis

A

Plical fusion

Adhesions to ovary

Tubo-ovarian abscess

Peritonitis

Hydrosalpinx

Infertility: path of ovum disrupted

Ectopic pregnancy

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12
Q

What is an ectopic pregnancy?

A

Pregnancy occurring anywhere outside the uterus

Most commonly Fallopian tubes

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13
Q

What is this?

A

Salpingitis

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14
Q

List 3 pathologies which can occur in the cervix

A

Inflammation- acute/ chronic

Polyps

Dysplasia + carcinoma

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15
Q

Give 2 epidemiological facts about cervical cancer

A

2nd most common cancer affecting F worldwide

Mean age 45-50

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16
Q

List 5 risk factors for cervical cancer

A

Human Papilloma Virus: present in 95%

Many sexual partners

Sexually active early

Smoking

Immunosuppressive disorders

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17
Q

Which HPV types are low risk? What do they cause?

A

Most common: 6 + 11

Other types: 40, 42, 43, 44, 54, 61, 72, 73, 81

Genital + oral warts.

Low grade cervical abnormalities.

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18
Q

Which HPV types are high risk? What do they cause?

A

Most common: 16 + 18

Other types: 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68,82

Low + high grade cervical abnormalities.

Cervical cancer.

Vulval, vaginal, penile, + anal cancer.

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19
Q

What is cervical intraepithelial neoplasia (CIN)?

A

CIN= dysplasia in cervix.

Epithelial cells have undergone some phenotypic + genetic changes which are premalignant + preinvasive.

Basal membrane immediately deep to surface epithelium is intact.

Squamous epithelium (CIN) is involved more often than glandular epithelium (CGIN).

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20
Q

What do the precursors CIN and CGIN lead to?

A

CIN: Squamous cell carcinoma of the cervix

CGIN: Adenocarcinoma of the cervix

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21
Q

Briefly describe the progression from HPV to carcinoma

A

HPV infection: abnormal cells

CIN1: mild dyskariosis limited to most superficial ⅓ of epithelium

CIN2: moderate dyskariosis

CIN3: severe dyskariosis involves >⅔ epithelium

Carcinoma in situ: abnormal growth involves full thickness of epithelium + no penetration of surrounding tissue

Invasive malignancy: breeches basement membrane

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22
Q

What is cervical carcinoma?

A

Invasion through the BM defines change from CIN to invasive carcinoma.

2 types of cervical cancer:

  • Squamous cell carcinoma (most common)
  • Adenocarcinoma (20% of all invasive cases- HPV dependent or independent.)
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23
Q

What is this?

A

Squamous cell carcinoma (cervical carcinoma)

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24
Q

What is this?

A

Adenocarcinoma (cervical carcinoma)

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25
Give 4 factors affecting prognosis of cervical cancer
Tumour type Tumour grade Tumour stage: FIGO I (90%) - IV (10%) 5y S Lymphovascular space invasion
26
What are the 2 distinct biological states of HPV?
Non productive/ Latent Productive
27
How does HPV transform cells?
2 proteins E6 + E7 encoded by the virus have transforming genes. E6 + E7 bind to + inactivate 2 tumour suppressor genes: * Retinoblastoma gene (Rb) (E7) * P53 (E6) Interferes with apoptosis + increases unscheduled cellular proliferation, both of which contribute to oncogenesis.
28
What is the pathophysiology of HPV in non-productive/ latent phases?
HPV DNA continues to reside in basal cells. Infectious virions NOT produced. Replication of viral DNA is coupled to replication of the epithelial cells occurring in concert with replication of the host DNA. Complete viral particles NOT produced. Cellular effects of HPV infection NOT seen. Infection only identified by molecular methods.
29
What is the pathophysiology of HPV in productive viral infection stages?
Viral DNA replication occurs independently of host chromosomal DNA synthesis. Large no. viral DNA are produced + result in infectious virions. Characteristic cytological + histological features
30
What happens for most people infected with HPV?
Nothing. Immune system eliminates HPV HPV undetectable within 2y in 90% Relatively few develop Sx
31
What are the screening intervals for cervical cancer?
**25:** 1st invitation **25-49:** Every 3y **50-64:** Every 5y **65+:** Only if 1 of last 3 was abnormal
32
What are the screening approaches for cervical cancer?
Cervical cytology (less used): 50-95% sens. 90% spec. Hybrid Capture II (HC2) HPV DNA test: molecular genetics (used more)
33
What does HC2 HPV DNA test assess?
5 low risk HPV types 13 high risk HPV types
34
What cancers does the HPV vaccine help protect against?
Cervical Some cancers of anal/ genital areas + genital warts Some head + neck cancers
35
When are people offered the HPV vaccination?
Girls + boys aged 12-13 2nd dose 6-25m after
36
Which cancers are screened for in the UK?
Breast Bowel Cervical
37
Describe the layers of the uterus
Endometrium: lines uterus, contains glands + stroma. Shed in menstruation. Myometrium: thick muscle layer, contracts in birth. Perimetrium: smooth outer layer
38
What are endometrial indications for uterine biopsies?
Infertility Uterine bleeding Thickened endometrium on imaging
39
What are uterus/ related mass indications for biopsies?
Lesion identified on imaging As part of a wider resection
40
What is endometrial hyperplasia? What is this usually driven by? What is the most common presentation?
irregular proliferation of endometrial glands with an increase in gland to stroma ratio Driven by persistent oestrogen Usual presentation: abnormal uterine bleeding
41
List 5 causes of endometrial hyperplasia
Peri-menopause Persistent anovulation (persistently raised oestrogen) PCOS Ovarian Granulosa cell tumours Oestrogen therapy
42
What is the most common gynaecological malignancy in developed countries? What is the most common subtype?
Endometrial cancer: Endometrioid
43
List 4 risk factors for endometrial cancer
Nulliparity Obesity Diabetes mellitus Excessive oestrogen stimulation
44
Give 4 features of endometrioid carcinomas
Oestrogen dependent Often a/w atypical endometrial hyperplasia Low grade + high grade tumours Develop through the accumulation of mutations of different genes.
45
What is this?
Endometrioid Carcinoma
46
What is this?
Endometrioid carcinoma
47
Give 4 facts about serous and clear cell carcinomas
Older, postmenopausal Less oestrogen dependent Arise in atrophic endometrium High grade, deeper invasion, higher stage
48
Which mutations are associated with endometrial serous carcinomas?
P53 mutations in 90% PI3KCA mutations in 15% Her-2 amplification
49
Which mutations are associated with endometrial clear cell carcinoma?
PTEN mutation CTNNB1 mutation Her-2 amplification
50
What is this?
Endometrial serous carcinoma
51
What is this?
Endometrial clear cell carcinoma
52
Which endometrial cancers are considered high grade?
Serous Clear cell Mixed Undifferentiated Dedifferentiated Carcinosarcoma
53
What system is used to grade endometrioid carcinomas?
FIGO 3 tier system depending on: Architecture: % gland formation Cytological atypic of individual cells
54
What is the 2009 FIGO Staging for Carcinoma of the Endometrium?
**Stage I:** Tumour confined to corpus uteri. **Stage II:** Tumour invades cervical stroma. **Stage III:** Local +/- regional spread of tumour. **Stage IV:** Tumour invades bladder +/- bowel mucosa, +/- distant metastases.
55
What is this?
HMLH1 (A) PMS2 (B) MSH2 (C) MH6 (D) show strong nuclear expression in tumour cells of endometrioid carcinoma. (mutations in mismatch repair genes)
56
What are mesenchymal tumours (leiomyoma)?
Smooth muscle tumour of myometrium. Commonest uterine tumour 20% of women \>35y AKA fibroid Usually multiple May be intramural, submucosal or subserosal
57
What is this?
Leiomyoma
58
What are leiomyosarcomas?
Malignant counterpart of leiomyoma: rare. Usually solitary. Usually postmenopausal. Local invasion + blood stream spread. 5y survival 20-30%.
59
What is this?
Leiomyosarcoma
60
What is this?
Endometrial stromal sarcoma
61
What is this?
Endometrial stromal sarcoma
62
What is this?
Serous Epithelial Ovarian Tumour
63
What is this?
Mucinous Epithelial Ovarian Tumour
64
What is this?
Endometrioid Epithelial Ovarian Tumours
65
What is this?
Clear cell Epithelial Ovarian Tumours
66
What is this?
Brenner Epithelial Ovarian Tumours
67
What is this?
Serous borderline tumour
68
What is this?
Mucinous borderline tumour
69
Give 4 features of high grade ovarian serous carcinomas
Most common type of malignant tumours (80%). Aggressive. * Alteration in P53, in almost all. * BRCA1 or BRCA2 abnormalities (germline + somatic mutations; BRCA1 promoter methylation): encode proteins with important roles in DNA repair (homologous recombination).
70
Which mutation is though to confer an overall survival advantage in high-grade serous ovarian cancer?
BRCA2 mutation
71
Give 4 features of low grade ovarian serous carcinomas
Distinct pathogenesis from high grade serous carcinoma. Low grade, relatively indolent, arise de novo or from borderline ovarian tumours. Mutations in KRAS, BRAF. No association with BRCA mutations.
72
Give 5 features of Mucinous ovarian tumours
Very rare Morphological features similar to mutinous tumours of GIT KRAS mutations If unilateral= primary If bilateral: consider ovary as secondary
73
Where are common origin sites for secondary ovarian tumours?
**Metastatic colorectal carcinoma** **Krukenberg tumours:** * Bilateral mets composed of mucin producing signet ring cells. * Most often of gastric origin or breast.
74
Give 3 facts about metastatic colorectal cancer spread causing secondary ovarian tumours
* Ovaries= anatomic site prone to involvement by metastatic colorectal adenocarcinoma. * 4-10% of CRC go to ovary. * Ovarian lesions identified prior to primary tumor in 14-32% of cases.
75
Give 2 facts about Krukenberg tumour spread causing secondary ovarian tumours
Causes bilateral mets composed of mucin producing signet ring cells Often of gastric/ breast origin
76
What are the 3 different categories of sex-cord stromal tumours?
**Pure stromal tumours:** Fibroma, Thecoma, microcystic stromal tumour. **Pure sex cord cells:** Adult type + juvenile granulosa cell tumour. **Mixed sex cord-stromal tumours:** Sertoli Leydig cell tumour.
77
What is this?
Fibroma: Fibroblasts Benign, no endocrine production
78
What is this?
Granulosa cell tumor: Granulosa cells Variable behaviour, may produce estrogen
79
Give 3 facts about Thecomas
Derived from Thecal cells Benign May secrete Oestrogen or rarely androgens
80
Give 2 facts about Sertoli-Leydig cell tumours
Variable behaviour May be androgenic
81
What somatic mutation is found in 97% of adult type granulosa cell tumours?
FOXL2 (master transcription factor, regulates proliferation + apoptosis)
82
What is DICER1 Syndrome?
Germline mutation in DICER1, a gene encoding an RNAse III endoribonuclease. Familial multinodular goitre with sertoli/ leydig cell tumour + tumour susceptibility inc. pleuropulonry blastoma in childhood. Found in up to 60% of sertoli-Leydig cell tumours.
83
What is Peutz-Jegher's Syndrome?
Germline mutations of STK11 Sex cord stromal tumour with annular tubules Cases occurring in PJS usually show indolent behaviour.
84
Give 3 facts about germ cell tumours
Account for 20% of ovarian tumours 95% benign Predominantly occur in 1st + 2nd decade
85
What are immature teratomas?
Indicates presence of embryonic elements. Neural tissue particularly conspicuous. Malignant neoplasm grows rapidly, penetrates the capsule + forms adhesions to surrounding structures. Spreads in the peritoneal cavity by implantation. Mets to LN, lung, liver + other organs.
86
What is this?
Dysgerminoma | (germ cell tumour)
87
What is this?
Yolk sac tumour | (germ cell tumour)
88
What is this?
Embryonal carcinoma | (germ cell tumour)
89
What is this?
Choriocarcinoma | (germ cell tumour)
90
What is endometriosis?
Presence of endometrial glands + stroma outside of the uterus 10% of premenopausal women Ectopic endometrial tissue is functional + bleeds at time of menstruation: pain, scarring + infertility Can develop hyperplasia + malignancy
91
What are the non-neoplastic functional ovarian cysts? What symptoms may these cause?
Follicular + luteal cysts +/- Abdo pain/ mass Self resolving
92
What is an endometrioma?
Ovarian cyst in endometriosis “Chocolate cyst” Filled with old blood
93
Describe the epidemiology of epithelial ovarian tumours
65% of all ovarian tumours 95% of malignant ovarian tumours 50% in 45-65y
94
Describe the epidemiology of germ cell ovarian tumours
Bimodal distribution 15-21 65-69
95
Describe the epidemiology of sex cord stromal ovarian tumours
Most commonly in post-menopausal women Subtypes peak in 25-30y
96
What is a ‘borderline’ tumour?
Tumour whose biologic behaviour- can't be predicted on histologic grounds Have very low but definite metastatic potential Morphologically similar tumours may behave differently
97
List 4 benign epithelial ovarian tumours
Serous Cystadenomas Cystadenofibromas Mutinous cystadenomas Brenner tumour
98
Give 2 statistics about malignant epithelial ovarian tumours
6th most common cancer in F worldwide 2nd most common cancer causing death in F
99
List 5 risk factors for malignant epithelial ovarian tumours
Nulliparity Infertility Early menarche Late menopause FH: ovarian/ breast cancers
100
List 3 familial syndromes associated with epithelial ovarian cancer
Familial breast-ovarian cancer syndrome a/w BRCA1+2 Site-specific ovarian cancer a/w BRCA1+2 Cancer family syndrome (Lynch type II)
101
How are the familial syndromes associated with epithelial ovarian cancer transmitted?
Autosomal dominant Hereditary ovarian cancer occurs at younger age than sporadic
102
Which ovarian cancers are most common in patients with Lynch II syndrome?
Endometrioid Clear cell
103
Which is the most common ovarian malignancy in the general population?
Serous carcinoma
104
Which cancer does endometriosis have a strong association with?
Clear cell ovarian carcinoma
105
Which cancer does endometriosis have a weak association with?
Endometrioid ovarian carcinoma (10-20% of endometrioid carcinoma cases)
106
Give 2 facts about endometrioid carcinoma
Most thought to be derived from surface epithelium Co-existance with endometrioid carcinoma in uterus is common
107
Give 5 facts about mature teratomas (Dermoid)
Commonest germ cell tumour Benign Solid or cystic May show many lines of differentiation but all mature adult type tissues Teeth + hair v common
108
Which part of the female genital tract is the most common site of metastasis?
Ovaries

YR5 Histopathology (27 decks)

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