Gynaecological Pathology

Question 1

What is the transformation zone of the cervix

Answer 1

Where the columnar epithelium undergoes physiological metaplasia to tougher and more resistant squamous epithelium, as a result of the acidic pH of the vagina

Question 2

What is dysplasia of the cervix called?

Answer 2

cervical intraepithelial neoplasia (CIN)

Question 3

What is the major risk factor for the development of CIN and cervical cancer?

Answer 3

persistent HPV infection

Question 4

What is the main differential to investigate in post coital bleeding?

Answer 4

cervical cancer!

Question 5

How is cervical cancer investigated?

Answer 5

biopsy (type and grade)

staging - examination under anaesthesia, abode/pelvis CT

Question 6

what is the staging system used in cervical cancer?

Answer 6

FIGO

Question 7

What is the most common type of cervical canceR?

Answer 7

80% invasive SCC

20% adenocarcinomas

Question 8

Cervical screening

Answer 8

aims to detect and treat premalignant lesions

women are screened every 3 years from 25-49y age group, and every 5 years from 50-64y

Question 9

What is dyskaryosis

Answer 9

abnormalities of the cell nucleus

Question 10

What is borderline nuclear change?

Answer 10

a reporting category which is bet thought of as a holding category used when the pathologist is uncertain whether the smear is normal or shows dyskaryosis

Question 11

Management of CIN

Answer 11

CIN 1 - observation and regular follow up

CIN 2 and 3 - xcisionof the transformation zone with cutting diathermy under LA (LLETZ)

Question 12

Endometrial hyperplasia

Answer 12

increase in the number of endometrial GLANDS relative to the endometrial stroma - it results in thickening of the endometrium, which can be seen at hysteroscopy or on imaging (transvaginal USS)

usually presents clinically as abnormal vaginal bleeding

caused by high levels of unopposed oestrogen

Question 13

What are causes of high levels of unopposed oestrogen?

Answer 13

PCOS
obesity
tamoxifen therapy
anovulatory cycles in the perimenopause
unopposed oestrogen HRT

Question 14

What are the types of endometrial hyperplasia?

Answer 14

non-atypical hyperplasia - without cytological atypica (untreated very low risk of progression to cancer <2% so general not regarded as pre malignant and treated with exogenous progesterone therapy)

atypical hyperplasia - with cytological atypica (left untreated the risk of progression to cancer is up to 50% so this is regarded as premalignant, patients are usually recommended to have a hysterectomy)

Question 15

Endometrial cancer epidemiology

Answer 15

most common gynae cancer

> 90% occur in women aged >50y

the majority are adenocarcinomas from atypical hyperplasia

Question 16

What is the mot important differential to investigate in post menopausal bleeding?

Answer 16

ENDOMETRIAL CANCER!

Question 17

Endometrial cancer investigations

Answer 17

Gold standard is hysteroscopy and endometrial biopsy

Question 18

What staging system is used for endometrial cancers?

Answer 18

FIGO

Question 19

Mature cystic teratoma (“dermoid cyst”)

Answer 19

common benign tumours of the ovary typically occurring in the pre-menopausal age group

asymptomatic but rupture is painful

Question 20

What are teratomas

Answer 20

germ cell tumour which form form normal issue structures

most contain elements derived form all three embryonic layers (ectoderm, mesoderm, endoderm)

Question 21

high grade serous carcinoma

Answer 21

the most common malignant ovarian tumour

may appear solid but has solid and cystic components

Question 22

Pathology of ovarian cancer

Answer 22

about 90% are carcinomas

the most common type is high grade serous carcinoma (HGSC)

HGSC accounts for about 705 of all ovarian carcinomas

Question 23

risk factors for ovarian carcinoma

Answer 23

number of ovulations

family history

Question 24

clinical presentation of ovarian carcinomas

Answer 24

diverse and non-specific
often only manifest when the tumour is large
present late
bloating, feeling of fullness
loss of appetite
pelvic or abdominal ain
increased urgency or frequency of urination
B symptoms

often a delay in diagnosis

Question 25

what is the tumour marker for ovarian cancer?

Answer 25

CA125

Question 26

testicular cancer epidemiology

Answer 26

uncommon
however, in the male 15-49y age group it is the most common type of cancer
highly responsive to treatment

important to recognise and diagnose!

Question 27

testicular cancer presentation

Answer 27

painless lump

refer on 2WW

Question 28

testicular cancer investigations

Answer 28

USS of the testicles

serum tumour markers

Question 29

What is the most common type of testicular cancer?

Answer 29

over 90% are germ cell tumours

can be seminoma or non-seminomatous GCT

Question 30

differences between seminoma and NSGCT?

Answer 30

NSGCT more aggressive

NSGCT often require chemo in addition to radical orchidectomy

Question 31

Seminoma epidemiology

Answer 31

peak incidence in the 30-40y age group

germ cell tumour arising from the seminiferous tubules of the testis

the seminiferous tubules are the site of spermatogenesis

Question 32

what is the sequence of spermatogenesis?

Answer 32

germ cell
spermatogonia
spermatocyte
spermatid
spermatozoa

Question 33

primary treatment for seminoma?

Answer 33

radical orchidectomy

Question 34

how does seminoma spread?

Answer 34

late via the lymphatics to the para-aortic retroperitoneal lymph nodes

Question 35

what tumour markers may be useful in testicular masses?

Answer 35

alpha fetoprotein (AFT) - yolk sac tumours

HCG - choriocarcinomas

LDH - useful in assessing tumour burden as corresponds with the bulk of the tumour

Question 36

cure rates in testicular germ cell tumours?

Answer 36

ver chemo and radiosensitive
cure rates are more than 80% even in those with metastases!

treatment can be less intensive when diagnosed at an earlier stage