Gynaecological Pathology Flashcards
What is the transformation zone of the cervix
Where the columnar epithelium undergoes physiological metaplasia to tougher and more resistant squamous epithelium, as a result of the acidic pH of the vagina
What is dysplasia of the cervix called?
cervical intraepithelial neoplasia (CIN)
What is the major risk factor for the development of CIN and cervical cancer?
persistent HPV infection
What is the main differential to investigate in post coital bleeding?
cervical cancer!
How is cervical cancer investigated?
biopsy (type and grade)
staging - examination under anaesthesia, abode/pelvis CT
what is the staging system used in cervical cancer?
FIGO
What is the most common type of cervical canceR?
80% invasive SCC
20% adenocarcinomas
Cervical screening
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
What is dyskaryosis
abnormalities of the cell nucleus
What is borderline nuclear change?
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
Management of CIN
CIN 1 - observation and regular follow up
CIN 2 and 3 - xcisionof the transformation zone with cutting diathermy under LA (LLETZ)
Endometrial hyperplasia
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
What are causes of high levels of unopposed oestrogen?
PCOS obesity tamoxifen therapy anovulatory cycles in the perimenopause unopposed oestrogen HRT
What are the types of endometrial hyperplasia?
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)
Endometrial cancer epidemiology
most common gynae cancer
> 90% occur in women aged >50y
the majority are adenocarcinomas from atypical hyperplasia
What is the mot important differential to investigate in post menopausal bleeding?
ENDOMETRIAL CANCER!
Endometrial cancer investigations
Gold standard is hysteroscopy and endometrial biopsy
What staging system is used for endometrial cancers?
FIGO
Mature cystic teratoma (“dermoid cyst”)
common benign tumours of the ovary typically occurring in the pre-menopausal age group
asymptomatic but rupture is painful
What are teratomas
germ cell tumour which form form normal issue structures
most contain elements derived form all three embryonic layers (ectoderm, mesoderm, endoderm)
high grade serous carcinoma
the most common malignant ovarian tumour
may appear solid but has solid and cystic components
Pathology of ovarian cancer
about 90% are carcinomas
the most common type is high grade serous carcinoma (HGSC)
HGSC accounts for about 705 of all ovarian carcinomas
risk factors for ovarian carcinoma
number of ovulations
family history
clinical presentation of ovarian carcinomas
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
what is the tumour marker for ovarian cancer?
CA125
testicular cancer epidemiology
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!
testicular cancer presentation
painless lump
refer on 2WW
testicular cancer investigations
USS of the testicles
serum tumour markers
What is the most common type of testicular cancer?
over 90% are germ cell tumours
can be seminoma or non-seminomatous GCT
differences between seminoma and NSGCT?
NSGCT more aggressive
NSGCT often require chemo in addition to radical orchidectomy
Seminoma epidemiology
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
what is the sequence of spermatogenesis?
germ cell spermatogonia spermatocyte spermatid spermatozoa
primary treatment for seminoma?
radical orchidectomy
how does seminoma spread?
late via the lymphatics to the para-aortic retroperitoneal lymph nodes
what tumour markers may be useful in testicular masses?
alpha fetoprotein (AFT) - yolk sac tumours
HCG - choriocarcinomas
LDH - useful in assessing tumour burden as corresponds with the bulk of the tumour
cure rates in testicular germ cell tumours?
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
