Gynaecological Pathology Flashcards
What is pelvic inflammatory disease?
This is an infection ascending from the vagina into the uterus and fallopian tubes.
What are the most common organisms to cause pelvic inflammatory disease?
- Chlamydia trachomatis
- Neisseria gonorrhoea
What are the clinical features of pelvic inflammatory disease?
- Lower abdominal pain
- Dyspareunia
- Vaginal bleeding/discharge
- Adnexal tenderness
What are the complications of pelvic inflammatory disease?
- Fitz-Hugh-Curtis syndrome
- Infertility
- Increased risk of ectopic pregnancy
- Plical fusion
What is endometriosis?
Presence of endometrial tissue outside the uterus
What theories exist for the aetiology of endometriosis?
- Metaplastic transformation of epithelial cells
- Implantation due to retrograde menstrual flow
- Lymphatic/vascular dissemination of cells
What are the clinical features of endometriosis?
- Pelvic pain, dysmenorrhea, deep dyspareunia and reduced fertility
- Cyclical pain and bleeding, depending on the location
What are the macroscopic features of endometriosis?
- Chocolate cysts in ovaries
- Red-blue to brown nodules
What are the abnormalities of the uterus?
- Duplication
- Agenesis
What are the microscopic features of endometriosis?
Endometrial glands and stroma
What is adenomyosis?
The presence of endometrial tissue within the uterine muscle (myometrium).
What is gestational trophoblastic disease?
An uncommon condition involving too much paternal tissue, with the possibility of becoming malignant.
What is a leiomyoma?
This is more commonly known as a fibroid. It is the most common tumour of th female genital tract and is completely benign.
What are the different types of leiomyoma?
They can be intramural, submucosal or subserosal
What is the cause of fibroids?
Largely unknown but it is associated with oestrogen exposure. They regress after menopause.
What are the macroscopic features of a leiomyoma?
A sharply circumscribes, discrete, round and firm tumour, of variable size.
What are the microscopic features of a leiomyoma?
Bundle of smooth muscle cells
What are the clinical features of a leiomyoma?
They can be asymptomatic, according to size
- Heavy menstrual bleeding
- Dysmenorrhea
- Pressure effects
- Subfertility
- Can degenerate in pregnancy, causing haemorrhage
What is a leiomyosarcoma?
A malignant form of leiomyoma - but transition from the benign type to the malignant type is exceptionally rare.
They usually occur in post-menopausal women.
What is main clinical feature of endometrial carcinoma?
Post-menopausal bleeding, 10% of those with PMB will have endometrial carcinoma
How are endometrial carcinomas divided?
Endometrioid (80%)
- Usually lower grade tumours
- Related to oestrogen excess
- K-ras mutations
Non-endometrioid (20%)
- More aggressive and include papillary and serous types
- Unrelated to oestrogen excess
- p53 mutations
What is normal vulval histology?
Squamous epithelium (skin)
What is vulval intraepithelial neoplasia?
Dysplasia of the epithelium of the vulva, graded as I, II and III
- Can progress to malignancy, but has a lower to propensity to do this than CIN
- Associated with HPV 16
What is vulval carcinoma?
This is usually an SCC, sometimes arising from VIN, or from other skin abnormalities (Paget’s disease).
What are the risk factors for ovarian carcinomas?
- Genetics
- Family history
- Hormone replacement therapy
- Endometriosis
How are ovarian carcinomas subdivided?
- Epithelial (70%)
- Germ cell (20%)
- Sex chord/stroma (10%)
Describe epithelial ovarian tumours
Tumours derived from epithelial cells, which can be low grade, or high grade
Serous cystadenoma
- Most common type
- Mimics tubal epithelium
- 30-50% can be bilateral
Mucinous cystadenoma
- Mucin secreting cells from endocervical mucosa or intestinal tract
- Affects younger women
Endometrioid
- Mimics the endometrium
- Endometriosis is a risk factor
Clear cell
- Clear cytoplasm (high cytoplasmic glycogen)
- Poor prognosis
Describe germ cell ovarian tumours
Tumour derived from the germ cells, peak at 15-21 and again at 65-69
Dysgerminoma
- Rare
- Female testicular seminoma
Teratoma
- Most common germ cell
- 95% are mature and benign
- Hair, teeth, skin etc.
- Immature teratomas can be malignant
- Secretes alpha-fetoprotein
Choriocarcinoma
- Secrete hCG
- Malignant
- Responds to chemotherapy
Describe sec chord/stromal ovarian tumours
Tumours derived from the sec chord or the stromal tissue; they can be male or female structures
Fibroma
- No hormone production
- Benign
Granulosa-Theca cell tumour
- Produce oestrogen
- Granulosa cells can be malignant
Sertoli-Leydig cell tumours
- Secrete androgens
- Can be malignant
Name some secondary ovarian tumours
Krukenberg
- From the gastric or breast tissue)
Colorectal cancers
What is cervical intraepithelial neoplasia?
Dysplasia at the transformation zone, as a result of infection of HPV 16 and 18
What is the cervical transformation zone?
The area where squamous epithelial tissue changes into columnar epithelial tissue.
How is CIN graded?
I, II and II
I = dysplasia of the lower third of the TZ
II - dysplasia of the lower 2 thirds of the TZ
III = dysplasia of full thickness of the TZ but with the basement membrane intact
When does CIN become cervical cancer?
When it invades through the basement membrane
What are the risk factors for CIN?
- Early age of first intercourse
- Multiple partners
- Multiparity
- Smoking
- HIV
- Immunosuppression
What is the CIN screening programme?
Cervical swabs taken every three years from the age of 25 to 49, every 5 years from the age of 50 to 64, with continues screening based on indication after the age of 65.
What is cervical glandular intraepithelial neoplasia?
This is less common than CIN with glandular tissue instead of epithelial tissue being the dysplasia.
Describe cervical carcinoma
It usually arises from CIN and is most commonly SCC.
Clinical features include: post-coital bleeding, intermenstrual bleeding, postmenopausal bleeding, pain and discharge
How does the herpes papilloma virus work?
It inhibits p53, causing increased mutation
It can be latent (not dividing independently of host cell) or productive (dividing independently of host cell)
