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Histopathology > Gynaecological Pathology > Flashcards

Gynaecological Pathology Flashcards

1
Q

What is pelvic inflammatory disease?

A

This is an infection ascending from the vagina into the uterus and fallopian tubes.

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2
Q

What are the most common organisms to cause pelvic inflammatory disease?

A
  • Chlamydia trachomatis

- Neisseria gonorrhoea

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3
Q

What are the clinical features of pelvic inflammatory disease?

A
  • Lower abdominal pain
  • Dyspareunia
  • Vaginal bleeding/discharge
  • Adnexal tenderness
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4
Q

What are the complications of pelvic inflammatory disease?

A
  • Fitz-Hugh-Curtis syndrome
  • Infertility
  • Increased risk of ectopic pregnancy
  • Plical fusion
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5
Q

What is endometriosis?

A

Presence of endometrial tissue outside the uterus

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6
Q

What theories exist for the aetiology of endometriosis?

A
  • Metaplastic transformation of epithelial cells
  • Implantation due to retrograde menstrual flow
  • Lymphatic/vascular dissemination of cells
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7
Q

What are the clinical features of endometriosis?

A
  • Pelvic pain, dysmenorrhea, deep dyspareunia and reduced fertility
  • Cyclical pain and bleeding, depending on the location
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8
Q

What are the macroscopic features of endometriosis?

A
  • Chocolate cysts in ovaries

- Red-blue to brown nodules

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9
Q

What are the abnormalities of the uterus?

A
  • Duplication

- Agenesis

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10
Q

What are the microscopic features of endometriosis?

A

Endometrial glands and stroma

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11
Q

What is adenomyosis?

A

The presence of endometrial tissue within the uterine muscle (myometrium).

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12
Q

What is gestational trophoblastic disease?

A

An uncommon condition involving too much paternal tissue, with the possibility of becoming malignant.

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13
Q

What is a leiomyoma?

A

This is more commonly known as a fibroid. It is the most common tumour of th female genital tract and is completely benign.

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14
Q

What are the different types of leiomyoma?

A

They can be intramural, submucosal or subserosal

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15
Q

What is the cause of fibroids?

A

Largely unknown but it is associated with oestrogen exposure. They regress after menopause.

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16
Q

What are the macroscopic features of a leiomyoma?

A

A sharply circumscribes, discrete, round and firm tumour, of variable size.

17
Q

What are the microscopic features of a leiomyoma?

A

Bundle of smooth muscle cells

18
Q

What are the clinical features of a leiomyoma?

A

They can be asymptomatic, according to size

  • Heavy menstrual bleeding
  • Dysmenorrhea
  • Pressure effects
  • Subfertility
  • Can degenerate in pregnancy, causing haemorrhage
19
Q

What is a leiomyosarcoma?

A

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.

20
Q

What is main clinical feature of endometrial carcinoma?

A

Post-menopausal bleeding, 10% of those with PMB will have endometrial carcinoma

21
Q

How are endometrial carcinomas divided?

A

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
22
Q

What is normal vulval histology?

A

Squamous epithelium (skin)

23
Q

What is vulval intraepithelial neoplasia?

A

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
24
Q

What is vulval carcinoma?

A

This is usually an SCC, sometimes arising from VIN, or from other skin abnormalities (Paget’s disease).

25
Q

What are the risk factors for ovarian carcinomas?

A
  • Genetics
  • Family history
  • Hormone replacement therapy
  • Endometriosis
26
Q

How are ovarian carcinomas subdivided?

A
  • Epithelial (70%)
  • Germ cell (20%)
  • Sex chord/stroma (10%)
27
Q

Describe epithelial ovarian tumours

A

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
28
Q

Describe germ cell ovarian tumours

A

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
29
Q

Describe sec chord/stromal ovarian tumours

A

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
30
Q

Name some secondary ovarian tumours

A

Krukenberg
- From the gastric or breast tissue)

Colorectal cancers

31
Q

What is cervical intraepithelial neoplasia?

A

Dysplasia at the transformation zone, as a result of infection of HPV 16 and 18

32
Q

What is the cervical transformation zone?

A

The area where squamous epithelial tissue changes into columnar epithelial tissue.

33
Q

How is CIN graded?

A

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

34
Q

When does CIN become cervical cancer?

A

When it invades through the basement membrane

35
Q

What are the risk factors for CIN?

A
  • Early age of first intercourse
  • Multiple partners
  • Multiparity
  • Smoking
  • HIV
  • Immunosuppression
36
Q

What is the CIN screening programme?

A

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.

37
Q

What is cervical glandular intraepithelial neoplasia?

A

This is less common than CIN with glandular tissue instead of epithelial tissue being the dysplasia.

38
Q

Describe cervical carcinoma

A

It usually arises from CIN and is most commonly SCC.

Clinical features include: post-coital bleeding, intermenstrual bleeding, postmenopausal bleeding, pain and discharge

39
Q

How does the herpes papilloma virus work?

A

It inhibits p53, causing increased mutation

It can be latent (not dividing independently of host cell) or productive (dividing independently of host cell)

Histopathology (21 decks)

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