Gynaecological pathology Flashcards
Malignant signet ring cells containing mucin
Krunkenburg tumour (ovarian tumour spreading from GI tract - classically from the stomach. Results in the formation of little signet cells containing mucin which will also be found at the primary site)
Benign large unilateral ovarian mass
Mucinous tumour
Germ cells mixed with lymphocytes
Dysgerminoma
Fibrous tissue containing spindle cells + lipid
Thecoma
Low-risk HPV types
6+11 Cause warts)
High-risk HPV types
16+18 (Cause cervical, penile, anal cancer)
Two types of HPV vaccine
Quadrivalent - 6+11, 16+18 (Yeast)
Bivalent 16+18 (Baculovirus)
Sub-types of endometrial carcinoma
Adenocarcinomas Type I (80-85%) - secretory, , mucinous or endometrioid) ~ oestrogen dependent, related to hyperplasia! Type II (15-20%) - papillary, serous, clear cell ~ older + post menopausal, not oestrogen dependent
PTEN, PI3KCA, K-ras, CTNNB1
Type 1 endometrial carcinoma
p53, PI3KCA, HER2, PTEN, CTNNB1
Type II endometrial carcinoma
FIGO staging endometrial carcinoma
1 Uterus
2 Cervix
3 Adnexa / vagina / local LNs
4 Pelvic organs / distant spread
Most common organisms PID
Chlamydia trachomatis
Neisseria gonorrhoea
Red-blue / brown cigarette burn nodules
Chocolate cysts in ovaries
Endometrial glands + stroma outside uterus
Endometriosis
Endometriosis triad
Dysmenorrhoea, deep dyspareunia, subfertility
Endometrial tissue in myometrium
Globular ‘boggy’ uterus
Adenomyosis
Bundles of smooth muscle cells
Red-degeneration in pregnancy
Firm grey-white tumours
Leiomyoma
Endometrial cancer key difference between types
Type I is oestrogen dependent (more common), type II is not
Squamous cell carcinoma
HPV-16
Vulval carcinoma
Types of VIN
Usual type (warty, basaloid) - younger Differentiated type (keratinising) - older, more likely malignant
Paget’s disease of the vulva
Adenocarcinoma in situ
Epithelial types at cervix
Inner columnar - TZ - outer squamous
Cytology cervical grading
Mild, moderate, severe dyskaryosis
Histology cervical grading
CIN1 (dysplasia in lower 1/3)
CIN2 (dysplasia in lower 2/3)
CIN3 (full thickness dysplasia)
Invasion through BM = carcinoma
RF cervical cancer
Early age at first intercourse, multiple partners, smoking, immunosuppression (e.g. HIV)
cGIN vs CIN
Dysplasia in columnar epithelium vs squamous epithelium (CIN more common)
FIGO staging cervical carcinoma
Stage 0 - CIN Stage 1 - cervix Stage 2 - < pelvic side wall or lower 1/3 vagina Stage 3 - > above Stage 4 - beyond pelvis
3 main cell types in ovary
Surface epithelium
Germ cells (oocytes)
Sex cord / stromal cells (incl. granulosa + thecal, Sertoli + Leydig, fibrocyte (CT) cells)
5 types of benign ovarian cysts
- Functional (incl. follicular, corpus luteal, theca luteal)
- Inflammatory (incl. tubo-ovarian abscess, endometrioma)
- Epithelial
- Germ cell
- Sex cord / stromal
Large developing primordial follicle
Follicular cyst (Functional cyst)
Large CL remnant after ovulation
Corpus luteal cyst (Functional cyst)
Occur in pregnancy + GTD
Caused by excessive B-hCG stimulation
Usually multiple + bilateral
Resolve after pregnancy
Theca luteal cyst (Functional cyst)
Chocolate cysts
Accompanied by ‘cigarette burn’ powder lesions
Dyspareunia, dysmenorrhoea, subfertility
Endometrioma (Inflammatory cyst)
Cyst of inflammatory exudate
Post PID / appendicitis
Tubo-ovarian abscess (Inflammatory cyst)
PID Treatment
Metronidazole + Doxycycline for 14d + IM Ceftriaxone
20% ovarian tumours, 40% become malignant
Columnar epithelium
Psammoma bodies
Small, unilateral + fluid filled
Serous cystadenoma (Epithelial cyst)
Mostly benign
Mucin-secreting epithelium
Large + bilateral
Mucin-filled
Mucinous cystadenoma
Rare + usually malignant
Derive from ectopic bladder transitional cells
Hobnail appearance
Abundant clear cytoplasm with intracellular glycogen
Transitional ‘Brenner’ clear cell cystadenoma
Contain paste-like sebum
Derived from all 3 germ layers
Ectodermal tissue - hair, teeth etc. within Rokitansky’s protuberance
Mature teratoma (aka dermoid cyst) (germ cell)
Fibrocyte cells
Ascites + pleural effusion
Firboma (sex cord stromal)
Ascites + pleural effusion + ovarian cyst = Meig’s syndrome
Ascites + pleural effusion + ovarian cyst
Meig’s syndrome
Malignant and solid
Secretes AFP
Immature teratoma (germ cell)
Most common ovarian malignancy in young women
Central nuclei surrounded by clear cytoplasm
Very sensitive to chemo
Dysgerminoma (germ cell)
Trophoblast cells
Lots of B-hCG
Choriocarcinoma (germ cell)
Rings of cells around vessels (Schiller Duual bodies)
Children
Yolk sac tumour (germ cell)
Meigs syndrome
No hormone production
Fibroma (sex cord / stromal - stromal)
Secrete oestrogen
= Breast enlargement, endometrial hyperplasia, irregular menstruation)
Granulosa-thecal (sex cord / stromal - sex cord)
Most common malignant epithelial tumour
High-grade serous cystadenoma
Secrete androgens
= Defeminisation, breast atrophy, virilisation
Sertoli-Leydig (sex cord / stromal - sex cord)
Infection of Fallopian tubes
Can lead to hydrosalpinx
Salpingitis
What is hydrosalpinx?
Obstruction of ends of Fallopian tubes (e.g. from scarring in salpingitis)
Fluid collects in tube leading to swelling
Risk factors ovarian cancer
Familial risk factors - BRCA1/2 (breast, colon, endometrial), Lynch (also HNPCC), PJS Increased ovulation (nulliparity, late menopause, early menarche)
Endometrial cancer
Breast cancer
Colon cancer
Ovarian cancer
BRCA1/2
Most common ovarian cancer
90% epithelial
70-80% high-grade serous epithelial
Ovarian cancer
HNPCC
Lynch syndrome
Benign hamartomatous polyps GI tract
Ovarian cancer
Hyperpigmented macular on lips / oral mucosa
AD inheritance
Peutz-Jeughers syndrome
