Gynaecological tumours Flashcards
Where can you get gynaecological tumours?
Vulva Cervix (neck of uterus) Endometrium (lining of uterus) Myometrium (body of uterus) Ovary Tumours of gestation (pregnancy)
What are the two most common types of carcinoma of the cervix?
Squamous carcinomaAdenocarcinoma
Give some rarer type of cervical carcinoma
• adenosquamous • clear cell (?DES) • neuroendocrine • sarcoma • lymphoma • metastasis
What are some risk factors for cervical cancer?
Sexual intercource, multiple partnersImmunosuppressionCigarette smokingLong term use of OCPEarly 1st pregnancyMultiple pregnanciesFamilial tendency
What is the main viral cause for cervical carcinoma?
Human Papilloma Virus
What does HPV cause?
wartsflat wartsacanthosiskoilocytosispapillomatosis
What are the type of HPV that lead to cervical carcinoma?
HPV 16 and 18
Which genes are involved?
E6 and E7
What are the characteristics of a squamous carcinoma of the cervix?
Have cervical expansionUlcer and nodule formationPresents with post-coital, intermenstrual or postmenopausal bleeding
What are some histological features of squamous carcinoma of the cervix/
Have infiltrating tongues of squamous epitheliumPresence of cytological features of malignancyCan be defined as well, moderately or poorly differentiated.
Where can carcinoma of the cervix spread locally?
UretersRectum - fecal incontinenceBladder - urinary incontinenceCan have the formation of fistulas
What is the pattern of lymphatic drainage in cervical carcinoma?
Iliac lymph nodesAortic lymph nodes
What is cervical intraepithelial neoplasia?
Potentially premalignant transformation and abnormal growth which can lead onto development of squamous cell carcinoma.
Give a specific characteristic of CIN which helps with diagnosis
All cells at all levels are abnormal– what you are looking for with cervical screening programmes
How is CIN graded?
• mitotic activity • nuclear pleomorphism, hyperchromasia • nuclear/cytoplasmic ratio
What is the prognosis for cervical carcinoma?
Stage one – cure in most casesOverall have a 62% 10 year survival rate
Give some characteristics of cervical screening
Start age = 25Every 3 years till 50Every 5 years from 50-65Abnormal cells present will indicate a referral for colposcopy
What strains of HPV are vaccinated against?
8, 11 (warts) and 16, 18 (cervical cancer)
What is a disadvantage of not vaccinating boys?
Do not get herd immunity as half the population are not protected and they can pass on the virus to females
What are the two main types of endometrial carcinoma?
Type I - unopposed oestrogenType II - clear cell and uterine serous property
What factors give rise to an increase in circulating levels of oestrogen?
nulliparousearly menarchelate menopauseiatrogenicobesitydiabetesHRT
Why is obesity related to high oestrogen levels?
It causes an increase in androgen production levels from the ovaries, therefore increasing oestrogen levels.
Give some characteristics of endometrial carcinoma
GlandsMalignant epitheliumSome squamous areasInvades the myometrium and the cervixSpread to adnexa (areas adjacent to the uterus)
How is the prognosis of endometrial carcinoma determined?
If the depth is less or greater than half of the myometriumInvolvement of cervical stroma/adnexaIs there any associated hyperplasiaWhat grade and type it is
What is a carcinosarcoma?
The presence of malignant glands and stroma. Tends to occur more in older womenHas a poor prognosis
What are the different type of endometrial hyperplasia that you can get?
SimpleComplexComplex with atypia
Define simple endometrial hypoerplasia
Enlargement of cystic glands as well as having an abundant stroma
Define complex endometrial hyperplasia
Glands which are crowded, branched of budded.
Define complex with atypia
Has same features as complex with the cytological features of malignancy of varying degrees.
What happens when a cervical screening comes back as abnormal?
Referral fro colposcopyAbnormal areas are highlights with diluted acetic acidAreas are removed by diathermyThen cytology of biopsy
What type of tumours are myometrial tumours?
Smooth muscle leiomyoma AKA fibroidsand benign tumours
What are some of the effects of smmooth muscle leiomyoma?
Are dependent on oestrogenHeavy/painful periodsInfertilityCan have multiple or single
Give some of the histological features of leiomyoma
• Interlacing bundles of smooth muscle • rounded ends to nuclei • fibrotic or myxoid stroma • Atypical types
What is a leiomyosarcoma?
Are malignancies found in smooth muscle of myometrium
What is a specific characteristic of leiomyosarcomas?
Are not derived form benign leimyomas
Where can ovarian neoplasms arise from?
- surface epithelium - stroma - sex cord components - germ cells - metastases
What are the symptoms of ovarian neoplasms?
No symptoms of the precursorSymptoms present late- ascites- effects of a mass- menstrual disturbances- inappropriate sex hormones
What are the different classifications of ovarian carcinomas?
Epithelial - serous- mucinous- endometrioid- clear cell- Brenner (transitional)
What are some of the causes of ovarian epithelial neoplasms?
- IVF- HRT- Smoking- Obesity- Endometriosis- Talcum powder (asbestos fibres)- Prior cyst
What are the types of sex cord tumour that you can get?
Granulosa cell tumourFibroma or thecomaSertoli leydig cell tumour
Give some characteristic of granulosa cell tumours
Oestrogen producingIntra-abdominal spreadUsually recurs in 5 yearsCan also have late recurrenceDistant metastases are rareCan develop iso-sexual precocious puberty
Give some histological characteristics of granulosa cell tumours
Regular cells with coffee bean nucleiHave circular gaps in the tissue, which are known as Call-Exner bodies
Describe a leydig cell tumour
Is uncommon and causes virilisation - produces androgens
Give some histological characteristics of leydig cell tumours
Pink cells with abundant cytoplasmUsually are benign
Describe a teratoma
Ovarian germ cell neoplasmIs a mature cystic teratoma which can contain:- skin- teeth- hair- bone- thyroid- gliaAre benign
Describe vulval tumours
Most are squamous carcinomasCaused by HPV in younger womenMainly found in the labia
What are some causes for vulval carcinoma in older women?
Differentiated vulval intraepithelial neoplasiaChronic irritationLichen sclerosusSquamous hyperplasiaSmokingHypertensionDiabetes
What is lichen sclerosus?
degeneration of stromal tissue
What are the macroscpoic characteristics of vulvo intraepithelial neoplasia?
Scaly red patches around anusWhite around the clitorisIs painful and itchy
How would you treat a vulval carcinoma?
Surgery to remove tumour and any lymph nodes involved. Can be curative if all tumour and metastases are removed.
How does the tumour spread?
Locally Metastasises to the inguinal lymph nodes
What is a hydatiform mole?
An abnormal form of pregnancy in which a non-viable fertilised egg implant in the uterus and will fail to come to term. – Gestational trophoblastic disease
What are the different types of gestational trophoblastic disease?
Hydatiform mole - benignInvasive mole- choriocarcinoma- placental site trophoblastic tumour
What genotypes can you get with a hydatiform mole?
Complete 46XX or 46XY but both will be paternal15% risk of malignancyPartial 69XXY triploid- one egg and two sperm0.5% risk of malignancy
