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4 - Repro > Gynaecological tumours > Flashcards

Gynaecological tumours Flashcards

1
Q

Where can you get gynaecological tumours?

A

Vulva Cervix (neck of uterus) Endometrium (lining of uterus) Myometrium (body of uterus) Ovary Tumours of gestation (pregnancy)

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2
Q

What are the two most common types of carcinoma of the cervix?

A

Squamous carcinomaAdenocarcinoma

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3
Q

Give some rarer type of cervical carcinoma

A

• adenosquamous • clear cell (?DES) • neuroendocrine • sarcoma • lymphoma • metastasis

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4
Q

What are some risk factors for cervical cancer?

A

Sexual intercource, multiple partnersImmunosuppressionCigarette smokingLong term use of OCPEarly 1st pregnancyMultiple pregnanciesFamilial tendency

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5
Q

What is the main viral cause for cervical carcinoma?

A

Human Papilloma Virus

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6
Q

What does HPV cause?

A

wartsflat wartsacanthosiskoilocytosispapillomatosis

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7
Q

What are the type of HPV that lead to cervical carcinoma?

A

HPV 16 and 18

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8
Q

Which genes are involved?

A

E6 and E7

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9
Q

What are the characteristics of a squamous carcinoma of the cervix?

A

Have cervical expansionUlcer and nodule formationPresents with post-coital, intermenstrual or postmenopausal bleeding

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10
Q

What are some histological features of squamous carcinoma of the cervix/

A

Have infiltrating tongues of squamous epitheliumPresence of cytological features of malignancyCan be defined as well, moderately or poorly differentiated.

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11
Q

Where can carcinoma of the cervix spread locally?

A

UretersRectum - fecal incontinenceBladder - urinary incontinenceCan have the formation of fistulas

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12
Q

What is the pattern of lymphatic drainage in cervical carcinoma?

A

Iliac lymph nodesAortic lymph nodes

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13
Q

What is cervical intraepithelial neoplasia?

A

Potentially premalignant transformation and abnormal growth which can lead onto development of squamous cell carcinoma.

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14
Q

Give a specific characteristic of CIN which helps with diagnosis

A

All cells at all levels are abnormal– what you are looking for with cervical screening programmes

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15
Q

How is CIN graded?

A

• mitotic activity • nuclear pleomorphism, hyperchromasia • nuclear/cytoplasmic ratio

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16
Q

What is the prognosis for cervical carcinoma?

A

Stage one – cure in most casesOverall have a 62% 10 year survival rate

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17
Q

Give some characteristics of cervical screening

A

Start age = 25Every 3 years till 50Every 5 years from 50-65Abnormal cells present will indicate a referral for colposcopy

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18
Q

What strains of HPV are vaccinated against?

A

8, 11 (warts) and 16, 18 (cervical cancer)

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19
Q

What is a disadvantage of not vaccinating boys?

A

Do not get herd immunity as half the population are not protected and they can pass on the virus to females

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20
Q

What are the two main types of endometrial carcinoma?

A

Type I - unopposed oestrogenType II - clear cell and uterine serous property

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21
Q

What factors give rise to an increase in circulating levels of oestrogen?

A

nulliparousearly menarchelate menopauseiatrogenicobesitydiabetesHRT

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22
Q

Why is obesity related to high oestrogen levels?

A

It causes an increase in androgen production levels from the ovaries, therefore increasing oestrogen levels.

23
Q

Give some characteristics of endometrial carcinoma

A

GlandsMalignant epitheliumSome squamous areasInvades the myometrium and the cervixSpread to adnexa (areas adjacent to the uterus)

24
Q

How is the prognosis of endometrial carcinoma determined?

A

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

25
Q

What is a carcinosarcoma?

A

The presence of malignant glands and stroma. Tends to occur more in older womenHas a poor prognosis

26
Q

What are the different type of endometrial hyperplasia that you can get?

A

SimpleComplexComplex with atypia

27
Q

Define simple endometrial hypoerplasia

A

Enlargement of cystic glands as well as having an abundant stroma

28
Q

Define complex endometrial hyperplasia

A

Glands which are crowded, branched of budded.

29
Q

Define complex with atypia

A

Has same features as complex with the cytological features of malignancy of varying degrees.

30
Q

What happens when a cervical screening comes back as abnormal?

A

Referral fro colposcopyAbnormal areas are highlights with diluted acetic acidAreas are removed by diathermyThen cytology of biopsy

31
Q

What type of tumours are myometrial tumours?

A

Smooth muscle leiomyoma AKA fibroidsand benign tumours

32
Q

What are some of the effects of smmooth muscle leiomyoma?

A

Are dependent on oestrogenHeavy/painful periodsInfertilityCan have multiple or single

33
Q

Give some of the histological features of leiomyoma

A

• Interlacing bundles of smooth muscle • rounded ends to nuclei • fibrotic or myxoid stroma • Atypical types

34
Q

What is a leiomyosarcoma?

A

Are malignancies found in smooth muscle of myometrium

35
Q

What is a specific characteristic of leiomyosarcomas?

A

Are not derived form benign leimyomas

36
Q

Where can ovarian neoplasms arise from?

A
  • surface epithelium - stroma - sex cord components - germ cells - metastases
37
Q

What are the symptoms of ovarian neoplasms?

A

No symptoms of the precursorSymptoms present late- ascites- effects of a mass- menstrual disturbances- inappropriate sex hormones

38
Q

What are the different classifications of ovarian carcinomas?

A

Epithelial - serous- mucinous- endometrioid- clear cell- Brenner (transitional)

39
Q

What are some of the causes of ovarian epithelial neoplasms?

A
  • IVF- HRT- Smoking- Obesity- Endometriosis- Talcum powder (asbestos fibres)- Prior cyst
40
Q

What are the types of sex cord tumour that you can get?

A

Granulosa cell tumourFibroma or thecomaSertoli leydig cell tumour

41
Q

Give some characteristic of granulosa cell tumours

A

Oestrogen producingIntra-abdominal spreadUsually recurs in 5 yearsCan also have late recurrenceDistant metastases are rareCan develop iso-sexual precocious puberty

42
Q

Give some histological characteristics of granulosa cell tumours

A

Regular cells with coffee bean nucleiHave circular gaps in the tissue, which are known as Call-Exner bodies

43
Q

Describe a leydig cell tumour

A

Is uncommon and causes virilisation - produces androgens

44
Q

Give some histological characteristics of leydig cell tumours

A

Pink cells with abundant cytoplasmUsually are benign

45
Q

Describe a teratoma

A

Ovarian germ cell neoplasmIs a mature cystic teratoma which can contain:- skin- teeth- hair- bone- thyroid- gliaAre benign

46
Q

Describe vulval tumours

A

Most are squamous carcinomasCaused by HPV in younger womenMainly found in the labia

47
Q

What are some causes for vulval carcinoma in older women?

A

Differentiated vulval intraepithelial neoplasiaChronic irritationLichen sclerosusSquamous hyperplasiaSmokingHypertensionDiabetes

48
Q

What is lichen sclerosus?

A

degeneration of stromal tissue

49
Q

What are the macroscpoic characteristics of vulvo intraepithelial neoplasia?

A

Scaly red patches around anusWhite around the clitorisIs painful and itchy

50
Q

How would you treat a vulval carcinoma?

A

Surgery to remove tumour and any lymph nodes involved. Can be curative if all tumour and metastases are removed.

51
Q

How does the tumour spread?

A

Locally Metastasises to the inguinal lymph nodes

52
Q

What is a hydatiform mole?

A

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

53
Q

What are the different types of gestational trophoblastic disease?

A

Hydatiform mole - benignInvasive mole- choriocarcinoma- placental site trophoblastic tumour

54
Q

What genotypes can you get with a hydatiform mole?

A

Complete 46XX or 46XY but both will be paternal15% risk of malignancyPartial 69XXY triploid- one egg and two sperm0.5% risk of malignancy

4 - Repro (13 decks)

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