HISTO: Gynae and breast

Question 1

What is the most common cervical cancer type?

Answer 1

SCC

Question 2

What are the two transforming genes in HPV and what does each target?

Answer 2

E6 and E7

P53 and Rb respectively

Question 3

What does the HPV vaccine do?

Answer 3

Prevents progression to Ca

Question 4

What is the most common type of endometrial cancer?

Answer 4

Endometrioid - oestrogen dependent

Question 5

What is grade of endometrioid cancer based on?

Answer 5

%glands and cytological atypia

Question 6

What is the most common uterine tumour?

Answer 6

Leiomyoma

Question 7

Which endometrial cancers arise in atrophic endometrium and are high grade?

Answer 7

Serous = p53

Clear cell = PTEN

Question 8

What are the cancer genome atlas groups?

Answer 8

Type 1 - POLE mutations (highest survival)
Type 2 - MSI
Type 3- CN low
Type 4 - CN high (lowest survival)

Question 9

What are the epithelial subtypes of ovarian tumours? What conditions are they associated with?

Answer 9

Serous, mucinous, endometrioid, clear cell, seromucinous, Brenner, mixed

BRCA1/2 and Lynch II/HNPCC

Question 10

What is the most common ovarian cancer subtype? What mutation is it associated with?

Answer 10

Serous P53

low grade ones have KRAS/BRAF

Question 11

What epithelial ovarian tumour is most associated with endometriosis?

Answer 11

Clear cell - MSI/PIK3CA

Question 12

What % of endometrioid ovarian tumours are associated with endometriosis?

Answer 12

20%

Question 13

What age group do most sex-cord stromal ovarian tumours occur in?

Answer 13

Post-menopausal

Question 14

What do these mixed sex cord stromal tumours release:

• Thecoma
• Granulosa
• Sertoli-Leydig
• Fibroma

Answer 14

Thecoma –> oestrogen
Granulosa –> oestrogen
Sertoli-Leydig –> androgenic
Fibromas – X none

Question 15

Which syndromes predispose to sex-cord stromal tumours?

Answer 15

DICER1 --> 60% of sertoli-leydig
Peutz Jeghers (STK11) --> sertoli-leydig with annular tubules

Question 16

What are the subtypes of stromal ovarian tumours?

Answer 16

Fibroma, thecoma, microcystic stromal (CTNNB1 -beta catetin positive)

Question 17

What is an example of an ovarian sex cord tumour?

Answer 17

Granulosa cell (FOXL2)

Question 18

What are germ-cell ovarian tumours graded based on?

Answer 18

Primitive elements

Question 19

Which BRCA confers survival advantage? Why?

Answer 19

BRCA2 because PARP inhibitors can ve used (compared to BRCA 1 or negative)

Question 20

What are Krukenberg tumours?

Answer 20

Bilateral mets to ovaries from gastric or breast origin

Question 21

What is characteristic of Krukenberg tumours on histology?

Answer 21

Signet ring cells making mucin

Question 22

What ovarian tumour are these markers of:

• Ca19-9
• CA125
• Inhibin
• beta-HCG
• AFP

Answer 22

Ca19-9 = mucinous 
CA125 = epithelial 
Inhibin = granulosa (sex cord stromal)
Beta HCG = chroio or dysgerminoma 
AFP = immature teratoma, endodermal yolk sac

Question 23

What types of tissue do Brenner tumours contain?

Answer 23

Urothelial like

Question 24

What are the subtypes of Germ cell tumours?

Answer 24

Teratoma
Dysgerminoma
Choriocarcinoma

Question 25

Summarise the main classes of ovarian tumours.

Answer 25

Epithelial Sex cord stromal Germ cell Metastatic e.g. Krukenberg

Question 26

Summarise the subtypes of sex cord-stromal tumours.

Answer 26

Sex-cord includes: granulosa Stromal includes: fibroma, thecoma Mixed includes: sertoli-leydig

Question 27

What are the types of ovarian cysts?

Answer 27

Physiological- follicular, corpus luteal, theca luteal Inflammatory - endometrioid Germ cell - dermoid Epithelial - serous/mucinous cystadenoma, Brenner tumour Sex-cord stromal - fibroma, thecoma

Question 28

Which cyst is Meig's syndrome most common with?

Answer 28

Fibroma

Question 29

What is Meig's syndrome?

Answer 29

Effusion, ascites, fibroma

Question 30

Which cyst is associated with pregnancy?

Answer 30

Theca luteal

Question 31

Which cyst looks like ground glass on USS?

Answer 31

Endometrioma aka chocolate cysts

Question 32

Which cyst can cause pseudomyxoma peritonei on rupture?

Answer 32

Mucinous cystadenoma

Question 33

``` What does coding with these letters in breast pathology mean: C M U B ```

Answer 33

``` C = cytology coding M = clinical coding U = radiology coding B = core biopsy coding ```

Question 34

Summarise the cytology coding for breast tissue.

Answer 34

C1 = inadequate; C2 = benign, C3= atypia/benign, C4 = suspicious, C5= malignant

Question 35

Summarise the core biopsy coding for breast tissue.

Answer 35

B1= normal; B2= benign; B3= uncertain; B4= suspicious; B5 = malignant B5a=DCIS B5b=invasive carcinoma

Question 36

What does this describe? | "Monolayer sheet of myoepithelial cells on FNA, well circumscribed"

Answer 36

Fibroadenoma = proliferation of fibrous tissue

Question 37

What is a Phyllodes tumour?

Answer 37

Malignant fibroepithelial tumour with cellular dense stroma and mitosis

Question 38

Which age group is most affected by Phyllodes tumours?

Answer 38

>50yrs

Question 39

How are intraductal papillomas managed?

Answer 39

Should be excised

Question 40

How do intraductal carcinomas present based on location? Which age group are these seen in ?

Answer 40

Central - discharge Peripheral - silent Occurs in 40-60yo

Question 41

What does this describe? | "Stellate on mammogram, central scarring with peripheral glandular proliferation"

Answer 41

Radial scar

Question 42

What happens if a radial scar is left undisturbed?

Answer 42

Will progress to tubular carcinoma

Question 43

What are the two main types of proliferative breast disease? Which has the higher risk of progression to cancer?

Answer 43

Usual epithelial hyperplasia | Flat epithelial hyperplasia - higher risk of atypical ductal carcinoma

Question 44

Name 2 in-situ breast tumours. What is their risk of progression to carcinoma?

Answer 44

In situ lobular neoplasia - x10 risk | Ductal carcinoma in situ - small risk but still excised

Question 45

Which tumour is most often detected as areas of calcification on mammography or as lump/discharge/eczema of the nipple?

Answer 45

Ducal carcinoma in situ

Question 46

What is eczema of the nipple called?

Answer 46

Paget's

Question 47

What is the most common breast carcinoma?

Answer 47

Ductal invasive carcinoma

Question 48

What breast carcinoma presents with prominent lymphocytic infiltrate and central necrosis?

Answer 48

Basal-like

Question 49

Which breast carcinoma is associated with BRCA?

Answer 49

Basal-like carcinoma

Question 50

How do basal-like carcinomas spread?

Answer 50

Vascular, often distant, spread

Question 51

What are the 3 categories used to grade basal-like carcinomas?

Answer 51

Tubule formation Nuclear pleomorphism Mitosis (each is scored out of 3)

Question 52

What does ER/PR/Her2 positive/negative mean in terms of prognosis? Which is best?

Answer 52

``` ER/PR+ = good Her2 = bad ```

Question 53

What is the most important factor for prognosis in breast cancer?

Answer 53

Status of axillary lymph nodes

Question 54

Which breast cancer is "triple negative"?

Answer 54

Basal-like carcinoma

Question 55

What is the histopathology of gynaecomastia?

Answer 55

Epithelial hyperplasia

Question 56

Which ovarian tumours are strongly positive for beta-catetin?

Answer 56

Microcystic stromal tumours - CTNNB1

Question 57

Which breast change occurs due to imbalances in progesterone and oestrogen?

Answer 57

Fibrocystic disease - some calcification on mammogram but benign on histopathology

Question 58

Name 2 benign breast lesions that commonly mimic breast cancer on radiology.

Answer 58

Fat necrosis | Radial scar