Histo: Gynaecological pathology Flashcards
List some gynaecological infections that cause discomofrt but no serious complications.
- Candida
- Trichomonas vaginalis
- Gardnerella
List some gynaecological infections that cause serious complications.
- Chlamydia (infertility)
- Gonorrhoea (infertility)
- Mycoplasma (spontaneous abortion and chorioamnionitis)
- HPV (cancer)
What is the term used to describe infection of the entire female genital tract?
Pelvic inflammatory disease
What are the usual causes of pelvic inflammatory disease?
- Gonococci
- Chlamydia
- Enterococci
List some complications of pelvic inflammatory disease.
- Peritonitis
- Intestinal obstruction due to adhesions
- Bacteraemia
- Infertility
List some complications of salpingitis.
- Plical fusion
- Adhesions to the ovary
- Tubo-ovarian abscess
- Peritonitis
- Hydrosalpinx
- Infertility
- Ectopic pregnancy
What is an ectopic pregnancy?
When the fertilised ovum implants outside the uterus (e.g. in the Fallopian tube)
List some risk factors for cervical cancer.
- HPV
- Many sexual partners
- Sexually active early
- Smoking
- Immunosuppression
What strains of HPV are considered:
- High risk
- Low risk
- High risk = 16, 18
- Low risk = 6, 11
NOTE: these can cause genital and oral warts and low-grade cervical abnormalities
What is the outcome of HPV infection in most people?
- Undetectable within 2 years in 90% of people
- Persistent infection is associated with high-risk HPV types
What feature of high-risk HPV viruses are responsible for the carcinogenic effects of HPV?
- E6 protein - inactivates p53
- E7 protein - inactivates retinoblastoma
What are the two types of HPV infection? Describe them.
-
Latent (non-productive)
- HPV DNA continues to reside within basal cells
- Infectious virions are not produced
- Replication of viral DNA is coupled to replication of epithelial cells
- This means that complete viral particles are not produced
- Cellular effects of HPV are not seen
-
Productive
- Viral DNA replication occur independently of host chromosomal DNA synthesis
- Large amount of viral DNA and infectious virions are produced
- Characteristic cytological and histological featuers are seen (halo around the nucleus - koilocyte)
What is the cervical transformation zone?
This is the point at which the stratified squamous epithelium becomes columnar epithelium.
Describe the classification of cervical intraepithelial neoplasia.
- CIN1 = lower 1/3 of the epithelium
- CIN2 = lower 2/3 of the epithelium
- CIN3 = entire epithelium
In which type of epithelium does CIN occur?
Usually squamous
What is the term used to describe CIN occurring in columnar epithelium?
Cervical glandular intraepithelial neoplasia (CGIN)
What are the two types of cervical cancer?
- Squamous cell carcinoma
- Adenocarcinoma (20%)
Which staging system is used for cervical cancer?
FIGO staging
Outline the screening intervals for cervical cancer screening.
- 25-49 = every 3 years
- 49-64 = every 5 years
- 65+ = if no screening since 50 or if abnormal test results
Other than CIN, what else is screened for in some centres?
- High risk HPV using molecular genetic analysis
- Hybrid captue II (HC2) HPV DNA test - smear is mixed with fluid containing RNA probes that match 5 low-risk and 13 high-risk types of HPV
What are the two HPV vaccines that are currently available?
- Bivalent = 16 + 18
- Quadrivalent = 6 + 11 + 16 + 18
NOTE: vaccination is done in girls aged 12 years
List some diseases of the uterine body.
- Congenital anomalies
- Inflammation
- Adenomyosis
- Dysfunctional uterine bleeding
- Enodetrial atrophy/hyperplasia
- Leiomyoma
- Endometrial polyp
- Tumours
What is a leiomyoma? Outline its key features.
- A benign smooth muscle cell tumour in the uterus (MOST COMMON uterine tumour)
- Present in > 20% of women > 35 years
- Often multiple
- Usually asymptomatic
What are the three types of leiomyoma?
- Intramural
- Submucosal
- Subserosal
What is endometrial hyperplasia?
- Increase in stromal and glandular tissue of the endometrium
- Usually driven by oestrogen
- Usually occurs in the perimenopausal period
List some causes of endometrial hyperplasia.
- Persistant anovulation (due to persistently raised oestrogen)
- PCOS
- Granuloma cell tumour of the ovary
- Oestrogen therapy
List some risk factors for endometrial carcinoma.
- Nulliparity
- Obesity
- Diabetes mellitus
- Excessive oestrogen stimulation
What are the subtypes of type I endometrial carcinoma?
- Endometrioid adenocarcinoma
- Mucinous adenocarcinoma
- Secretory adenocarcinoma
What are the key features of type I endometrial carcinoma?
- Younger patients
- Oestrogen-dependent
- Often associated with atypical endometrial hyperplasia
- Low-grade tumours that are superficially invasive
- Genetic mutations: PTEN, P13KCA, K-Ras, CTNNB1, FGFR2, p53