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YEAR 5: Histopathology > Histo: Gynaecological pathology > Flashcards

Histo: Gynaecological pathology Flashcards

1
Q

List some gynaecological infections that cause discomfort but no serious complications.

A
  • Candida
  • Trichomonas vaginalis
  • Gardnerella
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2
Q

List some gynaecological infections that cause serious complications.

A
  • Chlamydia (infertility)
  • Gonorrhoea (infertility)
  • Mycoplasma (spontaneous abortion and chorioamnionitis)
  • HPV (cancer)
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3
Q

What is pelvic inflammatory disease?

A

Ascending infection of the female genital tract that can affect the uterus, fallopian tubes and ovaries

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4
Q

What are the usual causes of pelvic inflammatory disease?

A
  • Gonococci
  • Chlamydia
  • Enteric bacteria
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5
Q

List some complications of pelvic inflammatory disease.

A
  • Peritonitis
  • Intestinal obstruction due to adhesions
  • Bacteraemia (sepsis)
  • Infertility
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6
Q

What is salpingitis?

A

Infection of the fallopian tubes

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7
Q

List some complications of salpingitis.

A
  • Infertility
  • Ectopic pregnancy
  • Plical fusion
  • Adhesions to the ovary
  • Tubo-ovarian abscess
  • Peritonitis
  • Hydrosalpinx
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8
Q

What is an ectopic pregnancy?

A

When the fertilised ovum implants outside the uterus (e.g. in the Fallopian tube)

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9
Q

What is the mean age of onset of cervical cancer?

A

45-50 years

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10
Q

List some risk factors for cervical cancer.

A
  • Human papilloma virus (present in 95%)
  • Many sexual partners
  • Sexually active early
  • Smoking
  • Immunosuppression
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11
Q

Which HPV strains are considered low risk and what is infection associated with?

A

Types 6, 11
Associated with warts and low grade cervical dysplasia

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12
Q

Which HPV strains are considered high risk and what is infection associated with?

A

Types 16, 18, 31, 33
Associated with:
* Low and high grade cervical dysplasia
* Cervical cancer
* Vulval, vaginal, penile, and anal cancer

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13
Q

What epithelium type is the found in the cervix?

A

Endocervix - columnar epithelium
Ectocervix - stratified squamous epithelium

Sepearted by the transformation zone

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14
Q

What is the outcome of HPV infection in most people?

A
  • Nothing - virus is eliminated by immune system and becomes undetectable within 2 years in 90% of people
  • Persistent infection with high-risk HPV types is associated with dysplasia and cancerous changes
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15
Q

What are the two states of HPV infection? Describe them.

A
  • 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)
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16
Q

What components of high-risk HPV viruses are responsible for the carcinogenic effects of HPV?

A

Viral proteins can inactivate tumour suppressor genes
* E6 protein - inactivates p53 gene
* E7 protein - inactivates retinoblastoma (Rb) gene

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17
Q

What is cervical intraepithelial neoplasia?

A

Epithelial cells have undergone malignant changes but basement membrane is intact (no invasion)

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18
Q

Describe the classification of cervical intraepithelial neoplasia.

A
  • CIN1 = lower 1/3 of the epithelium
  • CIN2 = lower 2/3 of the epithelium
  • CIN3 = entire epithelium
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19
Q

In which type of cervical epithelium does CIN occur?

A

Squamous epithelium is involved more often (CIN) than glandular epithelium (CGIN)

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20
Q

What is the term used to describe CIN occurring in columnar epithelium?

A

Cervical glandular intraepithelial neoplasia (CGIN)

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21
Q

What differentiates CIN from cervical cancer?

A

Invasion through the basement membrane defines change from CIN to invasive carcinoma

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22
Q

What are the two types of cervical cancer?

A
  • Squamous cell carcinoma (most common)
  • Adenocarcinoma (20%)
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23
Q

Which staging system is used for cervical cancer?

A

FIGO staging

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24
Q

Outline the screening intervals for cervical cancer screening.

A
  • 25-49 = every 3 years
  • 50-64 = every 5 years
  • 65+ = if no screening since 50 or if abnormal test results
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25
Q

Describe the process of the cervical cancer screening

A

Women are first screened for high-risk HPV. If positive, sample then undergoes cytological analysis

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26
Q

How is HPV detected

A

Hybridisation assay with signal amplification that uses long synthetic RNA probes complementary to the DNA sequence of numerous low and high risk HPV strains

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27
Q

What vaccine is protect against HPV?

A

Gardasil 9
Protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58

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28
Q

At what age to children receive HPV vaccine?

A

12-13 years old:
* First dose in year 8
* Second dose 6-24 months later

29
Q

Describe the structure of the uterine wall

A
30
Q

List some diseases of the uterine body.

A
  • Congenital anomalies
  • Inflammation - endometritis
  • Adenomyosis - endometrium present within muscle wall
  • Dysfunctional uterine bleeding
  • Enodetrial atrophy/hyperplasia
  • Leiomyoma
  • Endometrial polyp
  • Tumours
31
Q

What is endometrial hyperplasia?

A

Defined as irregular proliferation of the endometrial glands with an increase in the gland to stroma ratio when compared with proliferative endometrium.
* Usually driven by oestrogen
* Usually occurs in the perimenopausal period
* May be associated with atypia

32
Q

List some causes of endometrial hyperplasia.

A
  • Persistant anovulation (due to persistently raised oestrogen)
  • PCOS
  • Oestrogen therapy (without progesterone)
  • Obesity
  • Granuloma cell tumour of the ovary
33
Q

List some risk factors for endometrial carcinoma.

A
  • Nulliparity
  • Early menarche, late menopause
  • PCOS
  • Obesity
  • Diabetes mellitus
  • Excessive oestrogen stimulation
34
Q

List some prognostic factors in endometrial carcinoma.

A
  • Histological type
  • Grade
  • Stage
  • Lymphovascular invasion
35
Q

What are the 2 subgroups of endometrial cancer and what differentiates them?

A

Type 1 and type 2
* Type 1 are oestrogen-dependent, better prognosis
* Type 2 are oestrogen-independent, worse prognosis

36
Q

What subgroup is endometroid carcinoma in and what are its key features

A

Endometrioid carcinoma is a type 1 endometrial cancer
Key features:
- MOST COMMON TYPE OF ENDOMETRIAL CANCER
- Oestrogen dependent
- Affects perimenopausal women
- Associated with atypical endometrial hyperplasia

37
Q

Which endometrial cancers are classified as type 2?

A

Serous and clear cell carcinomas

38
Q

What are the key features of type II endometrial carcinoma?

A
  • Affect older, postmenopausal patients
  • Oestrogen-independent
  • Arise in atrophic endometrium
  • High grade, deeper invasion and higher stage
39
Q

Which genetic mutations are associated with the two types of type II endometrial carcinoma?

A

Endometrial Serous Carcinoma

  • P53 (90%)
  • P13KCA (15%)
  • Her2 amplification

Clear Cell Carcinoma

  • PTEN
  • CTNNB1
  • Her2 amplification
40
Q

What criteria is the FIGO grading system based on?

A

3 tier system: grades 1,2, and 3 depending on
* Tissue architecture: % of gland formation
* Cytological atypia

41
Q

Briefly describe the FIGO staging system (for endometrial cancer)

A

-

42
Q

What is a leiomyoma? Outline its key features.

A
  • A benign smooth muscle cell tumour in the uterus (MOST COMMON uterine tumour)
  • aka. Fibroid
  • Present in > 20% of women > 35 years
  • Often multiple
  • Usually asymptomatic
43
Q

What are the three types of leiomyoma?

A
  • Intramural
  • Submucosal
  • Subserosal
44
Q

What is a leiomyosarcoma?

A

Malignant counterpart of leimyoma
* Rare
* Usually solitary
* Affect mainly the postmenopausal
* Local invasion and bloodstream spread
* 20-30% 5 year survival

45
Q

What is endometriosis? How common is it?

A

Presence of endometrial tissue outside the uterus
Common - affects 10% of premenopausal women

46
Q

Outline the possible pathogenesis of endometriosis.

A
  • Metaplasia of pelvic peritoneum
  • Retrograde menstruation - endometrial lining travels up the fallopian tubes, into the peritoneal cavity and implants outside the uterus
47
Q

Why is endometriosis an issue?

A
  • It is functional and bleeds at the time of menstruation
  • Can lead to pain, scarring and infertility
  • May develop hyperplasia or malignancy
48
Q

What is adenomyosis?

A
  • Ectopic endometrial tissue deep within the myometrium
  • Causes dysmenorrhoea (because it bleeds into the muscle layer and causes pain)
49
Q

List two types of non-neoplastic ovarian cysts.

A
  • Follicular and luteal cysts
  • Endometriotic (chocolate) cyst
50
Q

What are some manifestations of polycystic ovarian syndrome?

A
  • Oligo/amenorrhoea
  • Polycystic ovaries
  • Hyperandrogenism
51
Q

What three types of tissue do ovaries consist of?

A
  • Surface epithelium
  • Ovarian stroma
  • Germ cells
52
Q

List three types of primary specific ovarian tumour. Which is the most common

A
  • Epithelial tumours - make up 60% of all ovarian tumours and 95% of malignant ovarian tumours
  • Sex cord stromal tumours
  • Germ cell tumours
53
Q

Which age groups do epithelial, germ cell, and sex cord stromal tumours predominantly affect?

A

Epithelial: 45-65 years
Germ cell: bimodal, peak at 15-21, and 65-69
Sex cord stromal: mainly postmenopausal women but can also affect children

54
Q

List some risk factors for ovarian cancer.

A
  • Genetic predisposition (family history of breast/ovarian cancer)
  • Nulliparity
  • Early menarche
  • Late menopause
  • Infertility
  • Endometriosis
  • HRT
  • Inflammation (PID)
55
Q

List some benign epithelial ovarian tumours. Which is most common?

A
  • Serous cystadenoma (most common)
  • Cystadenofibroma
  • Mucinous cystadenoma
  • Brenner tumour
56
Q

What are borderline tumours?

A
  • Tumours where their biological behaviour cannot be predicted based on histology
  • Low but definite malignant potential
57
Q

What is the most common malignant ovarian tumour?

A

High grade serous carcinoma (80%)
* Aggressive
* Mutated p53
* Associated with BRCA1 and BRCA2

58
Q

What proportion of ovarian cancers are familial?

A

Up to 10%

59
Q

Which heritable mutations account for 90% of familial ovarian cancers

A

BRCA1 and BRCA2

60
Q

Which 2 ovarian cancers are associated with endometrosis?

A

Endometroid carcinoma
Clear cell carcinoma

61
Q

List four types of sex cord stromal tumours.

A
  • Fibroma
  • Granulosa cell tumour - may produce oestrogen
  • Thecoma - may produce oestrogen (rarely androgens)
  • Sertoli-Leydig cell tumour - may be androgenic
62
Q

What syndrome are ovarian fibromas associated with?

A

Meigs’s sydrome. Triad of:
- Ovarian tumour
- Ascites
- Pleural effusion

(Also associated with Brenner’s tumour)

63
Q

What are the key features of germ cell tumours?

A
  • Account for 20% of ovarian tumours
  • 95% are benign
  • Mainly occur in < 20 years
64
Q

What are the four main types of germ cell tumour?

A
  • Dysgerminoma - no differentiation
  • Teratoma - from embryonic tissues
  • Endodermal sinus tumour - from extraembryonic tissue (e.g. yolk sac)
  • Choriocarcinoma - from trophoblastic cells which would form the placenta
65
Q

What are the key features of a mature teratoma?

A
  • Most common type of germ cell tumour
  • Benign
  • Can be solid or cystic
  • May show numerous different mature tissue types
  • Teeth and hair are common
66
Q

What are the key features of an immature teratoma?

A
  • Indicates presence of embryonic elements (most commonly neural tissue)
  • Malignant tumour that grows rapidly, penetrates the capsule and forms adhesions
  • Spreads within peritoneal cavity and metastasis to the lymph nodes, lungs, liver and other organs
67
Q

What is a mature cystic teratoma with malignant transformation?

A

When any type of mature tissue within a teratoma becomes malignant (most commonly squamous cell carcinoma)

68
Q

Name two secondary ovarian tumours.

A

Krukenberg Tumour
* Bilateral metastases composed of mucin-producing signet ring cells
* Usually of breast or gastric origin

Metastatic colorectal cancer
* 4-10% of CRC metatasise to ovaries

YEAR 5: Histopathology (20 decks)

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