Histo: Gynaecological pathology Flashcards
1
Q
List some gynaecological infections that cause discomfort but no serious complications.
A
- Candida
- Trichomonas vaginalis
- Gardnerella
2
Q
List some gynaecological infections that cause serious complications.
A
- Chlamydia (infertility)
- Gonorrhoea (infertility)
- Mycoplasma (spontaneous abortion and chorioamnionitis)
- HPV (cancer)
3
Q
What is pelvic inflammatory disease?
A
Ascending infection of the female genital tract that can affect the uterus, fallopian tubes and ovaries
4
Q
What are the usual causes of pelvic inflammatory disease?
A
- Gonococci
- Chlamydia
- Enteric bacteria
5
Q
List some complications of pelvic inflammatory disease.
A
- Peritonitis
- Intestinal obstruction due to adhesions
- Bacteraemia (sepsis)
- Infertility
6
Q
What is salpingitis?
A
Infection of the fallopian tubes
7
Q
List some complications of salpingitis.
A
- Infertility
- Ectopic pregnancy
- Plical fusion
- Adhesions to the ovary
- Tubo-ovarian abscess
- Peritonitis
- Hydrosalpinx
8
Q
What is an ectopic pregnancy?
A
When the fertilised ovum implants outside the uterus (e.g. in the Fallopian tube)
9
Q
What is the mean age of onset of cervical cancer?
A
45-50 years
10
Q
List some risk factors for cervical cancer.
A
- Human papilloma virus (present in 95%)
- Many sexual partners
- Sexually active early
- Smoking
- Immunosuppression
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
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
13
Q
What epithelium type is the found in the cervix?
A
Endocervix - columnar epithelium
Ectocervix - stratified squamous epithelium
Sepearted by the transformation zone
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
15
Q
What are the two types 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)
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
17
Q
What is cervical intraepithelial neoplasia?
A
Epithelial cells have undergone malignant changes but basement membrane is intact (no invasion)
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
19
Q
In which type of cervical epithelium does CIN occur?
A
Squamous epithelium is involved more often (CIN) than glandular epithelium (CGIN)
20
Q
What is the term used to describe CIN occurring in columnar epithelium?
A
Cervical glandular intraepithelial neoplasia (CGIN)
21
Q
What differentiates CIN from cervical cancer?
A
Invasion through the basement membrane defines change from CIN to invasive carcinoma
22
Q
What are the two types of cervical cancer?
A
- Squamous cell carcinoma (most common)
- Adenocarcinoma (20%)
23
Q
Which staging system is used for cervical cancer?
A
FIGO staging
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
25
Describe the process of the cervical cancer screening
Women are first screened for high-risk HPV. If positive, sample then undergoes cytological analysis
26
How is HPV detected
**Hybridisation assay**
Signal amplification
Uses long synthetic RNA probes complementary to the DNA sequence of numerous low and high risk HPV strains
27
What vaccine is protect against HPV?
**Gardasil 9**
Protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58
28
At what age to children receive HPV vaccine?
12-13 years old:
* First dose in year 8
* Second dose 6-24 months later
29
Describe the structure of the uterine wall
30
List some diseases of the uterine body.
* Congenital anomalies
* Inflammation - endometritis
* Adenomyosis - endometrium present within muscle wall
* Dysfunctional uterine bleeding
* Enodetrial atrophy/hyperplasia
* Leiomyoma
* Endometrial polyp
* Tumours
31
What is endometrial hyperplasia?
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
List some causes of endometrial hyperplasia.
* Persistant anovulation (due to persistently raised oestrogen)
* PCOS
* Oestrogen therapy (without progesterone)
* Obesity
* Granuloma cell tumour of the ovary
33
List some risk factors for endometrial carcinoma.
* Nulliparity
* Early menarche, late menopause
* PCOS
* Obesity
* Diabetes mellitus
* Excessive oestrogen stimulation
34
List some prognostic factors in endometrial carcinoma.
* Histological type
* Grade
* Stage
* Lymphovascular invasion
35
What are the 2 subgroups of endometrial cancer and what differentiates them?
Type 1 and type 2
* Type 1 are oestrogen-dependent, better prognosis
* Type 2 are oestrogen-independent, worse prognosis
36
What subgroup is endometroid carcinoma in and what are its key features
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
Which endometrial cancers are classified as type 2?
Serous and clear cell carcinomas
38
What are the key features of type II endometrial carcinoma?
* Affect older, postmenopausal patients
* Oestrogen-independent
* Arise in atrophic endometrium
* High grade, deeper invasion and higher stage
39
Which genetic mutations are associated with the two types of type II endometrial carcinoma?
**Endometrial Serous Carcinoma**
* P53 (90%)
* P13KCA (15%) Her2 amplification
**Clear Cell Carcinoma**
* PTEN
* CTNNB1
* Her2 amplification
40
What criteria is the FIGO grading system based on?
3 tier system: grades 1,2, and 3 depending on
* Tissue architecture: % of gland formation
* Cytological atypia
41
Briefly describe the FIGO staging system
42
What is a leiomyoma? Outline its key features.
* 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
What are the three types of leiomyoma?
* Intramural
* Submucosal
* Subserosal
44
What is a leiomyosarcoma?
Malignant counterpart of leiomyoma
* Rare
* Usually solitary
* Affect mainly the postmenopausal
* Local invasion and bloodstream spread
* 20-30% 5 year survival
45
What is endometriosis? How common is it?
Presence of endometrial tissue outside the uterus
Common - affects 10% of premenopausal women
46
Outline the possible pathogenesis of endometriosis.
* Metaplasia of pelvic peritoneum
* Retrograde menstruation - endometrial lining travels up the fallopian tubes, into the peritoneal cavity and implants outside the uterus
47
Why is endometriosis an issue?
* It is functional and bleeds at the time of menstruation
* Can lead to pain, scarring and infertility
* May develop hyperplasia or malignancy
48
What is adenomyosis?
* Ectopic endometrial tissue deep within the myometrium
* Causes dysmenorrhoea (because it bleeds into the muscle layer and causes pain)
49
List two types of non-neoplastic ovarian cysts.
* Follicular and luteal cysts
* Endometriotic (chocolate) cyst
50
What are some manifestations of polycystic ovarian syndrome?
* Oligo/amenorrhoea
* Polycystic ovaries
* Hyperandrogenism
51
What three types of tissue do ovaries consist of?
* Surface epithelium
* Ovarian stroma
* Germ cells
52
List three types of primary specific ovarian tumour. Which is the most common
* **Epithelial tumours** - make up 60% of all ovarian tumours and 95% of malignant ovarian tumours
* Sex cord stromal tumours
* Germ cell tumours
53
Which age groups do epithelial, germ cell, and sex cord stromal tumours predominantly affect?
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
List some risk factors for ovarian cancer.
* Genetic predisposition (family history of breast/ovarian cancer)
* Nulliparity
* Early menarche
* Late menopause
* Infertility
* Endometriosis
* HRT
* Inflammation (PID)
55
List some benign epithelial ovarian tumours. Which is most common?
* Serous cystadenoma (most common)
* Cystadenofibroma
* Mucinous cystadenoma
* Brenner tumour
56
What are borderline tumours?
* Tumours where their biological behaviour cannot be predicted based on histology
* Low but definite malignant potential
57
What is the most common malignant ovarian tumour?
**High grade serous carcinoma (cystadenocarcinoma)** (80%)
* Aggressive
* Mutated p53
* Associated with BRCA1 and BRCA2
58
What proportion of ovarian cancers are familial?
Up to 10%
59
Which heritable mutations account for 90% of familial ovarian cancers
BRCA1 and BRCA2
60
Which 2 ovarian cancers are associated with endometrosis?
Endometroid carcinoma
Clear cell carcinoma
61
List four types of sex cord stromal tumours.
* Fibroma
* Granulosa cell tumour - may produce oestrogen
* Thecoma - may produce oestrogen (rarely androgens)
* Sertoli-Leydig cell tumour - may be androgenic
62
What syndrome are ovarian fibromas associated with?
**Meigs's sydrome**
Triad of:
- Ovarian tumour
- Ascites
- Pleural effusion
(Also associated with Brenner's tumour)
63
What are the key features of germ cell tumours?
* Account for 20% of ovarian tumours
* 95% are benign
* Mainly occur in < 20 years
64
What are the four main types of germ cell tumour?
* **Dysgerminoma** - no differentiation (female equivalent of male seminoma)
* **Teratoma** - from embryonic tissues
* **Endodermal sinus tumour** - from extraembryonic tissue (e.g. yolk sac)
* **Choriocarcinoma** - from trophoblastic cells which would form the placenta
65
What are the key features of a mature teratoma?
* 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
What are the key features of an immature teratoma?
* 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
What is a mature cystic teratoma with malignant transformation?
When any type of mature tissue within a teratoma becomes malignant (most commonly squamous cell carcinoma)
68
Name two secondary ovarian tumours.
**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
