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Edit YEAR 5: Histopathology > Histo: Gynaecological pathology > Flashcards

Histo: Gynaecological pathology Flashcards

1
Q

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

A
  • Candida
  • Trichomonas vaginalis
  • Gardnerella
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2
Q

List some gynaecological infections that cause serous complications.

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

What is the term used to describe infection of the entire female genital tract?

A

Pelvic inflammatory disease

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4
Q

What are the usual causes of pelvic inflammatory disease?

A
  • Gonococci
  • Chlamydia
  • Enterococci
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5
Q

List some complications of pelvic inflammatory disease.

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

List some complications of salpingitis.

A
  • Plical fusion
  • Adhesions to the ovary
  • Tubo-ovarian abscess
  • Peritonitis
  • Hydrosalpinx
  • Infertility
  • Ectopic pregnancy
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7
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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8
Q

List some risk factors for cervical cancer.

A
  • HPV
  • Many sexual partners
  • Sexually active early
  • Smoking
  • Immunosuppression
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9
Q

What strains of HPV are considered:

  • High risk
  • Low risk
A
  • High risk = 16, 18
  • Low risk = 6, 11

NOTE: these can cause genital and oral warts and low-grade cervical abnormalities

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10
Q

What is the outcome of HPV infection in most people?

A
  • Undetectable within 2 years in 90% of people
  • Persistent infection is associated with high-risk HPV types
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11
Q

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

A
  • E6 protein - inactivates p53
  • E7 protein - inactivates retinoblastoma
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12
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)
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13
Q

What is the cervical transformation zone?

A

This is the point at which the stratified squamous epithelium becomes columnar epithelium.

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14
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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15
Q

In which type of epithelium does CIN occur?

A

Usually squamous

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16
Q

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

A

Cervical glandular intraepithelial neoplasia (CGIN)

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17
Q

What are the two types of cervical cancer?

A
  • Squamous cell carcinoma
  • Adenocarcinoma (20%)
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18
Q

Which staging system is used for cervical cancer?

A

FIGO staging

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19
Q

Outline the screening intervals for cervical cancer screening.

A
  • 25-49 = every 3 years
  • 49-64 = every 5 years
  • 65+ = if no screening since 50 or if abnormal test results
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20
Q

Other than CIN, what else is screened for in some centres?

A
  • 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
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21
Q

What are the two HPV vaccines that are currently available?

A
  • Bivalent = 16 + 18
  • Quadrivalent = 6 + 11 + 16 + 18

NOTE: vaccination is done in girls aged 12 years

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22
Q

List some diseases of the uterine body.

A
  • Congenital anomalies
  • Inflammation
  • Adenomyosis
  • Dysfunctional uterine bleeding
  • Enodetrial atrophy/hyperplasia
  • Leiomyoma
  • Endometrial polyp
  • Tumours
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23
Q

What is a leiomyoma? Outline its key features.

A
  • A benign smooth muscle cell tumour in the uterus (MOST COMMON uterine tumour)
  • Present in > 20% of women > 35 years
  • Often multiple
  • Usually asymptomatic
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24
Q

What are the three types of leiomyoma?

A
  • Intramural
  • Submucosal
  • Subserosal
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25
What is endometrial hyperplasia?
* Increase in stromal and glandular tissue of the endometrium * Usually driven by oestrogen * Usually occurs in the perimenopausal period
26
List some causes of endometrial hyperplasia.
* Persistant anovulation (due to persistently raised oestrogen) * PCOS * Granuloma cell tumour of the ovary * Oestrogen therapy
27
List some risk factors for endometrial carcinoma.
* Nulliparity * Obesity * Diabetes mellitus * Excessive oestrogen stimulation
28
What are the subtypes of type I endometrial carcinoma?
* Endometrioid adenocarcinoma * Mucinous adenocarcinoma * Secretory adenocarcinoma
29
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
30
What are the subtypes of type II endometrial carcinoma?
Serous and clear cell tumours
31
What are the key features of type II endometrial carcinoma?
* Older patients * Less oestrogen-dependent * Arise in atrophic endometrium * High grade, deeper invasion and higher stage
32
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
33
List some prognostic factors in endometrial carcinoma.
* Type * Grade * Stage * Tumour ploidy (diploid has a better prognosis) * Hormone receptor expression
34
What is: * FIGO Stage I * FIGO Stage 4
* **FIGO Stage I** = confined to the uterus * **FIGO Stage 4** = Other pelvic organs outside uterus, adnexae and vagina and other distant spread (e.g. distant lymph nodes)
35
What is gestational trophoblastic disease?
A spectrum of tumours characterised by proliferation of pregnancy-associated trophoblastic tissue
36
List three types of gestational trophoblastic disease.
* Complete and partial mole * Invasive mole * Choriocarcinoma
37
What is the prevalence of complete and partial moles?
1 in 1000 pregnancies
38
How do complete and partial moles present?
Spontaneous abortion Sometimes detected as abnormal ultrasound
39
What is a characteristic investigation finding in complete and partial moles?
Very very high hCG
40
What are the chances of moles progressing to malignancy?
* NO partial moles progress to malignancy * 2.5% of complete moles progress to malignancy * 10% of complete moles develop into locally destructive invasive moles
41
Describe how complete and partial moles form.
**Complete mole** * Occurs when you get fertilisation of an EMPTY egg * Reduplication of the 23X from sperm results in a homozygous diploid 46XX genome * Can also occur due to fertilisation of an empty egg by 2 sperms with 2 independent sets of 23X or 23Y **Partial mole** * A normal ovum containing 23X gets fertilised by TWO sperm leading to the presence of 3 sets of chromosomes (2 paternal + 1 maternal) * Dispermia → diandry * Overdose of male chromosomes driver proliferation * Can also occur due to fertilisation of a normal egg by a sperm carrying unreduced paternal genome (46XY)
42
What is choriocarcinoma?
* Rare (1 in 20,000) rapidly invasive and widely metastasising tumour * Responds well to chemotherapy * 50% arise in moles * 25% arise in patients with previous abortion * 22% arise in normal pregnancy
43
What is endometriosis?
Presence of endometrial tissue outside the uterus
44
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
45
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
46
What is adenomyosis?
* Ectopic endometrial tissue deep within the myometrium * Causes dysmenorrhoea (because it bleeds into the muscle layer and causes pain)
47
List two types of non-neoplastic functional cysts.
* Follicular and luteal cysts * Endometriotic cyst
48
What are some manifestations of polycystic ovarian syndrome?
* Persistant anovulation * Obesity * Hirsutism
49
What three types of tissue do ovaries consist of?
* Surface epithelium * Ovarian stroma * Germ cells
50
List three types of primary specific ovarian tumour.
* Surface epithelial tumours * Sex cord stromal tumours * Germ cell tumours
51
List some risk factors for ovarian cancer.
* Nulliparity * Early menarche * Late menopause * Genetic predisposition (MOST SIGNIFICANT) * Infertility * Endometriosis * HRT * Inflammation (PID)
52
List some protective factors for ovarian cancer.
* After pregnancy * OCP
53
Outline the classification o epithelial ovarian tumours.
**Type 1** * Low grade * Relatively indolent and arise from well characterised precursors (benign tumours) and endometriosis * Mutations: K-Ras, BRAF, P13KCA, Her2, PTEN, beta-catenin **Type 2** * HIGH GRADE * Aggressive * P53 mutation in 75% of cases * NO precursor lesion
54
Give examples of Type 1 and Type 2 ovarian tumours.
* Type 1 = low grade serous, endometrioid, mucinous and clear cell * Type 2 = mostly serous
55
List some benign ovarian tumours.
* Serous cystadenoma * 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 are the key features of serous tumours?
* MOST COMMON type of ovarian tumour * Usually cystic * 30-50% bilateral * Benign tumours are lined by bland epithelium * Borderline tumours have a more complex, atypical epithelial lining with papillae but no invasion through the basement membrane * Malignant tumours are invasive with a poor prognosis
58
What are the key features of mucinous tumours?
* 10-20% of ovarian tumours * Composed of mucin-secreting epithelium (may resemble endocervical or GI epithelium)
59
What are the key features of endometrioid tumours?
* 10-24% of ovarian tumours * 10-20% associated with endometrisis * Better prognosis than mucinous and serous
60
What are the key features of clear cell tumours?
Strong association with endometriosis NOTE: called clear cell because the cytoplasm contains a lot of glycogen
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 are the key features of germ cell tumours?
* 20% of ovarian tumours * 95% are benign * Mainly occur in \< 20 years * Classified based on how they differentiate
63
What are the four main types of germ cell tumour?
* **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
64
What are the key features of a mature teratoma?
* Most common type of germ cell tumour * Benign * May show different lines of maturation but all tissues will mature to adult-type tissues * Teeth and hair are common
65
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
66
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)
67
Name two secondary ovarian tumours.
* Krukenberg Tumour - bilateral metastases composed of mucin-producing signet ring cells (usually from breast or gastric cancer) * Metastatic colorectal cancer
68
What proportion of ovarian tumours are familial?
Up to 10%
69
List three familial syndromes associated with ovarian cancer.
* Familial breast-ovarian cancer syndrome * Site-specific ovarian cancer * Cancer family syndrome (Lynch type II)
70
List some specific genetic associations for serous, mucinous and endometrioid carcinoma.
* Serous - BRCA * Mucinous and endometrioid - HNPCC
71
What is lichen sclerosus?
Thinning of the vulval epithelium with a layer of hyalinisation underneath
72
Name a benign tumour of the vulva.
Papillary hidradenoma
73
List some other types of malignant tumour of the vulva.
* Squamous cell carcinoma (85%) * Paget's diase (adenocarcinoma *in situ*) * Adenocarcinoma * Malignant melanoma * BCC
74
What are some diseases that can affect the vagina?
* Congenital anomalies (e.g. atresia) * Tumours (rare) * Carcinoma (squamous cell carcinoma) * Adenocarcinoma (increased risk of clear cell carcinoma in women with threatened miscarriage treated with diethyl stillbosterol) * Rhabdomyosarcoma

Edit YEAR 5: Histopathology (26 decks)

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