Histo: Gynaecological pathology Pt.2 Flashcards
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
What vaccine is protect against HPV?
Gardasil 9
Protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58
At what age to children receive HPV vaccine?
12-13 years old:
- First dose in year 8
- Second dose 6-24 months later
Describe the structure of the uterine wall
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
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
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
List some risk factors for endometrial carcinoma.
- Nulliparity
- Early menarche, late menopause
- PCOS
- Obesity
- Diabetes mellitus
- Excessive oestrogen stimulation
List some prognostic factors in endometrial carcinoma.
- Histological type
- Grade
- Stage
- Lymphovascular invasion
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
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
Which endometrial cancers are classified as type 2?
Serous and clear cell carcinomas
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
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
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
Briefly describe the FIGO staging system
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
What are the three types of leiomyoma?
- Intramural
- Submucosal
- Subserosal
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
What is endometriosis? How common is it?
Presence of endometrial tissue outside the uterus
Common - affects 10% of premenopausal women
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
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
What is adenomyosis?
- Ectopic endometrial tissue deep within the myometrium
- Causes dysmenorrhoea (because it bleeds into the muscle layer and causes pain)
List two types of non-neoplastic ovarian cysts.
- Follicular and luteal cysts
- Endometriotic (chocolate) cyst
