HistoPath - Gynae Flashcards
What are the congenital abnormalities of the uterus
Duplication (i.e. uterus didelphys)
Agenesis
Give examples of common infections of the genital tract
Infections that cause discomfort with NO serious complications
- Candida: more common in DM, OCP, pregnancy
- Trichomonas vaginalis: protozoan
- Gardenerella: Gram-negative bacillus causes vaginitis
Infections that cause SERIOUS complications
- Chlamydia: major cause of infertility
- Gonorrhoea: major cause of infertility
- Mycoplasma: causes spontaneous abortion and chorioamnionitis
- HPV: implicated in cancer
What are the common causes of PID
- Ascending from LGT: Chlamydia, Gonorrhoea
- Secondary to TOP: staph aureus, strep, clostridium perfringens (spread via lymphatics and blood vessels)
What are the complications of PID
Peritonitis
Bacteraemia and sepsis
Chronic PID
Adhesions → intestinal obstruction
Fitz-Hugh-Curtis syndrome
Salpingitis:
Tubo-ovarian abscess
Ectopic pregnancy
Infertility
Plical fusion
Hydrosalpinx (fallopian filled with fluid)
What is the most common site of ectopic pregnancy
Ampulla of fallopian tube
Define endometriosis
presence of endometrial tissue outside the uterus
What are the theories of endometriosis pathogenesis
Metaplasia of pelvic peritoneum (coelomic) → implantation
Retrograde menstruation
What are the symptoms and signs of endometriosis
Dysmenorrhoea
Pelvic pain
Dyspareunia
Subfertility
Nodules
Tenderness
Fixed retroverted uterus
What malignancies is endometriosis associated with
Strongly: clear cell (mesonephroid/epithelial) ovarian cancer
Less strongly: endometroid (epithelial) ovarian cancer
What would be found on histology for endometriosis
Laparoscopically: powder burns (red/blue vesicles) and endometriomas
Micro: endometrial glands and stroma
What is adenomyosis and what are the signs on examination
Ectopic endometrial tissue in the myometrium
O/E boggy uterus
What are leiomyomas and what are the types
Smooth muscle tumour of the myometrium
MOST COMMON (20% of >35yo) uterine tumour
Usually multiple
May be submucosal, intramural, or subserosal (outermost)
What is a malignant leiomyoma
leiomyosarcoma
RARE and usually solitary
Usually post-menopausal women
5-year survival of 20-30%
Local invasion and spread via the blood stream
What are the histological features of leiomyomas
Macro: sharp, circumscribed mass, discrete benign tumour
Micro: bundle of smooth muscle cells
What is endometrial hyperplasia and what are the causes
Increase in stroma and glands (usually driven by oestrogen)
Peri-menopausal
Persistent anovulation (because of persistently raised oestrogen levels)
PCOS can also cause persistently elevated levels of oestrogen giving rise to endometrial hyperplasia
Granuloma cell tumours of the ovary
Oestrogen therapy
What is the most common gynaecological malignancy in developed countries
Endometrial cancer
Describe type 1 endometrial cancers
Type 1 (85%): endometrioid (+mucinous and secretory adenocarcinoma)
- Younger (peri-menopausal)
- Oestrogen-dependent
- Associated with atypical endometrial hyperplasia
- Low grade tumours
- Associated with PTEN, K-Ras, FGFR2, p53 etc.
Describe type 2 endometrial cancers
15%: serous and clear cell
- Older patients
- Not oestrogen dependent
- Atrophic endometrium
- High grade, deeper invasion
- Associated with Her-2, p53, PTEN etc.
Describe is the staging for endometrial cancer
FIGO
I = limited to uterus
II = spread to cervix
III = spread adjacent (pelvis)
IV = distant spread
What are the prognostic factors of endometrial cancer
Type, grade (glands vs solid, degree of cytological aplasia), stage
Tumour ploidy - diploid have a better prognosis
Hormone receptor expression
What are the risk factors for endometrial cancer
Nulliparity
Obesity
Early menarche
Late menopause
COCP
HRT
Tamoxifen
Diabetes Mellitus
What is gestational trophoblastic disease and what are the types
spectrum of tumours characterised by proliferation of trophoblastic tissue
- Complete (2.5% malignancy; 10% invasive moles)
- Partial mole
- Invasive mole
- Choriocarcinoma
What are complete and partial moles
Complete = empty egg fertilised by 2 sperm (or 1 which duplicates DNA)
46 XY or 46 XX (paternal origin only)
Partial = normal egg fertilised by 2 sperm (or 1 which duplicates DNA)
69 XXX or 69 XXY (1x maternal and 2x paternal origin)
What is the prevalence of complete/partial moles and what are the clinical features
Prevalence: 1 in 1000 pregnancies
Features:
- Spontaneous abortion
- USS – snowstorm, cluster of grapes
- Very high hCG
What are the features of choriocarcinoma (prevalence, origin, invasion, response to therapy)
Incidence: 1 in 20,000-30,000 pregnancies
50% arise in moles
25% arise in previous abortion
22% arise in normal pregnancy
Rapidly invasive, widely metastasising (lung, vagina, brain, liver, kidney)
Responds well to chemotherapy
What are the types of ovarian cyst
Follicular (dominant follicle does not rupture)
Luteal cysts (CL does not break down → intraperitoneal cysts → “Ring of fire” on US
Endometriotic cyst
What are the risk factors for ovarian tumours
Nulliparity
Early menarche
Late menopause
Genetic predisposition
Infertility
Endometriosis
HRT
Inflammation (PID)
FHx ovarian/breast cancer
What are the types of ovarian tumours
Epithelial, germ cell, sex chord (Stromal)
Epithelial
Type 1: endometrioma, clear cell, mucinous, low-grade serous
Type 2: serous
Germ cell
Teratoma
Dysgerminoma
Choriocarcinoma
Endodermal sinus tumour
Sex chord/stromal
Fibroma
Granulosa cell tumour
Sertoli-Leydig cells
Thecoma
Describe serous cystadenomas
Epithelial tumours - most common
Mostly benign
30-50% are bilateral
Ciliated cells, Psamomma body seen
If malignant = cystadenocarcinoma
NOT associated with KRAS, BRAF
Describe mucinous cystadenoma
Mostly benign
Mucin secreting cells (epithelium resemble gastrointestinal or endocervical epithelium)
Pseudomyoxoma peritonei
Associated with KRAS mutations
Describe endometriomas
Epithelial
Mostly malignant
Associated with Endometriosis and Endometrioid carcinoma
Chocolate cysts
Describe clear cell tumours
Epithelial
Mostly malignant
Strong association with endometriosis
Clear cells (cytoplasm is clear due to the presence of a lot of glycogen)
Hobnail appearance
Describe teratomas
Germ cell tumour
<20yo
Arise from all 3 germ cell layers
Mature (most common): benign, tissues mature to adult-type tissue e.g. teeth, hair - “Dermoid cyst”
Immature: embryonic elements present (most commonly neural tissue), malignant
Mature cystic with malignant transformation: SCC
Describe dysgerminoma
Germ cell tumour
Female testicular seminoma
Describe choriocarcinoma
Germ cell tumour
Malignancy of the trophoblastic cells of placenta
Raised HCG
Describe endodermal sinus tumours
Germ cell tumours
From extra-embryonic tissue e.g. amniotic sac
Describe fibromas
Sex cord stromal tumour
Arises from fibroblasts
No endocrine production
What is Meig’s syndrome
- Fibroma
- Ascites
- Pleural effusion
Describe granulosa cell tumours
Sex cord stromal tumour
Variable behaviour
May produce oestrogen → precocious puberty
Cal exner bodies
Describe sertoli-Leydig cells
Sex cord stromal tumour
Secrete testosterone (androgenic) → virilisation, defeminisation
Associated with Peutz-Jegher Syndrome
Describe thecomas
Sex cord stromal tumour
Arises from thecal cells
Secretes oestrogen
Describe Krukenberg tumours
Bilateral metastases composed of mucin-producing signet ring cells
Most often from gastric or breast cancer
Which familial syndrome give rise to ovarian cancer
BRCA1: Familial breast-ovarian cancer syndrome
BRCA1: Site-specific ovarian cancer
Cancer family syndrome (Lynch type II)
BRCA: serous tumours
HNPCC: mucinous and endometrioid carcinomas
What is lichen sclerosus
Thinning epithelium with a layer of hyalinisation underneath
Sometimes associated with epithelial dysplasia and development of malignancy
What are the types of vulval cancer
Type 1: usual type
RF: HPV, smoking
35-55
Warts
Type 2: Differentiated
Keratinated SqCC (most common)
RF: lichen sclerosus
Older females
What are the types of vulval cancer
Type 1: usual type
RF: HPV, smoking
35-55
Warts
Type 2: Differentiated
Keratinated SqCC (most common)
RF: lichen sclerosus
Older females
What are the risk factors for cervical cancer
45-50 years
HPV 16 and 18 (6 and 11 for warts)
Many sexual partners
Sexually active early
Smoking
Immunosuppression (i.e. HIV)
What is the pathogenesis of HPV infection
In most people, the immune system eliminates HPV → undetectable within 2 years
HPV 16 and 18 → encodes for proteins E6 and E7 which binds and inactivates TSGs
- E6: p53
- E7: retinoblastoma
What is the difference between latent and productive HPV infection
Latent = HPV resides in cell and only replicates when the cell divides
- Complete viral particles not produced
- Cellular changes of HPV not seen
Productive = HPV replicates independently of cell cycle
- Cellular changes of HPV are seen
- Halo around the nucleus (koilocyte)
What are the stages of CIN
CIN I: lower 1/3
CIN II: lower 2/3
CIN III: entire epithelium
Invasion through BM → invasive malignancy (most commonly SqCC)
Describe the staging for Cervical cancer
FIGO
0: CIN
1: Cervix
2: upper 1/3 vagina
3. Lower 2/3 vagina + pelvic side wall
4. Mets
What are the screening approaches to cervical cancer
Cervical cytology
Hybrid Capture II (HC2) HPV DNA Test
Which HPV vaccines are available
Bivalent (16 + 18)
Quadrivalent (6, 11, 16, 18)
National vaccination programme for girls aged 12 + boys aged 13
