Histopath: Gynae path

Question 1

What is PID usually caused by? which organisms in the UK? which organisms in the world?

Answer 1

Usually caused by ascending infections

MOST COMMON UK: Chlamydia and gonorrhea

MOST COMMON WORLD: TB and schistosomiasis

Question 2

What are some potential complications of PID? - most likely to come up in path

Answer 2

Peritonitis

Intestinal obstructions due to adhesions

Bacteraemia

Subfertility

Tubo-ovarian abscess

Fitz Hugh Curtis Syndrome

Question 3

What are the textbook buzzwords for PID?

Answer 3

Dyspareunia

Adnexal tenderness

Cervical excitation

Question 4

What is Fitz Hugh Curtis Syndrome?

Answer 4

Fitz-Hugh Curtis syndrome consists of right upper quadrant pain following the transabdominal spread of infection from pelvic inflammatory disease (PID)

Perihepatic adhesions form with the anterior abdominal wall or diaphragm and they are classically descried as like a ‘violin string’ (IMPORTANT)

Question 5

What are some buzzwords associated w/ endometriosis?

Answer 5

Chronic pelvic pain

PR bleeding -> inflammation in pouch of douglas irritates rectum

Immobile uterus -> due to adhesions

Question 6

What is the diagnostic test for endometriosis and what does it show?

Answer 6

Powder burn spots on diagnostic laparoscopy

Question 7

What are the features / buzzwords associated w/ adenomyosis?

Answer 7

This is endometrium growing w/in the myometrium

BW = bulky uterus + chornic pelvic pain

Question 8

What are the key features / buzzwords of fibroids

Answer 8

benign tumours of smooth muscle

BW = HMB

Question 9

When do fibroids grow / shrink?

Answer 9

Grow during pregnancy - red degeneration (haemorrage)

Shrink during menopause

Question 10

What are the features to know about vulval cancer?

Answer 10

VIN = pre-cancerous

post-menopausal = increased risk

Normally present w/ superficial skin changes - itchiness etc

Question 11

How can ovarian cancers be characterised?

Answer 11

Epithelial (70%)

Germ cell
Sex cord stromal
Secondary

Question 12

What is the most common type of ovarian malignancy?

Answer 12

Serous cystadenoma = Cyst lined by ciliated cells (BENIGN) - often bilateral

Question 13

In which ovarian cancer does the epithelium resemble GI or endocervical epithelium?

Answer 13

Mucinous cystadenoma (BENIGN) = Cyst lined by ciliated cells

Question 14

What does histology of serous cystadenoma show?

Answer 14

Columnar epithelium

psammoma bodies (concentric laminated calcifications) - IMPORTANT

Question 15

What does histology of mucinous cystadenomas show?

Answer 15

Mucin secreting cells (IMPORTANT)

NO psammoma bodies

Question 16

Which epithelial ovarian cancers tend to be malignant? Prognosis for these?

Answer 16

Endometriod carcinomas - better prognosis than serous / mucinous

Clear cell carcinomas - poor prognosis

Question 17

What do endometriod carcinomas tend to coexist w?

Answer 17

Endometrial cancer

Question 18

What is a major RF for enometrioid and clear cell carcinomas?

Answer 18

ENDOMETRIOSIS

Question 19

What is the histological appearace of endometrioid carcinomas?

Answer 19

Tubular glands present

Question 20

What is the histological appearace of clear cell carcinomas?

Answer 20

Clear cells (abundance of glycogen)

Hobnail appearance (bulbous nucleus + nuclear projections into cytoplasm)

Question 21

Which ovarian tumour is associated w Associated with pseudomyxoma peritonei? + what is Associated with pseudomyxoma peritonei?

Answer 21

Pseudomyxoma peritonei is caused by cancerous cells that produce abundantmucinor gelatinousascites

Mucinous cystadenoma is often associated w/ Pseudomyxoma peritonei

Question 22

What are the benign ovarian tumours which is most common?

Answer 22

Serous cystadenoma - most common
BW = Ciliated cells

Mucinous cystadenoma
BW = mucous secreting cells

Question 23

What are psammoma bodies?

Answer 23

concentric laminated calcifications = collection of calcium

Question 24

What are the different types of germ cell cancers?

Answer 24

Dysgerminoma (Most common ovarian cancer in Y women, malignant)

Cystic teratoma / dermoid cyst = MOST COMMON germ cell tumour (bone, skin, teeth, hair) - malignant

Yolk sac tumour - malignant

Choriocarcinoma - GTD, malignant

Question 25

What ovarian tumour secretes AFP?

Answer 25

yolk sac tumour

Question 26

What ovarian tumour secretes hCG?

Answer 26

Choriocarcinoma

Question 27

Which ovarian tumour is associated w schiller-duval bodies on histology?

Answer 27

Yolk sac tumour

Question 28

What are the different types of sex cord tumours?

Answer 28

Granulosa / theca cell tumours - malignant

Sertoli-leydig cell tumours - benign

Fibromas - benign

Question 29

Buzz words for the different sex cord tumours?

Answer 29

Granulosa / theca cell tumours - Precocious puberty, Cal Exner bodies

Sertoli-leydig cell tumours - Peutz-Jegher Syndrome

Fibromas - Associated with Meigs’ syndrome (R sided - ascites, pleural effusion)

Question 30

Which ovarian tumour secretes oestrogen? what does this cause

Answer 30

Granulosa / theca cell tumours, excess oestrogen –> PMB, IMB, endometrial cancer, breast cancer + breast enlargement

Question 31

Which ovarian tumour secretes androgens? what does this cause

Answer 31

Sertoli-leydig cell tumours, excess androgens –> virilisation, defeminisation, breast atrophy, hirsuitism, enlarged clitoris

Question 32

Where do fibromas arise from? associated w/?

Answer 32

Fibroblasts

MEIGS SYNDROME = Triad of R pleural effusion, ascites + fibroma

Question 33

What is a krukenberg tumour? Most common form of this?

Answer 33

Ovarian cancer that metastases from a gastrointestinal tumourresulting in amucin-secreting signet-ring cell adenocarcinoma

MOST COMMON: Gastric adenocarcinoma at pylorus

Usually bilateral

Question 34

Why are HPV 16 and 18 considered high-rsik?

Answer 34

They can produce proteins E6 and E7

These proteins can inactivate tumour supression genes:

• P53 = E6
• Rb = E7

Question 35

Difference between CIN and cervical cancer?

Answer 35

CIN (Cervical intraepithelial neoplasia) has intact basement membrane

Question 36

What are the two types of cervical cancer?

Answer 36

Squamous cell carcinoma (if it starts with CIN)

Adenocarcinoma (20%) (if it starts with CGIN)

NB- CGIN = cervical glandular intraepithelial neoplasia

Question 37

Describe the FIGO staging of endometrial cancer?

Answer 37

1 = confined to uterus

2 = spread to cervix

3 = spread to adnexae, vagina and local LN

4 = other pelvic organs + distant spread

Question 38

What are the types of endometrial cancer?

Answer 38

Type I = 85%, oestrogen dependeent, younger pts - assc w/ atypica endometrial hyperplasia

Type II = 15%, less oestrogen dependent, older pts - assc w/ ATROPHIC endometrium

RFs = Nulliparity, Obesity, DM, ↑Oestrogen

Question 39

A 45 year old lady presents to your GP clinic suffering from abdominal pain, bloating and pain during sexual intercourse. On examination you notice that she has noticeable abdominal distension with a noticeable fluid thrill. You refer her to gynecology who notice an ovarian mass. Histology of the mass shows signet ring cells. What is the most likely diagnosis?

Teratoma 
Sertoli Leydig 
Endometrioma 
Krukenburg Tumor 
Serous Cystadenoma

Answer 39

Krukenburg Tumor