Histopath: Gynae path Flashcards
What is PID usually caused by? which organisms in the UK? which organisms in the world?
Usually caused by ascending infections
MOST COMMON UK: Chlamydia and gonorrhea
MOST COMMON WORLD: TB and schistosomiasis
What are some potential complications of PID? - most likely to come up in path
Peritonitis
Intestinal obstructions due to adhesions
Bacteraemia
Subfertility
Tubo-ovarian abscess
Fitz Hugh Curtis Syndrome
What are the textbook buzzwords for PID?
Dyspareunia
Adnexal tenderness
Cervical excitation
What is Fitz Hugh Curtis Syndrome?
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)
What are some buzzwords associated w/ endometriosis?
Chronic pelvic pain
PR bleeding -> inflammation in pouch of douglas irritates rectum
Immobile uterus -> due to adhesions
What is the diagnostic test for endometriosis and what does it show?
Powder burn spots on diagnostic laparoscopy
What are the features / buzzwords associated w/ adenomyosis?
This is endometrium growing w/in the myometrium
BW = bulky uterus + chornic pelvic pain
What are the key features / buzzwords of fibroids
benign tumours of smooth muscle
BW = HMB
When do fibroids grow / shrink?
Grow during pregnancy - red degeneration (haemorrage)
Shrink during menopause
What are the features to know about vulval cancer?
VIN = pre-cancerous
post-menopausal = increased risk
Normally present w/ superficial skin changes - itchiness etc
How can ovarian cancers be characterised?
Epithelial (70%)
Germ cell
Sex cord stromal
Secondary
What is the most common type of ovarian malignancy?
Serous cystadenoma = Cyst lined by ciliated cells (BENIGN) - often bilateral
In which ovarian cancer does the epithelium resemble GI or endocervical epithelium?
Mucinous cystadenoma (BENIGN) = Cyst lined by ciliated cells
What does histology of serous cystadenoma show?
Columnar epithelium
psammoma bodies (concentric laminated calcifications) - IMPORTANT
What does histology of mucinous cystadenomas show?
Mucin secreting cells (IMPORTANT)
NO psammoma bodies
Which epithelial ovarian cancers tend to be malignant? Prognosis for these?
Endometriod carcinomas - better prognosis than serous / mucinous
Clear cell carcinomas - poor prognosis
What do endometriod carcinomas tend to coexist w?
Endometrial cancer
What is a major RF for enometrioid and clear cell carcinomas?
ENDOMETRIOSIS
What is the histological appearace of endometrioid carcinomas?
Tubular glands present
What is the histological appearace of clear cell carcinomas?
Clear cells (abundance of glycogen)
Hobnail appearance (bulbous nucleus + nuclear projections into cytoplasm)
Which ovarian tumour is associated w Associated with pseudomyxoma peritonei? + what is Associated with pseudomyxoma peritonei?
Pseudomyxoma peritonei is caused by cancerous cells that produce abundantmucinor gelatinousascites
Mucinous cystadenoma is often associated w/ Pseudomyxoma peritonei
What are the benign ovarian tumours which is most common?
Serous cystadenoma - most common
BW = Ciliated cells
Mucinous cystadenoma
BW = mucous secreting cells
What are psammoma bodies?
concentric laminated calcifications = collection of calcium
What are the different types of germ cell cancers?
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
What ovarian tumour secretes AFP?
yolk sac tumour
What ovarian tumour secretes hCG?
Choriocarcinoma
Which ovarian tumour is associated w schiller-duval bodies on histology?
Yolk sac tumour
What are the different types of sex cord tumours?
Granulosa / theca cell tumours - malignant
Sertoli-leydig cell tumours - benign
Fibromas - benign
Buzz words for the different sex cord tumours?
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)
Which ovarian tumour secretes oestrogen? what does this cause
Granulosa / theca cell tumours, excess oestrogen –> PMB, IMB, endometrial cancer, breast cancer + breast enlargement
Which ovarian tumour secretes androgens? what does this cause
Sertoli-leydig cell tumours, excess androgens –> virilisation, defeminisation, breast atrophy, hirsuitism, enlarged clitoris
Where do fibromas arise from? associated w/?
Fibroblasts
MEIGS SYNDROME = Triad of R pleural effusion, ascites + fibroma
What is a krukenberg tumour? Most common form of this?
Ovarian cancer that metastases from a gastrointestinal tumourresulting in amucin-secreting signet-ring cell adenocarcinoma
MOST COMMON: Gastric adenocarcinoma at pylorus
Usually bilateral
Why are HPV 16 and 18 considered high-rsik?
They can produce proteins E6 and E7
These proteins can inactivate tumour supression genes:
- P53 = E6
- Rb = E7
Difference between CIN and cervical cancer?
CIN (Cervical intraepithelial neoplasia) has intact basement membrane
What are the two types of cervical cancer?
Squamous cell carcinoma (if it starts with CIN)
Adenocarcinoma (20%) (if it starts with CGIN)
NB- CGIN = cervical glandular intraepithelial neoplasia
Describe the FIGO staging of endometrial cancer?
1 = confined to uterus
2 = spread to cervix
3 = spread to adnexae, vagina and local LN
4 = other pelvic organs + distant spread
What are the types of endometrial cancer?
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
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
Krukenburg Tumor
