Histopathology 6: Gynaecological pathology

Question 1

What is the most common site of ectopic pregnancy ?

Answer 1

Ampulla of the fallopian tube

Question 2

List 2 high risk HPV serotypes for cervical cancer ?

Answer 2

HPV 16

HPV 18

Question 3

Which cells are characteristic of HPV on histology and appear to have a halo around the nucleus

Answer 3

Koilocytes

Question 4

Describe CIN 1, CIN2, CIN 3, carcinoma?

Answer 4

CIN 1: Mild dyskaryosis limited to 1/3 of epithelium
CIN 2: Moderate dyskaryosis limited to 2/3 of epithelium
CIN 3: Severe dyskaryosis affecting entire epithelium
Carcinoma: Evidence of invasion through the basement membrane

Question 5

At what age do girls receive the HPV vaccine ?

Answer 5

12-13

Question 6

List 3 causes of PID ?

Answer 6

Chlamydia
Gonorrhoea
TB

Question 7

What happens to the position of the uterus in severe endometriosis ?

Answer 7

It becomes retroverted

Question 8

What is meant by chocolate cyst of the ovary?

Answer 8

Endometrioma

Question 9

List 2 complications of Fibroids around pregnancy?

Answer 9

Red degeneration

Post-partum torsion

Question 10

What is the most common type of endometrial cancer ?

Answer 10

Endometroid adenocarcinoma

Question 11

Which mutation is most commonly associated with Serous adenocarcinoma of the endometrium ?

Answer 11

P53

Question 12

Define FIGO stage 1 of endometrial cancer

Answer 12

Confined to the endometrium

Question 13

Define FIGO stage 2 of endometrial cancer

Answer 13

Spread to the cervix

Question 14

Define FIGO stage 3 of endometrial cancer

Answer 14

Spread to adnexa, vagina or local lymph nodes

Question 15

Define FIGO stage 4 of endometrial cancer

Answer 15

Distal metastasis or other pelvic organ spread

Question 16

Into which 3 categories are ovarian tumour often subdivided ?

Answer 16

• Epithelial
• Germ cell
• Sex cord/ stromal

Question 17

Which bilateral ovarian tumour is likely if Signet ring cells are present ?

Answer 17

Kreukenberg tumour

Question 18

List 4 epithelial cell Ovarian tumours ?

Answer 18

Serous cystadenoma
Mucinous cystadenoma
Endometroid
Clear cell

Question 19

Which ovarian tumour has Psamomma bodies ?

Answer 19

Serous cystadenocarcinoma

Question 20

Which ovarian tumour is associated with pseudomyxoma peritonei ?

Answer 20

Mucinous cystadenocarcinoma

Question 21

Which ovarian tumour has Walthard cell rests and “coffee bean” nuclei ?

Answer 21

Brenner tumour

Question 22

Which ovarian tumours contain ectodermal, endodermal and mesodermal cell lines ?

Answer 22

Teratoma (dermoid cyst)

Question 23

Which Ovarian tumour is histologicaly similar to a testicular seminoma and associated with Turner’s syndrome ?(Typically secrete hCG and LDH)

Answer 23

Dysgerminoma

Question 24

Which Ovarian germ cell tumour is associated with high levels of beta HCG ?

Answer 24

Choriocarcinoma

Question 25

Which germ cell ovarian tumours typically secrete AFP and show Schiller-Duval bodies on histology ?

Answer 25

Yolk sac tumours

Question 26

Which sex cord/ Stromal Ovarian tumour produces oestrogen leading to precocious puberty if in children or endometrial hyperplasia in adult? (Histology shows Call-Exner bodies)

Answer 26

Granulosa (theca) cell tumour

Question 27

Which sex cord/ Stromal Ovarian tumour produces androgens leading to masculinizing effects? Which syndrome is this tumour associated with ?

Answer 27

Sertoli-Leydig cell tumour Peutz-Jegher syndrome

Question 28

Which ovarian tumour is associated with Peutz-Jegher syndrome

Answer 28

Sertoli-Leydig cell tumour

Question 29

Which ovarian tumour is associated with Meigs' syndrome and tends to occur around the menopause ? (histology shows bundles of spindle-shaped fibroblasts)

Answer 29

Fibroma

Question 30

List the triad of features seen in Meig's syndrome ?

Answer 30

Fibromas Ascites Pleural effusions

Question 31

Describe FIGO stage 1 of Ovarian cancer ?

Answer 31

Limited to the ovaries

Question 32

Describe FIGO stage 2 of Ovarian cancer ?

Answer 32

Limited to the pelvis

Question 33

Describe FIGO stage 3 of Ovarian cancer ?

Answer 33

Limited to the abdomen

Question 34

Describe FIGO stage 4 of Ovarian cancer ?

Answer 34

Distant metastases outside of the abdominal cavity

Question 35

which vaginal cancer are children of women who were treated with diethyl stilbosterol for threatened abortion at increased risk of?

Answer 35

Clear cell carcinoma

Question 36

3 infections that cause discomfort but no serious complications

Answer 36

candida - common in diabetes, OCP, pregnancy trichomonas vaginalis - protozoan gardenerella - gram negative bacillus causing vaginitis

Question 37

4 infections that cause serious complications

Answer 37

chlamydia - infertilty gonorrhoea - infertility mycoplasma - spontaneous abortion and chorioamnionitis HPV - cancer

Question 38

list causes of PID

Answer 38

gonococci chlamydia enteric bacteria ``` staph strep coliform bacteria clostridium perfringens (often secondary to abortion) ```

Question 39

complications of PID

Answer 39

peritonitis intestinal obstruction due to adhesions bacteraemia infertility

Question 40

complications of salpingitis

Answer 40

``` plical fusion adhesions to ovary tubo-ovarian abscess peritonitis hydrosalpinx (fallopian tube filled with fluid) infertility ectopic pregnancy ```

Question 41

what 2 factors can increase the risk of an ectopic

Answer 41

inflammation and obstruction of fallopain tubes

Question 42

RF for cervical cancer

Answer 42

``` HPV (95%) many sexual partners sexually active early smoking immunosuppression ```

Question 43

low risk HPV types

Answer 43

6 + 11 cause genital and oral warts low grade cervical abnormalities

Question 44

how does HPV lead to cervical cancer

Answer 44

two proteins E6 and E7 are encoded by the virus and have transforming genes E6+7 bind to and inactivate 2 tumour suppressor genes: - retinoblastoma (Rb) - E7 - P53 - E6 increases unscheduled cellular proliferation

Question 45

difference between latent and productive HPV

Answer 45

latent - HPV DNA resides in basal cells infectious virions not produced cellular effects not seen only ID via molecular methods productive - viral DNA replicates independently of host chromosomal DNA synthesis koilocytes

Question 46

what is the transformation zone

Answer 46

stratified squamous - columnar epithelium where cervix meets vagina vulnerable to developing problems

Question 47

what is CIN

Answer 47

``` cervical intraepithelial neoplasia = dysplasia of cervical epithelium epithelial cells have undergone pre-malignant and pre-invasive changes but BM is still intact usually squamous epithelium ``` if affecting columnar epithelium = cervical glandular intraepithelial neoplasia (CGIN)

Question 48

what are the 2 types of cervical cancer

Answer 48

``` squamous cell (if starts with CIN) adenocarcinoma (if starts with CGIN) ```

Question 49

cervical screening programme

Answer 49

25 yrs every 3 years 25-49 every 5 years 50-62 64+ only if not screened since 50 or had recent abnormal tests detection of high risk HPV by hybrid capture II (HC2) HPV DNA test

Question 50

types of leiomyoma

Answer 50

``` leiomyoma = fibroid most common uterine tumour smooth muscle tumour of the uterus 20% of women >35 yrs usually multiple intramural - in myometrial tissue submucosal - bulge into uterine cavity subserosal - project outside the uterus ``` malignant = leiomyosarcoma

Question 51

features of endometrial hyperplasia

Answer 51

``` driven by oestrogen occurs perimenopausal causes: - persistent anovulation - PCOS - granuloma cell tumours of ovary - oestrogen therapy ```

Question 52

feat | no ures of endometrial carcinoma

Answer 52

RF: - nulliparity - obesity - DM - excessive oestrogen stimulation Type 1 (85%) - endometrial, mucinous, secretory adenocarcionoma - mutations = PTEN, P13KCA, K-Ras, CTNB1, FGFR2, P53 Type 2 (15%) - endometrial serous carcinoma - P53, K13KCA - clear cell carcinoma - PTEN, CTNNB1, Her-2 amplification

Question 53

features of gestational trophoblastic disease

Answer 53

tumours an tumour like conditions characterised by proliferation of pregnancy-associated trophoblastic tissue - complete and partial mole - invasive mole - choriocarcinoma

Question 54

features of complete and partial moles

Answer 54

presents as spontaneous abortion/ abnormal USS/ very high hCG no partial moles will progress to malignancy 2.5% complete moles will become malignant complete mole - fertilisation of an empty egg partial mole - normal ovum fertilised by 2 sperm

Question 55

features of choricarcinoma

Answer 55

malignant cancer usually of the placenta rapidly invasive and widely metastasising ( lung, vagina, brain, liver, kidney) responds well to chemo

Question 56

features of endometriosis

Answer 56

presence of endometrial tissue outside the uterus 10% women ectopic endometrial tissue = functional and bleeds at the time of menstruation - pain, scarring, infertility

Question 57

features of adenomyosis

Answer 57

ectopic endometrial tissue deep within the myometrium | causes dysmenorrhoea

Question 58

types ovarian cyst

Answer 58

non-neoplastic functional cysts - follicular and luteal - endometriotic PCOS - persistent anovulation

Question 59

types of ovarian tumour

Answer 59

primary - surface epithelial (95%) , sex cord stromal, germ cell - sarcomas and lymphomas secondary - sarcomas, carcinomas, lymphomas

Question 60

what are type 1 and 2 epithelial tumours

Answer 60

type 1 - low grade, indolent, present as large stage 1 tumours mutations - K- Ras, BRAF, P13KCA, Her2, PTEN, beta-catenin type 2 - high grade, mostly serous, aggressive P53 mutations in 75%

Question 61

types of benign ovarian tumours

Answer 61

serous cystadenoma cystadenofibromas mucinous cystadenomas brenner tumour

Question 62

types of sex cord stromal tumours

Answer 62

fibromas granulosa cell tumours thecoma sertol-leydig cell tumour

Question 63

types of germ cell tumours

Answer 63

``` 90% benign <20 yrs dysgerminoma = no differentiation (teratoma, choriocarcinoma, endodermal sinus tumour) mature teratoma immature teratoma - malignant mature cystic teratoma with malignant transformation dysgerminoma yolk sac tumour choriocarcinoma embryonal carcinoma ```

Question 64

types of secondary ovarian tumour

Answer 64

krukenburg tumour - bilateral mets composed of mucin-producing signet ring cells often from gastric or breast cancer metastatic colorectal carcinoma

Question 65

what genes and syndromes are associated with hereditary ovarian cancer

Answer 65

``` 10% familial familial syndromes: - familial breast-ovarian cancer syndrome - site-specific ovarian cancer - cancer family syndrome (lynch type II) ``` BRCA 1 ``` serous = BRCA mucinous = HNPCC endometroid = HNPCC ```

Question 66

vulval diseases

Answer 66

lichen sclerosus - can be associated with epithelial dysplasia and dev of malignancy benign tumours = papillary hidradenoma malignant = SCC, pagets, adenocarcinoma, MM, BCC

Question 67

vaginal diseases

Answer 67

congenital ab | tumours rare

Question 68

what type of HPV is associated with VIN

Answer 68

16

Question 69

summarise epithelial ovarian carcinomas

Answer 69

serous cyst adenoma - most common, columnar, psammoma bodies mutinous cyst adenoma - mucin secreting, no psammoma bodies, oestrogen secreting, younger women endometroid - tubular glands, endometriosis = RF clear cell - clear cytoplasm - IC glycogen , hobnail appearance, malignant with poor prognosis

Question 70

summarise germ cell ovarian carcinomas

Answer 70

dysgerminoma - most common ovarian malignancy in young women, sensitive to radiotherapy teratoma - mature teratomas (dermoid cysts), immature teratomas (malignant, usually solid, secrete AFP) choriocarcinoma - secrete hCG, malignant

Question 71

summarise sex cord/stromal tumours

Answer 71

fibroma - no hormone production, 50% associated with Meig syndrome (ascites + pleural effusion) granulosa-theca cell tumour - produce E2, oestrogen effects sertoli-leydig cell tumours - secrete androgens, look for defeminisation and virilisation