Histopathology 6: Gynaecological pathology

Question 1

Malignant version of fibroid name

Answer 1

• Leiomyosarcoma
• usually solitary and often bigger in size
• very poor prognosis
• rapidly locally invade and is spread via the blood stream

Question 2

How Does HPV Transform Cells?

Answer 2

• There are TWO proteins that are encoded by the genome of the virus: E6 and E7
• E6 and E7 bind to and inactivate two TSGs:
  
  • p53 gene- E6
  • Retinoblastoma gene (Rb)- E7

Question 3

2 types of endometrial carcinoma

Answer 3

Type I: 80-85%

• Subtypes: Endometrioid, mucinous and secretory adenocarcinomas
• Younger age
• These are oestrogen dependent
• Often associated with atypical endometrial hyperplasia
• Low grade tumours, superficially invasive- don’t spread far from the uterus

Type II: 10-15%

• Subtypes: Serous and clear cell carcinomas
• Older, postmenopausal
• Less oestrogen dependent
• Arise in atrophic endometrium
• Higher grade, deeper invasion, higher stage

Question 4

Mutation in type 1 ovarian tumour (6)

Mutation in type 2

Answer 4

RAS, BRAF, P13KCA, HER2, PTEN and b-catenin

p53

Question 5

Most common ovarian tumour

Answer 5

Serous Tumours

• Usually cystic- often unilocular
• Can be benign or malignant

Question 6

Ovarian tumour associated with the presence of endometriosis (10-20%), but most others thought to be derived from the surface epithelium

Answer 6

Endometrioid Tumours

Question 7

Which ovarian cancer has close association with endometriosis?

Answer 7

Clear Cell Carcinoma

Question 8

Types of sex cord stromal ovarian tumour

Answer 8

• fibromas (fibroblast)
• granulosa cell tumour (granulosa cells)
• thecoma (Thecal cells): secrete oestrogen
• Sertoli-Leydig cell tumour (Sertoli-Leydig cells): hormone producing (androgenic)

Question 9

MOST COMMON type of germ cell ovarian tumour

Answer 9

Mature Teratoma (Dermoid) - this is benign

NB immature teratoma = behaves in a malignant way

Question 10

both ovaries are infiltrated with mucin secreting cells (signet ring cells) - which metastatic ovarian tumour is this?

Answer 10

Krukenberg tumours

• Bilateral metastases composed of mucin-producing signet ring cells

Question 11

Other secondary ovarian tumour other than Krukenberg tumour

Answer 11

Metastatic colorectal carcinoma

Question 12

Neoplasm types of vagina (3)

Answer 12

• Carcinoma: squamous cell carcinoma
• Adenocarcinoma
• Rhabdomyosarcoma

Question 13

Most common neoplasm of vulva

Answer 13

SCC

Question 15

Hereditary ovarian cancers (3)

Answer 15

• Serous tumours- BRCA associated (30% of all ovarian cancers)
• Mucinous tumours- HNPCC associated (10% of all ovarian cancers)
• Endometrioid carcinoma- HNPCC associated (20% of all)