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Year 5 path SW > Histopathology 6: Gynaecological pathology > Flashcards

Histopathology 6: Gynaecological pathology Flashcards

1
Q

What is the most common site of ectopic pregnancy ?

A

Ampulla of the fallopian tube

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2
Q

List 2 high risk HPV serotypes for cervical cancer ?

A

HPV 16

HPV 18

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3
Q

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

A

Koilocytes

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4
Q

Describe CIN 1, CIN2, CIN 3, carcinoma?

A

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

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5
Q

At what age do girls receive the HPV vaccine ?

A

12-13

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6
Q

List 3 causes of PID ?

A

Chlamydia
Gonorrhoea
TB

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7
Q

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

A

It becomes retroverted

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8
Q

What is meant by chocolate cyst of the ovary?

A

Endometrioma

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9
Q

List 2 complications of Fibroids around pregnancy ?

A

Red degeneration

Post-partum torsion

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10
Q

What is the most common type of endometrial cancer ?

A

Endometroid adenocarcinoma

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11
Q

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

A

P53

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12
Q

Define FIGO stage 1 of endometrial cancer

A

Confined to the endometrium

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13
Q

Define FIGO stage 2 of endometrial cancer

A

Spread to the cervix

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14
Q

Define FIGO stage 3 of endometrial cancer

A

Spread to adnexa, vagina or local lymph nodes

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15
Q

Define FIGO stage 4 of endometrial cancer

A

Distal metastasis or other pelvic organ spread

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16
Q

Into which 3 categories are ovarian tumour often subdivided ?

A
  • Epithelial
  • Germ cell
  • Sex cord/ stromal
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17
Q

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

A

Kreukenberg tumour

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18
Q

List 4 epithelial cell Ovarian tumours ?

A

Serous cystadenoma
Mucinous cystadenoma
Endometroid
Clear cell

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19
Q

Which ovarian tumour has Psamomma bodies ?

A

Serous cystadenocarcinoma

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20
Q

Which ovarian tumour is associated with pseudomyxoma peritonei ?

A

Mucinous cystadenocarcinoma

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21
Q

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

A

Brenner tumour

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22
Q

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

A

Teratoma (dermoid cyst)

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23
Q

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

A

Dysgerminoma

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24
Q

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

A

Choriocarcinoma

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25
Q

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

A

Yolk sac tumours

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26
Q

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)

A

Granulosa (theca) cell tumour

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27
Q

Which sex cord/ Stromal Ovarian tumour produces androgens leading to masculinizing effects?

Which syndrome is this tumour associated with ?

A

Sertoli-Leydig cell tumour

Peutz-Jegher syndrome

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28
Q

Which ovarian tumour is associated with Peutz-Jegher syndrome

A

Sertoli-Leydig cell tumour

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29
Q

Which ovarian tumour is associated with Meigs’ syndrome and tends to occur around the menopause ?

(histology shows bundles of spindle-shaped fibroblasts)

A

Fibroma

30
Q

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

A

Fibromas
Ascites
Pleural effusions

31
Q

Describe FIGO stage 1 of Ovarian cancer ?

A

Limited to the ovaries

32
Q

Describe FIGO stage 2 of Ovarian cancer ?

A

Limited to the pelvis

33
Q

Describe FIGO stage 3 of Ovarian cancer ?

A

Limited to the abdomen

34
Q

Describe FIGO stage 4 of Ovarian cancer ?

A

Distant metastases outside of the abdominal cavity

35
Q

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

A

Clear cell carcinoma

36
Q

3 infections that cause discomfort but no serious complications

A

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

37
Q

4 infections that cause serious complications

A

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

38
Q

list causes of PID

A

gonococci
chlamydia
enteric bacteria

staph 
strep 
coliform bacteria 
clostridium perfringens 
(often secondary to abortion)
39
Q

complications of PID

A

peritonitis
intestinal obstruction due to adhesions
bacteraemia
infertility

40
Q

complications of salpingitis

A 
plical fusion
adhesions to ovary 
tubo-ovarian abscess
peritonitis
hydrosalpinx (fallopian tube filled with fluid)
infertility 
ectopic pregnancy
41
Q

what 2 factors can increase the risk of an ectopic

A

inflammation and obstruction of fallopain tubes

42
Q

RF for cervical cancer

A 
HPV (95%)
many sexual partners 
sexually active early 
smoking 
immunosuppression
43
Q

low risk HPV types

A

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

44
Q

how does HPV lead to cervical cancer

A

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

45
Q

difference between latent and productive HPV

A

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

46
Q

what is the transformation zone

A

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

47
Q

what is CIN

A 
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)

48
Q

what are the 2 types of cervical cancer

A 
squamous cell (if starts with CIN)
adenocarcinoma (if starts with CGIN)
49
Q

cervical screening programme

A

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

50
Q

types of leiomyoma

A 
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

51
Q

features of endometrial hyperplasia

A 
driven by oestrogen 
occurs perimenopausal 
causes:
- persistent anovulation 
- PCOS
- granuloma cell tumours of ovary 
- oestrogen therapy
52
Q

feat

no ures of endometrial carcinoma

A

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
53
Q

features of gestational trophoblastic disease

A

tumours an tumour like conditions characterised by proliferation of pregnancy-associated trophoblastic tissue

  • complete and partial mole
  • invasive mole
  • choriocarcinoma
54
Q

features of complete and partial moles

A

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

55
Q

features of choricarcinoma

A

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

56
Q

features of endometriosis

A

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

57
Q

features of adenomyosis

A

ectopic endometrial tissue deep within the myometrium

causes dysmenorrhoea

58
Q

types ovarian cyst

A

non-neoplastic functional cysts

  • follicular and luteal
  • endometriotic

PCOS - persistent anovulation

59
Q

types of ovarian tumour

A

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

secondary - sarcomas, carcinomas, lymphomas

60
Q

what are type 1 and 2 epithelial tumours

A

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%

61
Q

types of benign ovarian tumours

A

serous cystadenoma
cystadenofibromas
mucinous cystadenomas
brenner tumour

62
Q

types of sex cord stromal tumours

A

fibromas
granulosa cell tumours
thecoma
sertol-leydig cell tumour

63
Q

types of germ cell tumours

A 
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
64
Q

types of secondary ovarian tumour

A

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

metastatic colorectal carcinoma

65
Q

what genes and syndromes are associated with hereditary ovarian cancer

A 
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
66
Q

vulval diseases

A

lichen sclerosus - can be associated with epithelial dysplasia and dev of malignancy

benign tumours = papillary hidradenoma

malignant = SCC, pagets, adenocarcinoma, MM, BCC

67
Q

vaginal diseases

A

congenital ab

tumours rare

68
Q

what type of HPV is associated with VIN

A

16

69
Q

summarise epithelial ovarian carcinomas

A

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

70
Q

summarise germ cell ovarian carcinomas

A

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

71
Q

summarise sex cord/stromal tumours

A

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

Year 5 path SW (106 decks)

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