Histopathology 6: Gynaecological pathology Flashcards
What is the most common site of ectopic pregnancy ?
Ampulla of the fallopian tube
List 2 high risk HPV serotypes for cervical cancer ?
HPV 16
HPV 18
Which cells are characteristic of HPV on histology and appear to have a halo around the nucleus
Koilocytes
Describe CIN 1, CIN2, CIN 3, carcinoma?
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
At what age do girls receive the HPV vaccine ?
12-13
List 3 causes of PID ?
Chlamydia
Gonorrhoea
TB
What happens to the position of the uterus in severe endometriosis ?
It becomes retroverted
What is meant by chocolate cyst of the ovary?
Endometrioma
List 2 complications of Fibroids around pregnancy ?
Red degeneration
Post-partum torsion
What is the most common type of endometrial cancer ?
Endometroid adenocarcinoma
Which mutation is most commonly associated with Serous adenocarcinoma of the endometrium ?
P53
Define FIGO stage 1 of endometrial cancer
Confined to the endometrium
Define FIGO stage 2 of endometrial cancer
Spread to the cervix
Define FIGO stage 3 of endometrial cancer
Spread to adnexa, vagina or local lymph nodes
Define FIGO stage 4 of endometrial cancer
Distal metastasis or other pelvic organ spread
Into which 3 categories are ovarian tumour often subdivided ?
- Epithelial
- Germ cell
- Sex cord/ stromal
Which bilateral ovarian tumour is likely if Signet ring cells are present ?
Kreukenberg tumour
List 4 epithelial cell Ovarian tumours ?
Serous cystadenoma
Mucinous cystadenoma
Endometroid
Clear cell
Which ovarian tumour has Psamomma bodies ?
Serous cystadenocarcinoma
Which ovarian tumour is associated with pseudomyxoma peritonei ?
Mucinous cystadenocarcinoma
Which ovarian tumour has Walthard cell rests and “coffee bean” nuclei ?
Brenner tumour
Which ovarian tumours contain ectodermal, endodermal and mesodermal cell lines ?
Teratoma (dermoid cyst)
Which Ovarian tumour is histologicaly similar to a testicular seminoma and associated with Turner’s syndrome ?(Typically secrete hCG and LDH)
Dysgerminoma
Which Ovarian germ cell tumour is associated with high levels of beta HCG ?
Choriocarcinoma
Which germ cell ovarian tumours typically secrete AFP and show Schiller-Duval bodies on histology ?
Yolk sac tumours
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)
Granulosa (theca) cell tumour
Which sex cord/ Stromal Ovarian tumour produces androgens leading to masculinizing effects?
Which syndrome is this tumour associated with ?
Sertoli-Leydig cell tumour
Peutz-Jegher syndrome
Which ovarian tumour is associated with Peutz-Jegher syndrome
Sertoli-Leydig cell tumour
Which ovarian tumour is associated with Meigs’ syndrome and tends to occur around the menopause ?
(histology shows bundles of spindle-shaped fibroblasts)
Fibroma
List the triad of features seen in Meig’s syndrome ?
Fibromas
Ascites
Pleural effusions
Describe FIGO stage 1 of Ovarian cancer ?
Limited to the ovaries
Describe FIGO stage 2 of Ovarian cancer ?
Limited to the pelvis
Describe FIGO stage 3 of Ovarian cancer ?
Limited to the abdomen
Describe FIGO stage 4 of Ovarian cancer ?
Distant metastases outside of the abdominal cavity
which vaginal cancer are children of women who were treated with diethyl stilbosterol for threatened abortion at increased risk of?
Clear cell carcinoma
3 infections that cause discomfort but no serious complications
candida - common in diabetes, OCP, pregnancy
trichomonas vaginalis - protozoan
gardenerella - gram negative bacillus causing vaginitis
4 infections that cause serious complications
chlamydia - infertilty
gonorrhoea - infertility
mycoplasma - spontaneous abortion and chorioamnionitis
HPV - cancer
list causes of PID
gonococci
chlamydia
enteric bacteria
staph strep coliform bacteria clostridium perfringens (often secondary to abortion)
complications of PID
peritonitis
intestinal obstruction due to adhesions
bacteraemia
infertility
complications of salpingitis
plical fusion adhesions to ovary tubo-ovarian abscess peritonitis hydrosalpinx (fallopian tube filled with fluid) infertility ectopic pregnancy
what 2 factors can increase the risk of an ectopic
inflammation and obstruction of fallopain tubes
RF for cervical cancer
HPV (95%) many sexual partners sexually active early smoking immunosuppression
low risk HPV types
6 + 11
cause genital and oral warts
low grade cervical abnormalities
how does HPV lead to cervical cancer
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
difference between latent and productive HPV
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
what is the transformation zone
stratified squamous - columnar epithelium
where cervix meets vagina
vulnerable to developing problems
what is CIN
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)
what are the 2 types of cervical cancer
squamous cell (if starts with CIN) adenocarcinoma (if starts with CGIN)
cervical screening programme
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
types of leiomyoma
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
features of endometrial hyperplasia
driven by oestrogen occurs perimenopausal causes: - persistent anovulation - PCOS - granuloma cell tumours of ovary - oestrogen therapy
feat
no ures of endometrial carcinoma
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
features of gestational trophoblastic disease
tumours an tumour like conditions characterised by proliferation of pregnancy-associated trophoblastic tissue
- complete and partial mole
- invasive mole
- choriocarcinoma
features of complete and partial moles
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
features of choricarcinoma
malignant cancer usually of the placenta
rapidly invasive and widely metastasising ( lung, vagina, brain, liver, kidney)
responds well to chemo
features of endometriosis
presence of endometrial tissue outside the uterus
10% women
ectopic endometrial tissue = functional and bleeds at the time of menstruation - pain, scarring, infertility
features of adenomyosis
ectopic endometrial tissue deep within the myometrium
causes dysmenorrhoea
types ovarian cyst
non-neoplastic functional cysts
- follicular and luteal
- endometriotic
PCOS - persistent anovulation
types of ovarian tumour
primary - surface epithelial (95%) , sex cord stromal, germ cell
- sarcomas and lymphomas
secondary - sarcomas, carcinomas, lymphomas
what are type 1 and 2 epithelial tumours
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%
types of benign ovarian tumours
serous cystadenoma
cystadenofibromas
mucinous cystadenomas
brenner tumour
types of sex cord stromal tumours
fibromas
granulosa cell tumours
thecoma
sertol-leydig cell tumour
types of germ cell tumours
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
types of secondary ovarian tumour
krukenburg tumour - bilateral mets composed of mucin-producing signet ring cells
often from gastric or breast cancer
metastatic colorectal carcinoma
what genes and syndromes are associated with hereditary ovarian cancer
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
vulval diseases
lichen sclerosus - can be associated with epithelial dysplasia and dev of malignancy
benign tumours = papillary hidradenoma
malignant = SCC, pagets, adenocarcinoma, MM, BCC
vaginal diseases
congenital ab
tumours rare
what type of HPV is associated with VIN
16
summarise epithelial ovarian carcinomas
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
summarise germ cell ovarian carcinomas
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
summarise sex cord/stromal tumours
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
