Histopathology - Gynaecological pathology Flashcards
What is salpingitis?
Infection of fallopian tubes
What are the possible complications of untreated salpingitis?
Adhesions
Abscesses
Peritonitis
Ectopic pregnancy
What are the high risk forms of HPV for cervical cancer?
16 and 18
Recall the stages of progression from normal cervical cells to cervical carcinoma
Normal
T positive HPV (abnormal cells)
CIN 1 (lower 1/3 cells dysplasia)
CIN 2 (2/3 of cells )
CIN 3 (full thickness neoplastic)
Carcinoma
What do CIN and CGIN stand for, and what is the main difference between them?
CIN = cervical intraepithelial neoplasia
CGIN = cervical glandular intraepithelial neoplasia
CIN progresses to squamous cell carcinoma
CGIN progresses to adenocarcinoma
How does HPV lead to neoplatic transformation of cervical cells?
E6 (deactivates p53) and E7 (deactivates retinoblastoma) (tumour suppressor genes)
What age range is invited to cervical screening?
25-64
Which HPV strains are included in the quadrivalent vaccine?
6,11,16,18
What is leiomyoma of the uterus?
Smooth muscle cell tumour of the uterus
What is a fibroid?
Leiomyoma
How are fibroids classified?
As either intramural, submucosal or subserosal
What is the biggest risk factor for endometrial hyperplasia?
Persistent oestrogen
What is the difference between type 1 and 2 endometrial carcinomas?
Type 1: adenocarcinomas, mucinous, secretory
Type 2: Serous/ clear cell carcinoma
What is the relative prevelance of type 1 vs type 2 endometrial carcinoma?
Type 1 = 80-85%
Type 2 = 10-15%
Recall the genetic associations of serous and clear cell endometrial carcinomas
Serous: p53 mutation
Clear cell: PTEN mutation
Which type of endometrial carcinoma is high grade and which is low grade?
Type 1 = low grade
Type 2 = high grade
Which type of endometrial carcinoma is most likely to arise in atrophic endometrium?
Type 2
Recall the FIGO stages of endometrial cancer
Stage 1: Confined to uterus
Stage 2: Spread to cervix
Stage 3: Spread to adnexa, vagina, local lymph nodes (pelvic/ para-aortic)
Stage 4: Distant metastases
Recall the different types of gestational trophoblastic disease
Partial/ complete mole
Invasive mole
Choriocarcinoma
How does gestational trophoblastic disease usually present?
As spontaneous abortion
What is the cause of gestational trophoblastic disease?
Fertilisation of one egg by 2 sperm
Describe the prognosis of choriocarcinoma
Very aggressive but also very responsive to treatment
What is endometriosis?
Presence of endometrial glands and stroma outside of the uterus - bleeding of ectopic material is painful
What is adenomyosis?
Ectopic endometrial tissue within the myometrium
What is the main symptom of adenomyosis?
Dysmennorhoea
What type of tumour are 70% of ovarian neoplasms? outline their key findings
epithelial tumours
=
serous - psammoma bodies, most common
mucinous - mucin producing, K- ras mutation in 75%
endometroid - endometriosis risk factors
clear cell - clear cytoplasm & hobnail appearance, strong association w endometriosis
Describe the 2 different types of ovarian carcinoma
Type 1 (low grade, has precursors) Type 2 (high grade, associated with p53 mutations)
What type of epithelium are most ovarian carcinomas derived from?
Serous
Which types of ovarian carcinoma are associated with endometriosis?
Endometrioid and clear cell carcinoma
Recall the 3 types of sex cord stromal tumours, outline their key aspects
sex cord stromal tumours = 10% of ovarian tumours
fibromas = associated w Meig’s syndrome (ascites + pleural effusion)
granulosa theca cell tumours = produce E2, cause oestrogenic effects
sertoli-leydig cell tumours = secrete androgens (look for defeminsation)
In what age group of women are germ cell tumours seen?
<20s
what are the other 20% of ovarian tumours?
germ cell tumours (of which 95% are benign)
dysgermioma = undifferentiated germ cells
teratoma (mature = most common = benign, immature = malignant)
choriocarcinoma - secrete hCG
Recall 2 types of cancer that commonly metastasise to the ovary
Krukenburg tumours mets grom gastric adenocarcinoma
Colon cancer
2 macroscopic findings of endometriosis
red-blue to brown nodules - “powder burns”
“chocolate cysts” in ovaries (endometriomas)
what’s the transformation zone
squamocolumnar junction
malignant version of a fibroid =
leiomyosarcoma
which subtype of endometrial carcinoma are oestrogen dependent & linked to endometrial hyperplasia
type 1 -85%
endometrioid, mucinous and secretory adenocarcinoma
-younger patients, usually lower grade,
which subtype of endometrial carcinoma are not oestrogen dependent
type 2-15%
serous and clear cell tumours
- older patients, higher grade
differentiate between complete mole and partial mole
complete = empty egg fertilised by 2 sperm (or 1 which duplicates DNA)
46 XY or 46 XX (paternal origin only)
partial = normal egg fertilised by 2 sperm (or 1 which duplicates DNA)
69 XXX or 69 XXY (1x maternal and 2x paternal origin)
what’s an important secondary ovarian tumour
Krukenberg Tumour:
Bilateral metastases from gastric or breast cancer composed of mucin-producing signet ring cells
outline the FIGO staging for ovarian cancer
Stage I: limited to ovaries (75-90%)
• Stage II: limited to pelvis (45-60%)
• Stage III: limited to abdomen (including regional LN metastases) (30-40%)
• Stage IV: distance metastases outside abdominal cavity (<20%)
what type of cervical carcinoma is most common
squamous cell carcinoma (70-80%)
outline the FIGO staging of cervical cancer
Stage0:CIN
1 - limited to cervix
2- beyond uterus but not to pelvic side wall or lower 1/3 of vagina
3- extension to pelvic side wall or lower 1/3 vagins
4- extension beyond true pelvis or involvement of bladder/bowel
what marks the change from CIN to cervical carcinoma
Invasion through the basement membrane
which gynae cancer accounts for most deaths in UK
ovarian carcinoma