Histopathology - Gynaecological pathology

Question 1

What is salpingitis?

Answer 1

Infection of fallopian tubes

Question 2

What are the possible complications of untreated salpingitis?

Answer 2

Adhesions
Abscesses
Peritonitis
Ectopic pregnancy

Question 3

What are the high risk forms of HPV for cervical cancer?

Answer 3

16 and 18

Question 4

Recall the stages of progression from normal cervical cells to cervical carcinoma

Answer 4

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

Question 5

What do CIN and CGIN stand for, and what is the main difference between them?

Answer 5

CIN = cervical intraepithelial neoplasia
CGIN = cervical glandular intraepithelial neoplasia
CIN progresses to squamous cell carcinoma
CGIN progresses to adenocarcinoma

Question 6

How does HPV lead to neoplatic transformation of cervical cells?

Answer 6

E6 (deactivates p53) and E7 (deactivates retinoblastoma) (tumour suppressor genes)

Question 7

What age range is invited to cervical screening?

Answer 7

25-64

Question 8

Which HPV strains are included in the quadrivalent vaccine?

Answer 8

6,11,16,18

Question 9

What is leiomyoma of the uterus?

Answer 9

Smooth muscle cell tumour of the uterus

Question 10

What is a fibroid?

Answer 10

Leiomyoma

Question 11

How are fibroids classified?

Answer 11

As either intramural, submucosal or subserosal

Question 12

What is the biggest risk factor for endometrial hyperplasia?

Answer 12

Persistent oestrogen

Question 13

What is the difference between type 1 and 2 endometrial carcinomas?

Answer 13

Type 1: adenocarcinomas, mucinous, secretory
Type 2: Serous/ clear cell carcinoma

Question 14

What is the relative prevelance of type 1 vs type 2 endometrial carcinoma?

Answer 14

Type 1 = 80-85%
Type 2 = 10-15%

Question 15

Recall the genetic associations of serous and clear cell endometrial carcinomas

Answer 15

Serous: p53 mutation
Clear cell: PTEN mutation

Question 16

Which type of endometrial carcinoma is high grade and which is low grade?

Answer 16

Type 1 = low grade
Type 2 = high grade

Question 17

Which type of endometrial carcinoma is most likely to arise in atrophic endometrium?

Answer 17

Type 2

Question 18

Recall the FIGO stages of endometrial cancer

Answer 18

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

Question 19

Recall the different types of gestational trophoblastic disease

Answer 19

Partial/ complete mole
Invasive mole
Choriocarcinoma

Question 20

How does gestational trophoblastic disease usually present?

Answer 20

As spontaneous abortion

Question 21

What is the cause of gestational trophoblastic disease?

Answer 21

Fertilisation of one egg by 2 sperm

Question 22

Describe the prognosis of choriocarcinoma

Answer 22

Very aggressive but also very responsive to treatment

Question 23

What is endometriosis?

Answer 23

Presence of endometrial glands and stroma outside of the uterus - bleeding of ectopic material is painful

Question 24

What is adenomyosis?

Answer 24

Ectopic endometrial tissue within the myometrium

Question 25

What is the main symptom of adenomyosis?

Answer 25

Dysmennorhoea

Question 26

What type of tumour are 70% of ovarian neoplasms? outline their key findings

Answer 26

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

Question 27

Describe the 2 different types of ovarian carcinoma

Answer 27

``` Type 1 (low grade, has precursors) Type 2 (high grade, associated with p53 mutations) ```

Question 28

What type of epithelium are most ovarian carcinomas derived from?

Answer 28

Serous

Question 29

Which types of ovarian carcinoma are associated with endometriosis?

Answer 29

Endometrioid and clear cell carcinoma

Question 30

Recall the 3 types of sex cord stromal tumours, outline their key aspects

Answer 30

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)

Question 31

In what age group of women are germ cell tumours seen?

Answer 31

\<20s

Question 32

what are the other 20% of ovarian tumours?

Answer 32

germ cell tumours (of which 95% are benign) dysgermioma = undifferentiated germ cells teratoma (mature = most common = benign, immature = malignant) choriocarcinoma - secrete hCG

Question 33

Recall 2 types of cancer that commonly metastasise to the ovary

Answer 33

Krukenburg tumours mets grom gastric adenocarcinoma Colon cancer

Question 34

2 macroscopic findings of endometriosis

Answer 34

red-blue to brown nodules - “powder burns” “chocolate cysts” in ovaries (endometriomas)

Question 35

what's the transformation zone

Answer 35

squamocolumnar junction

Question 36

malignant version of a fibroid =

Answer 36

leiomyosarcoma

Question 37

which subtype of endometrial carcinoma are oestrogen dependent & linked to endometrial hyperplasia

Answer 37

type 1 -85% endometrioid, mucinous and secretory adenocarcinoma -younger patients, usually lower grade,

Question 38

which subtype of endometrial carcinoma are not oestrogen dependent

Answer 38

type 2-15% serous and clear cell tumours - older patients, higher grade

Question 39

differentiate between complete mole and partial mole

Answer 39

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)

Question 40

what's an important secondary ovarian tumour

Answer 40

Krukenberg Tumour: Bilateral metastases from gastric or breast cancer composed of mucin-producing signet ring cells

Question 41

outline the FIGO staging for ovarian cancer

Answer 41

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%)

Question 42

what type of cervical carcinoma is most common

Answer 42

squamous cell carcinoma (70-80%)

Question 43

outline the FIGO staging of cervical cancer

Answer 43

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

Question 44

what marks the change from CIN to cervical carcinoma

Answer 44

Invasion through the basement membrane

Question 45

which gynae cancer accounts for most deaths in UK

Answer 45

ovarian carcinoma