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Pathology (Guide) > Histopathology - Gynaecological Pathology > Flashcards

Histopathology - Gynaecological Pathology Flashcards

1
Q

What is pelvic inflammatory disease?

A

An ascending infection from the vagina + cervix up to the uterus + fallopian tubes, leading to inflammation + the formation of adhesions

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2
Q

Which bacteria cause PID from ascension up the genital tract?

A
  • Neisseria gonorrhoea
  • Chlamydia trachomatis
  • Enteric bacteria
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3
Q

Which bacteria cause PID secondary to abortion/termination of pregnancy?

A
  • S. aureus
  • Streptococcus
  • C. perfringens
  • Coliforms
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4
Q

What are the two most common causative organisms of PID in the UK?

A
  • C. trachomatis
  • N. gonorrhoea
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5
Q

What are the two most common causative organisms of PID in the world?

A
  • TB
  • Schistosomiasis
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6
Q

How does PID clinically present?

A
  • Bilateral lower abdominal pain
  • Deep dyspareunia
  • Vaginal bleeding/discharge
  • Fever
  • Adnexal tenderness
  • Cervical excitation
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7
Q

What are the complications of PID?

A
  • Fitz-Hugh-Curtis Syndrome (10%)
  • Infertility
  • Increased risk of ectopic pregnancy
  • Bacteraemia (leading to sepsis)
  • Tubo-ovarian abscess
  • Chronic PID
  • Peritonitis
  • Pilcal fusion
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8
Q

What are the signs + symptoms of Fitz-Hugh-Curtis Syndrome?

A
  • RUQ pain from peri-hepatitis
  • “VIOLIN STRING” peri-hepatic adhesions
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9
Q

What is pilcal fusion?

A

When fimbrial ends of fallopian tubes adhere together

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10
Q

What is endometriosis?

A

The presence of endometrial glands or stroma in abnormal locations outside the uterus

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11
Q

What are the three aetiological theories of endometriosis?

A
  1. Retrograde menstruation flow
  2. Metaplastic transformation of coelomic epithelial cells
  3. Vascular/lymphatic dissemination of endometrial cells
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12
Q

How does endometriosis present clinically?

A
  • Cyclical pelvic pain
  • Dysmenorrhoea
  • Deep dyspareunia
  • Decreased fertility
  • Cyclical PR bleeding
  • Haematuria
  • Bleeding from umbilicus
  • Nodules/tenderness in vagina, posterior fornix or uterus
  • Immobile + retroverted uterus in advance disease
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13
Q

What are the macroscopic features of endometriosis?

A
  • Red-blue to brown vesicles (POWDER BURNS)
  • Endometriomas (blood-filled CHOCOLATE CYSTS on ovaries)
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14
Q

What are the microscopic features of endometriosis?

A
  • Endometrial glands + stroma
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15
Q

What is adenomysosis?

A

The presence of ectopic endometrial tissue deep within the myometrium

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16
Q

How does adenomysosis present clinically?

A
  • Heavy menstrual bleeding
  • Dysmenorrhoea
  • Deep dyspareunia
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17
Q

What are some buzzwords associated with adenomysosis?

A
  • Bulky uterus
  • Subendothelial linear striations
  • Globular uterus
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18
Q

What is a leiomyoma (fibroid)?

A

A benign tumour of the smooth muscle origin
- Most common tumour of femal genital tract (20% occurrence in >35y.o.)

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19
Q

What are the three types of leiomyomas?

A
  • Submucosal
  • Intramural
  • Subserosal
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20
Q

Why is oestrogen stimulation important for leiomyomas?

A
  • Enlarge during pregnancy
  • Regress post-menopause
  • Oestrogen-dependent growth
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21
Q

What are the macroscopic features of a leiomyoma?

A
  • Sharply circumscribed
  • Discrete, firm, gray-white tumours
  • Size variable
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22
Q

What are the microscopic features of a leiomyoma?

A
  • Bundles of smooth muscle cells
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23
Q

What are the clinical features of a leiomyoma?

A
  • Heavy menstrual bleeding
  • Dysmenorrhoea
  • Pressure effects (urinary frequency, tenesmus)
  • Subfertility
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24
Q

What happens to leiomyomas during pregnancy?

A

Red degeneration of fibroids
- Haemorrhagic infarction leasd to severe abdominal pain

Post-partum torsion

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25
Q

What are the different types of endometrial carcinomas?

A

Sarah Eats Meet, Paul Can’t Stand (it):
- S: Secretory
- E: Endometrioid
- M: Mucinous
- P: Papillary
- C: Clear cell
- S: Serous

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26
Q

What are the most common types of endometrial carcinomas?

A
  • Adenocarcinomas (85%)
  • SCC (15%)
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27
Q

What is the occurrence of endometriod carcinomas?

A

80%

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28
Q

What are the types of endometrioid carcinomas?

A
  • Secretory
  • Endometroid
  • Mucinous
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29
Q

What is the pathophysiology of endometrioid carcinomas?

A
  • Related to oestrogen excess (oestrogen-dependent)
  • Usually in peri-menopausal women
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30
Q

What are some risk factors for endometrioid carcinomas?

A

E2 excess:
- Obesity
- Nulliparous women
- Early menarche
- Late menopause
- Tamoxifen
- Anovulatory amenorrhoea (e.g. PCOS)

DM

HTN

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31
Q

What are the types of non-endometrioid carcinomas?

A
  • Papillary
  • Clear Cell
  • Serous
32
Q

What mutations are present in clear cell non-endometrioid carcinomas?

A
  • PTEN
  • p53
  • HER-2
33
Q

What is the pathophysiology of non-endometrioid carcinoma?

A
  • Unrelated to oestrogen excess (oestrogen-independent)
  • Usually in elderly women with endometrial atrophy
34
Q

How is endometrial carcinoma staged?

A

FIGO
- Stage 1: Cancer only in uterus
- Stage 2: Spread to cervix
- Stage 3: Spread to pelvic area
- Stage 4: Metastasis to rectum/bladder/distal organs

35
Q

What is the normal vulval histology?

A

Squamous epithelium (95%)

36
Q

What is VIN?

A
  • Like CIN
  • Dysplasia of epithelium of vulval cells
37
Q

How is vulval cancer graded?

A

VIN I, II, III

38
Q

What is the usual type of vulval abnormalities?

A
  • A/W: HPV 16/18, smoking, immunosuppression
  • Warty, basaloid, mixed
  • Women 35-55yrs
39
Q

What si the differentiated type of vulval abnormalities?

A
  • A/W: Lichen sclerosis + more common progression to cancer
  • Keratinised squamous cells
  • Older women
40
Q

What are some symptoms of vulval carcinoma?

A
  • Visible, painless lesion
  • ?Ulcerated
  • Itching + irritation
  • Difficulty urinating
  • FLAWS
41
Q

What is vulval carcinoma?

A
  • Mainly SCC
  • Clear cell adenocarcinoma = teenagers + COCP, rare, A/W Diethyltilbestrol (5%)
  • Primary vaginal carcinoma = older women + lichen sclerosis, usually SCC (95%)
42
Q

What are the two types of ovarian cysts and which is mots common?

A
  • Follicular cyst (Most common)
  • Corpus luteal (common in early pregnancy)
43
Q

What are some features of follicular ovarian cysts?

A
  • Due to non-rupture of dominant follicle/failure of atresia in non-dominant follicle
  • Commonly regress after several menstrual cycles
44
Q

What are some features of corpus luteal ovarian cysts?

A
  • During menstrual cycle if fertilisation doesn’t occur the corpus luteum breaks down + disappears; if it doesn’t happen then it bceomes filled with blood/fluid + become cyst
  • May present with intraperitoneal bleeds
45
Q

What are some features of ovarian carcinoma?

A
  • Leading cause of death from gynaecological malignancy in UK
  • Ovary = collection of several different cell types each with neoplastic development opportunity (90% = epithelial ovarian cancers)
  • Peak incidence = 75-84yrs
46
Q

What are the three different cell types that ovarian cancer can arise from, and their prevalence?

A
  • Epithelial (70%)
  • Germ cell (20%)
  • Sex cord stromal (10%)
  • Metastatic
47
Q

What are the benign epithelial ovarian cancers?

A
  • Serous cystadenoma
  • Mucinous cystadenoma
48
Q

What are some characteristics and the histology of serous cystadenomas?

A
  • Most common benign epithelial tumour
  • Mimics tubal epithelium (e.g. columnar epithelium)
  • Affects women: 30-40yrs

Histo:
- COLUMNAR EPITHELIUM
- PSAMMOMA BODIES

49
Q

What are some characteristics and the histology of mucinous cystadenomas?

A
  • 2nd most common benign epithelial tumour
  • MUCIN SECRETING CELLS (similar to those of endocervical mucosa)
  • Affects younger-women
  • Most common oestrogen-secreting tumour
  • K-ras mutation in 75%
  • Appendix tumour can metastasis to abdomen, peritoneum + ovaries leading to pseudomyxoma peritonei (Cx = v. rare)

Histo:
- MUCIN SECRETING CELLS

50
Q

What are the two malignant types of epithelial ovarian carcinoma?

A
  • Endometrioid
  • Clear cell
51
Q

What are some characteristics and histological features of endometrioid ovarian carcinomas?

A
  • Mimics endometrium = forms tubular glands
  • Endometriosis = RF
  • CA-125 often raised

Hist:
- TUBULAR GLANDS

52
Q

What are some characteristics + histological features of clear cell ovarian carcinomas?

A
  • Strong association with endometriosis

Histo:
- CLEAR CELLS
- CLEAR CYTOPLASM
- HOBNAIL APPEARANCE

53
Q

What are the benign germ cell ovarian carcinomas called?

A
  • Dysgerminoma
  • Teratoma
54
Q

What are some features of a dysgerminoma ovarian carcinoma?

A
  • Usually benign in adults (95%), malignant in children
  • Female counterpart of testicular seminoma
  • Rare
  • Most common ovarian malignancy in young women
  • Sensitive to radiotherapy
55
Q

What are some features of teratoma ovarian carcinomas?

A
  • Most common ovarian tumour in younger women (15-21yrs)
  • Shows differentiation towards somatic structures
  • A/w: Ovarian torsion

Mature teratomas:
- DERMOID CYST
- Benign
- 95% of teratomas
- Usually cystic
- Differentation of germ cells into mature tissues
- Bilateral + asymptomatic

Immature Teratomas:
- Malignant
- Usually solid
- Contains immature, embryonal tissues
- Secretes AFP

56
Q

What is the malignant clear cell ovarian carcinoma and its features?

A

Choriocarcinoma
- Secretes bhCG

57
Q

What are the types of sex cord/stroma ovarian carcinomas?

A
  • Fibroma
  • Granulosa-theca cell tumour
  • Sertoli-Leydig
58
Q

What are some features of a fibroma ovarian carcinoma?

A
  • No hormone production
  • ~Menopause
  • 50% A/W: Meig’s Syndrome
  • From cells of ovarian stroma
59
Q

What is the triad of Meig’s syndrome?

A
  • Fibroma
  • Ascites
  • Right-sided pleural effusion
60
Q

What are some general + histological features of a granulosa-theca cell tumour?

A
  • Produce E2
  • Oestrogenic effects: irregular menstrual cycles, breast enlargement, endometrial/breast cancer

Histo:
- CALL-EXNER BODIES

61
Q

What are some features of Sertoli-Leydig cell tumour ovarian carcinomas?

A
  • SECRETE ANDROGENS
  • Look defeminisation: Breast atrophy
  • Look for virilisation: Hirsutism, deepended voice, enlarged clitoris
62
Q

What is a metastatic ovarian carcinoma?

A
  • Krukenberg tumour
63
Q

What are some general + histological features of a Krukenberg tumour?

A
  • Bilateral mets
  • Malignancy of ovary that has metastasised from gastric/colonic cancer (Most common = gastric adenocarcinoma at pylorus)

Histo:
- MUCIN PRODUCING SIGNET RING CELLS

64
Q

What is the staging criteria used for ovarian cancer?

A

FIGO Staging:
- Stage I = ONLY in ovaries
- Stage II: Spread to pelvis
- Stage III: Spread to abdomen (inc. regional LN mets)
- Stage IV: Metastasis outside abdominal cavity

65
Q

What is normal cervical histology?

A
  • Outer ectocervix = continous with vagina, covered by squamous epithelium
  • Endocervical canal lined by columnar glandular epithelium
  • Squamocolumnar junction separates ecto + endo cervix
66
Q

What is the transformation zone?

A
  • The area where columnar epithelium transforms into squamous cells (squamous metaplasia)
  • Normal physiological process
  • Area susceptible to malignant change due to high rates of cell turnover
67
Q

What is CIN?

A
  • Dysplasia at the TZ as a result of infection by HPV 16 + 18 (HPV 6 + 11 = lower risk)
68
Q

How is CIN graded?

A
  • Mild, moderate or severe dyskaryosis on cytology
  • CIN1-3 on histology (from biopsy)
  • CIN I = dysplasia confined to deepest 1/3 of epithelium
  • CIN II = lower 2/3
  • CIN III = Full thickness, BM intact
69
Q

What are some RFs for CIN?

A
  • Early age at first intercourse
  • Multiple partners
  • Multiparity
  • Smoking
  • HIV or immunosuppression
70
Q

What is cGIN?

A
  • Cervical galndular intraepithelial neoplasia
  • Less common + more difficult to diagnose on cytology
  • Tx = excision of entire endocervix which can compromise fertility
71
Q

What are some features of cervical carcinoma?

A
  • 2nd most common cancer in women worldwide
  • Peak incidences: 30-39yrs + >70yrs
  • 80% = adenocarcinomas
  • 20% = SCC
  • Arises from CIN (invasion through basement membrane marks change from CIN III to carcinoma)
72
Q

What are somr RFs to cervical carcinoma?

A

Early exposure to HPV
- Early first sexual experience
- Multiple partners
- Non-barrier contraception

COCP
High parity
Smoking
Immunosuppression

73
Q

What are the two HPV vaccines and their differences?

A
  • Cervavix: bivalent = HPV 16 + 18
  • Gardasil: quadrivalent = HPV 6, 11, 16 + 18
74
Q

What are the two biological states of HPV infection?

A
  1. Non-productive/latent
  2. Productive: causes cytological + histological changes
75
Q

What is the pathophysiology of HPV causing cervical carcinoma?

A
  • HPV virus encodes E6 + E7 proteins (inactivate 2 TSGd)
  • E6 inactivates p53 = proliferation
  • E7 inactivates retinoblastoma (Rb) gene = proliferation
76
Q

How does cervical carcinoma present clinically?

A
  • Post-coital bleeding
  • Intermenstrual bleeding
  • Postmenopausal bleeding
  • Discharge
  • Pain
77
Q

How is cervical carcinoma staged?

A

FIGO:
- Stage 0 = CIN
- Stage I = only cervix
- Stage II = Spread into upper 1/3 vagina
- Stage III = spread into pelvic side wall +/or lower 1/3 vagina
- Stage IV: metastasis beyond pelvis to bladder/bowel

Pathology (Guide) (84 decks)

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