Histopathology - Gynaecological Pathology Flashcards
Peritoneum
Pelvic mesothelium
Fallopian tube
Ciliated serous epithelium
Endometrium
Endometrioid epithelium – glycogen secreting
Endocervix
Mucin secreting endocervical epithelium
Ectocervix
Squamous epithelium
Endometrium:
- Normal tissue
- Hyperplastic tissue: under hormonal stimulated more glands per unit area (more cells not bigger).
- Neoplasia – autonomous – cells mutated therefore don’t respond to removal of stimulation.
Endometrial Hyperplasia
- Disease of perimenopausal women
- Reflection of anovulatory cycles
- May result in menorrhagia
- Ultra scan > thickened endometrium
Endometrial hyperplasia types
- Simple cystic hyperplasia
- Complex hyperplasia
- Atypical hyperplasia
Endometrial hyperplasia Risks/Causes
- Obesity - more oestrogen
- Anovulatory cycles
- Prolonged exposure to oestrogen
- Polycystic ovary disease
- Functioning (steroid secreting) ovarian or adrenal tumours
Atyical Hyperplasia
AKA Endometrial Intraepithelial Neoplasia (EIN)
Atypical Hyperplasia presence of
Cytological abnormality (deregulation of cell division machinery)
Atypical Hyperplasia risk of
Progression of Adenocarcinoma = 25-40% (40-50 yrs)
Treatment
Hysterectomy (older) Progesterone therapy (young)
Endometrial Carcinoma epi
Most common malignant tumour of female genital tract in the develop world
Endometrial cancer risk of
Unopposed oestrogen treatment
Polycystic ovarian syndrome
Obesity
Endometrial Carcinoma: Genetic factors
HNPCC (Lynch Syndrome) risk 20-30%
→ Endometrial pre colorectal cancer
Endometrial Carcinoma: Presentation
Postmenopausal bleeding
Endometrial Carcinoma: Tumour structure
Low grade and low stage – good prognosis
Endometrial Carcinoma: Commonest morphology is
Endometrioid – loks like parent tissue
Endometrial Carcinoma:Grading on
Gland formation and nuclear atypia
Endometrial Carcinoma:Prognosis depends on
Grade and stage
Endometrial Carcinoma:Spread
Lymphatic, direct or transtubal to peritoneum (seed into peritoneum via fallopian).
Endometrial Carcinoma: Two types of endometrial carcinoma
Type 1: Oestrogen driven
Type 2: Developing de novo
Endometrial Carcinoma: Oestrogen driven
Endometrioid pattern
Lesions grade according to their amount of gland formation
Endometrial Carcinoma: Developing de novo
High grade serous papillary
Clear cell carcinoma
Cervix: UK epi
11th most common cancer in women
Cervical screening programme
- Accessible site for exfoliative cytology
- Pre-invasive state
- Slow progression of disease
- Stepwise progression of disease
- Eradication of early cancer feasible
Structure of cervix composed of 2 parts
- Ectocervix
* Endocervix
Ectocervix
• Squamous epithelium (stratified) w/ glycogen with lactobacilli which help maintain acidic environment to prevent infection
Endocervix
• Columnar cells: Mucin secreting glandular epithelium
Transformation zone
• Zone between original and functional squamo-columnar junction
→Metaplasia (associated with the stress from acidic ectocervix) is occurring allowing for one epithelium to change into another. The junction position varies through life according to hormonall stage e.g. menarche and menopaus
Cervical carcinoma: Risk factors
Early age at first intercourse – pick up infection early = HPV Multiple partners Smoking – immunomodulatory Genital infections Partner with multiple partners
Cervical carcinoma: HPV and squamous neoplasia:
- Normal epithelium and Negative
- Low grade dysplasia and koilocytosis. Low and high risk HPV. Viral replication with or without integration.
- Invasive Carcinoma, High risk HPV, Viral integration and secondary chromosomal abnormalities.
- High grade dysplasia. High risk HPV. Viral integration
Cervical carcinoma: Neoplasia of the cervix
Cervical intraepithelial neoplasia (CIN): turns into invasive squamous cell carcinoma
Cervical glandular intraepithelial neoplasia (CGIN): turns into adenocarcinoma
Carcinoma:
• Can presents with post coital bleeding
• Prevention is better than cure
• Prognosis is stage dependent
Ovarian Neoplasia: Classification (related to anatomical compartments)
- Surface epithelial stromal tumour
- Sex cord stromal tumours
- Germ cell tumour
- Metastatic tumours
Ovarian Neoplasia: Epi
Accounts for 30% of female genital tract cancers
Ovarian Neoplasia: Aetiology
High parity and use of oral contraceptives are associated with reduced risk
7% of women with ovarian cancer have one or more relatives with disease
Ovarian Neoplasia: Genetic factors
BRCA 1 and BRCA 2 – breast and ovarian
HNPCC
Surface Epithelial Tumours: Epithelial subtypes
Serous, endometroid, mucinous and transitional
Surface Epithelial Tumours: Biological behaviour is dictated by nature of epithelium
- Benign – ciliated, mucinous or columnar epithelium
- Borderline – papillary proliferation without invasion
- Malignant (adenocarcinoma) – invasive malignant epithelium – poor prognosis
Adenocarcinoma: Epi
- Commonest subtype is serous followed by endometrioid
* Primary mucinous carcinoma of the ovary are rare
Adenocarcinoma: Clinical presentation
Often advanced disease and ascites (reduced albumin therefore osmotic draw)
Adenocarcinoma: Prognosis is
Stage dependent
Germ cell tumours: histo and epi
Histogenesis for primordial germ cells
Hetergenous group of tumours
Accoutn for 30% of ovarian tumours
95% are mature cystic teratoma/dermoid cyst
Sex cord Stromal Tumours: Epi
Account 8% of all ovarian neoplasms
Sex cord Stromal Tumours: Cell of origin
Include granulose cells, theca cells, sertoli cells, Leydig cells and fibroblast of stromal origin.
Sex cord Stromal Tumours: Can produce
Estrogen
Metastatic Tumours: Epi
Account for 5-10% of ovarian neoplasms
Metastatic Tumours: Primary sites include
Stomach Colon Appendix Breast Pancreas →Spread as ovary has good blood supply
Metastatic Tumours: Krukenberg
Metastatic tumour with signet ring forms
