L20, 21. Female Genital tract pathology + clinical case studies

Question 1

What is the difference between cytology and histology

Answer 1

Cytology is study of cells on a slide whereas histology is study of tissues on a slide- different prep techniques

Question 2

What is the cell of origin for a Carcinoma, lymphoma, melanoma and sarcoma

Answer 2

Carcinoma: epithelial
Lymphoma: lymph node
Melanoma: melanocyte
Sarcoma: mesenchyme

Question 3

What’s the difference between metaplasia and dysplasia- eg, danger

Answer 3

Metaplasia: change in cells to a form that does not normally occur in the tissue in which is found - generally Benign
Dysplasia: abnormal development of cells indicative of early neoplastic process. Typically used when the cellular abnormality is restricted to the originating tissue as in early in-situ neoplasm

Question 4

What are the common pathologies of the ovary: non neoplastic, pre malignant, benign tumours and malignant tumours

Answer 4

NN: polycystic ovary syndrome, functional ovarian cysts
PM: N/A
BT: epithelial, germ cell and stromal tumours
MT: 1, ovarian carcinoma- serous or mucinous and 2, metastatic carcinoma-

Question 5

What are the common pathologies of the Fallopian tubes: non neoplastic, pre malignant, benign tumours and malignant tumours

Answer 5

NN: salphingitis, ectopic pregnancy
BT: Adenomatoid tumour
PM: Tubal intraepithelial carcinoma- dysplasic but not through BM
MT: 1 carcinoma and 2nday metastatic carcinoma

Question 6

What are the phases of the menstrual cycle and which hormones dominate in the uterus

Answer 6

Follicular phase: (proliferative) estradiol high leading to increased thickening of the endometrium until ovulation- prog low
Luteal phase: (secretory) Progesterone high - est low, with increased plumping of endometrium until menstruation.

Question 7

What are the common pathologies of the Endometrium: non neoplastic, pre malignant, benign tumours and malignant tumours

Answer 7

NN: Endometriosis, Endometritis
PM: Hyperplasia
BT: endometrial polyp
MT: endometrial adenocarcinoma, stromal sarcoma

Question 8

What are the common pathologies of the Myometrium: non neoplastic, pre malignant, benign tumours and malignant tumours

Answer 8

NN: Adenomyosis: endometrial tissue growing into the myometrium
PM; N/a
BT: leiomyoma (SM tumour)
MT: leimyosarcoma

Question 9

What are the 3 regions of the cervix and the place for cervical smears

Answer 9

Squamous epithelium lining the outside of the endocervical canal which has glandular epithelium inside.
The cervical smear is done in the transitional region between the two epithelium.

Question 10

What are the common pathologies of the Cervix: non neoplastic, pre malignant, benign tumours and malignant tumours

Answer 10

NN: Cervicitis, Candida
BT: Endocervical polyp
PM: Squamous intraepithelial lesion, Adenoma carinoma in situ - glandular part
MT: Squamous cell carcinoma, adenocarcinoma

Question 11

What is a precancer of the cervix aka and grading

Answer 11

AKA; Squamous intraepithelial lesion, Cervical intraepithelial neoplasia, dysplasia,
- these are cancerous cells in epithelium not beyond BM w no BV. Able to be removed and cured.

Grades are CN1: low 1/3 of basal layer
CN2 and CN3/carcinoma in situ: high- need to treat: 2/3-full thickness. After this is invasive

Question 12

What are the risk factors for HPV

Answer 12

• HPV16 or 18 persistent infection
• Genetic predisposition
• Sexual behaviour- age and number of partners
• Immunosuppression- smoking
• Presence of other STI
• Long term oral contraceptive use

Question 13

How is a tissue prepared for histological assessment

Answer 13

1. Macroscopic description done first
2. Paraffin embedded tissue
3. Mounted on glass slide and stained with Haematoxylin and eosin stain.
4. Light microscopy to see architecture and cytology

Question 14

What is a teratoma (dermoid cyst)

Answer 14

Cystic mass made of variety of mature tissues derived from ectoderm, mesoderm and endoderm from post meitotic germ cells. It is usually benign;occasionally malignant - from any mature tissue or immature post meiotic cells. Can affect all ages.

Question 15

What are the ways that Ovarian epithelial tumours - (most common) are classified

Answer 15

1. Mucinous epithelium vs Serous (tubal type) pseudostratified cilliated epithelium
2. Benign, Borderline (non invasive) or Malignant

Question 16

What are the features of a mucinous cystadenoma

Answer 16

Benign cystic tumour lined with mucinous epithelium. It can affect a wide age range and presents as abdo pain or mass lesion, can be very large and is usually unilateral

Question 17

What are the causes of infection which can lead to abnormal bleeding, vaginal discharge, acute unwellness with fever, abscesses, cysts, pain, or no symptoms?

Answer 17

1. Ascending bacterial infection: neisseria and chlamydia
2. TB (haematogenous spread
3. Parasites - eg. pinworm, schistoomiasis.

Question 18

What is salphingitis and consequences

Answer 18

Inflammation of the mucosa of the FT results in distorted architecture, where the microvilli join each other and ovum/blastocyte no longer able to travel down FT lumen

• Infertility
• Ectopic pregnancy- results in rupture of FT and infertility

Question 19

How do tumours of the myometrium present - urinary frequency, menorrhagia, dysmenorrhoea, large uterus

Answer 19

Leiomyoma or fibroid: Benign SM circular tumour which are common which start to regress following menopause.

Leiomyosarcoma: Malignant version. Lot of haemorrhage, necrosis, some invasion

Question 20

What is “chocolate cyst”

Answer 20

Haemorrhagic cyst of endometriosis. It is benign and smooth, filled with blood.

Question 21

Where does endometriosis occur and why is it a problem despite being ‘benign’

Answer 21

Most commonly ovaries but also rest of gynae tract, bowel, peritoneum, urinary tract, lungs, pleura, bone, upper GI tract.
It is a problem because it responds to hormones during menstrual cycle and bleeds into adjacent tissues causing pain, cysts, inflam, infertility.
It can also get malignant

Question 22

What is Endometrial carcinoma and what causes it

histology from pipelle or curettage biopsy of the uterus lining

Answer 22

It is caused from excessive oestrogen exposure which overcomes progesterone stimulation over a lifetime from obesity, HRT, Tamoxifen, Polycystic ovarian syndrome, Hormone secreting tumour, Early menarche, late menopause, nulliparity.

Overstimulation causes glands to proliferate, outstrip blood supply and breaks down as irregular bleeding, allows mutation and develop into neoplasia.
Early stages can be treated by progesterone.

Question 23

What is the difference in cytological appearance between low grade and high grade dysplasia
- high grade gets a letz cone biopsy,

Answer 23

CIN 1 low grade dysplasia has some normal squamous cells with cells with larger nuclei than normal
High grade dysplasia: most of the cells have nuclei that take up the whole cytoplasm