L30 - PATHOLOGY OF THE FEMALE GENITAL TRACT Flashcards
List 2 causes inflammation of vulva, vagina?
UTI e.g. Candida albicans
STD infection
List 2 non-neoplastic epithelial disorders of vulva and mucosa?
Lichen Sclerosis
Squamous hyperplasia
List 3 major types of neoplasm of the Vulva and vagina? ***
Adenocarcinoma
Invasive squamous cell carcinoma (SCC)
Vulvar and Vaginal Squamous Intraepithelial Lesion (SIL)
List 2 diseases of cervix caused by low-risk HPV?
Condyloma accuminata (anogenital warts)
Condyloma planum (flat)
List 4 Risk factors of cervical carcinoma?**
- HPV infection: High risk ***
- Early marriage and pregnancy
- Sexual promiscuity and STD
- Smoking
1 test for HPV status of cervical cancers?**
HPV molecular testing
Genotype + detection of HPV
Define the 2 types of Vulvar intra-epithelial neoplasia (VIN) or Vulvar Squamous Intraepithelial Lesion (SIL)?
Classic type: asso. with HPV infection
Differentiated type: asso. with chronic irritation such as lichen sclerosis or squamous hyperplasia, NO HPV INFECTION
3 causes of Invasive squamous cell carcinoma at vulva, vagina and cervix?
1) High-risk HPV infection»_space; Classic VIN/HSIL»_space; Basaloid or warty SCC
2) Differentiated VIN/SIL»_space; Keratinizing SCC
3) Second malignancy: cervical origin (LSIL/ invasive)
High risk, Low risk HPV genotypes?
High risk oncogenic: cause HSIL or CA: genotype 16,18…
Low risk non-ongenic: cause Anogenital warts or LSIL: genotype 6,11
What type of cervical cancer do most HSIL progress to ?
Carcinoma»_space; SCC of cervix
Prevention of cervical cancer? (2)
Avoid risk factors
HPV Bivalent, Tetravalent, Nonavalent vaccines
How to tell HSIL from invasive cervical cancer?
HSIL = No stromal invasion and dissemination
List 4 reasons for the success of cervical cancer screening? exam
- Cervix easily accessible to cytological screening
- Long period of progression from precursor lesion to invasive cancer
- Cost-effective cytology test
- Effective early treatment
List 2 main forms of Adenocarcinoma of Vulva and Vagina?
Extramammary Paget’s disease
Primary Adenocarcinoma (asso. w/ DES exposure + Vaginal adenosis)
2 detection technique for cervix carcinoma?
- Exfoliative cytology “Pap smear”: scraping the squamo-columnar junction
- Colposcopy and biopsy: identify cervical neoplasia
Endocervical polyp: presentation?
Single polyp
Usually asymptomatic/ vaginal bleeding or discharge
Histological features of SIL in the Cervix? Location?
@ Transformation zone of Cervix
Malignant features:
increase in N:C ratio, nuclear pleomorphism, increased and abnormal mitotic figures
List 4 common diseases of Cervix? (3 = major types of cervical neoplasia)
Endocervical polyp
Squamous Intra-epithelial Lesion (SIL)
Invasive SCC
Adenocarcinoma
Gross feature, 2 spread + 2 complication of Invasive SCC in cervix?
Ulcerative, indurated
Local invasion of pelvic structures + LN spread
Ureter obstruction + Renal failure
Cervical Adenocarcinoma Location in cervix? Ddx from SIL, SCC?
endocervical epithelium = Adenocarcinoma
Ddx: Transformation zone = SIL, SCC
3 Causes of Endometrial hyperplasia? progression to which cancer?
Hyper-estrogen stimulation:
1) Functioning ovarian tumours
2) Repeated anovulatory cycles
3) Prolonged exogenous estrogen use (e.g. Tamoxifen)
Atypical hyperplasia»_space; Endometrial ADENOCARCINOMA
5 Risk factors not causes of endometrial hyperplasia and endometrial carcinoma?
obesity, diabetes, hypertension, infertility
Genetic: Hereditary nonpolyposis colorectal cancer (HNPCC)
Compare the 2 major types of endometrium carcinoma?
Type I: endometrioid, hyper-estrogen stimulation, indolent
Type II: serous, clear cell, not high oestrogen, aggressive with poor prognosis
Spread of endometrium carcinoma?
Local: myometrium, parametrium, fallopian tubes, ovaries, vagina and pelvis
Para-aortic LN involvement
List 2 examples of endometrial stroma tumours?
Stromal Sarcoma
Mixed mullerian tumours
Cell origin of Gestational Trophoblastic Diseases? List some examples of GTDs?
origin = placental trophoblasts
hydatidiform mole, invasive mole, choriocarcinoma, PSTT, ETT
List 3 major neoplasms arising from Myometrium of uterus? **
-Adenomyosis
Smooth muscle tumours:
- Leiomyoma common
- Leiomyosarcoma
Gross morphology of Myometrium Adenomyosis?
Presentation?
nests of endometrial glands and stroma
Enlarged uterus with whorled surface + cystic space with blood
menorrhagia or dysmenorrhoea
Myometrium Leiomyoma: number, sites and extent of involvement, gross morphology?
multiple, @ smooth muscle
white, whorled, Well-circumscribed spherical nodules
Compare the gross morphology of Leiomyosarcoma with Leiomyoma of Myometrium?
Leiomyosarcoma = less well-demarcated with more necrosis and hemorrhage + malignant cell features
Cause and Complications of Fallopian tube inflammation?
Infection-caused inflammation: Acute, Chronic, Granulomatous
Impair fertility
Ectopic pregnancy
List the spectrum of diseases at the Fallopian tube? (4) **
Inflammation (Infective)
Ectopic pregnancy (rupture = emergency)
Endometriosis
Tumours
Most common primary fallopian tube tumour?
Papillary adenocarcinoma
Most common cause of ovarian enlargement? Presentation?
Non-neoplastic cysts:
e.g. follicular cysts, corpus luteum cysts
Asymptomatic/ Torsion, Hemoperitoneum, Pain, Infarct
Divide Ovarian neoplasms into 5 types?
- Surface Epithelial Tumours
- Germ Cell Tumours
- Sex Cord Stromal Tumours
- Metastatic tumours
- Miscellaneous - e.g. Lymphoma
Genetic risk factors of ovarian surface epithelial tumours?
Presentation?
- Breast and Ovarian Cancer syndrome
- HNPCC
Pelvic mass, Malignant ascites, Metastatic symptoms
List 5 surface epithelial tumours of ovary?
Serous tumour Mucinous t Endometrioid t Brenner t Clear cell t
List 5 types of germ cell tumours of the ovaries?
- Dysgeminoma (=seminoma)
- Embryonal carcinoma
- Teratoma
- Yolk sac tumour
- Choriocarcinoma
Epidemiology of ovarian germ cell tumours?
Children = >60% of all ovarian neoplasms, 1/3 malignant
Adult = rare, mature cystic teratoma, all benign
How to tell borderline ovarian surface epithelial tumour from benign/ malignant?
Borderline = low malignant potential
Different from the benign tumour:
- presence of epithelial budding
- increased mitotic activity
- nuclear atypia
Different from malignant:
- no destructive stromal invasion
List 3 major sex cord stromal tumours?
a) Granulosa cell tumour
b) Thecoma -Fibroma
c) Sertoli -Leydig cell tumour
3 subtypes of teratoma of ovaries?
(i) Mature Cystic teratoma
(ii) Immature teratoma
(iii) Teratoma with malignant transformation eg. SCC
List 2 germ cell tumours of ovaries that occurs in young women?
Dysgerminoma
Yolk Sac Tumour
Which malignant cancers commonly metastasize to ovaries?
carcinoma of breast, lower genital tract and gastrointestinal tract
