Lecture 20: Female tract pathology Flashcards
Describe the relation of cell or origin and tumour type:
Epithelial = Carcinoma Lymphoid = Lymphoma Melanocytic = Melaoma Mesenchymal = Sarcoma
(Some others)
Whats the difference between neoplastic and non-neoplastic?
Non-neoplastic are masses formed from infections, inflammation, deposits, hamaratomas…
Neoplastic (are cancerous) -> Benign vs malignant
Describe the different types of epithelium and the cancers they form:
Simple epithelium -> Carcinoma
Glandular epitheium -> Adenocarcinoma
Squamous epithelium -> Squamous cell carcinoma
Urothelium -> Urothelial carcinoma
What are the types of mesenchymal cancers?
Adipose -> Liposarcoma
Bone -> Osteosarcoma
Cartilage -> Chrondrosarcoma
What is metaplasia?
A change of cells to a form that does not nromally occur in the tissue in which it is found
What is dysplasia?
- An abnormal development of cells
- Dysplasia is often indicative of an early neoplastic process. The term dysplasia is typically used when the cellular abnormality is restricted to the originating tissue, as in the case of an early in situ neoplasm.
Give a brief overview of the ovary:
- 400k primordial follicles at birth
- Dormant till puberty
- Post puberty 20 follicles start maturing each month under FSH and LH influence
- One follicle reaches maturity and is released
- By menopause few follicles remain
What are the tumours of the ovary?
- Metastatic spread to ovary
- Germ cell tumours i.e teratoma
- Sex cord stromal tumours i.e fibroma
- The majority arise from the surface or the fimbrial end of the follopian tube
What are some non-neoplastic growths of the ovary and are there any pre-malignant ones?
Non-neoplastic
- PCOS
- Functional ovarian cysts i.e Follicular cysts, Corpus luteum cysts
Not many pre-malignant tumours
What are some benign tumours of the ovary?
Epithelum
- Mucinous cystadenoma
- Serous cystadenoma
Germ cell
- Dermoid (teratoma)
Strom tumours
- Fibroma
What are malignant tumours of the ovary?
Primary
- Ovarian carcinoma
Secondary
- Metastatic carcinoma
What are the follopian tubes?
- 9-11cm long
- Free (fimbrial) end composed of finger like projections adjacent to, but not attached to ovary
- FT opens into peritoneal cavity
What are the non-neoplastic and pre-malignant cancers of the follopian tubes?
Non-neoplastic:
- Salpingitis
- Ectopic pregnancy
Pre-malignant
- Tubal intra-epithelial carcinoma (Aka carcinoma in situ)
What are the benign and malignant tumours of the follopian tubes?
Benign
- Adenomatoid tumours
Malignant tumours
Primary - Carcinoma
Secondary - Metastatic carcinoma
Where do majority of fallopian tube tumours occur?
- Most arise from the distal fallopian tube or fimbrial end
- The majority arise from the epithelial lining of the fallopian tube
- Are often advanced by the time they are diagnosed
What is the uterus composed of?
Fundus
Body
Cervix
Myometrium lined with endometrium
What is the structure and function of the endometrium?
- Contains hormone receptors for oestrogen and progesterone
- Develops and sheds under the influence of oestrogen and progesterone
- Following menopause endometrium becomes inactive
Whats important when considering endometrial pathology?
Relate it to the phases of mensturation
What are the non-neoplastic and pre-malignant cancers of the endometrium?
Non-neoplastic
- Endometritis
- Endometriosis
Pre-malignant
- Hyperplasia
What are the benign and malignant tumours of the endometrium?
Benign
- Endometrial polyp
Malignant tumours
- Endometrial adenocarcinoma
- Stromal sarcoma
What are the non-neoplastic, premalignant, benign tumours and malignant tumours of the myometrium?
Non-neoplastic - Adenomyosis Pre-malignant - N/A Benign tumour - Leiomyoma (Fibroid) Malignant tumours - Leiomyosarcoma
What is the cervix?
- Neck
- Lower narrow portion of the uterus
- Protrudes through into the upper vagina
Whats collected in a smear?
Endo + Ectocervix collected
What are the non-neoplastic and pre-malignant cancers of the cervix?
Non-neoplastic
- Cervicitis
- Candida
Pre-malignant
- Squamous intraepithelial lesion
- Adenocarcinoma in situ
What are the benign and malignant tumours of the cervix?
Benign tumours
- Endocervical polyp
Malignant tumours
- Squamous cell carcinoma
- Adenocarcinoma
What is pre-cancerous squamous intra-epithelial lesion also known as and what can it be divided into?
Cervical intraepithelial neoplasia = dysplasia = squamous intraepithelial lesion
Can be divided into:
- Low grade squamous intraepithelial lesion (CIN1)
- High grade squamous intraepithelial lesion (CIN2 and 3)
What happens when the cervix contains pre-cancerous CIN cells?
- Pre cancer = neoplastic (Cancerous cells) are confined to the epithelium
- Not beyond basement membrane
- No blood vessels in epithelium so cannot metastasize
- Surgically removing the pre-cancer usually cures the patient
What does the grade of pre-cancer CIN in the cervix depend on?
- Severity and extent of atypia
- Precancerous cells can undergo further mutations that allow invasion through the basement membrane into the stroma and these neoplastic cells can no invade lymphatics or blood vessels and spread / metastasise
What are congenital abnormalities of the female reproductive tract?
- Intersex abnormalities
- Malformation of the uterus
- Abnormalities of development of the ovaries i.e absence
What is HPV and what is it associated with?
- HPV = STI
- Different HPV types are divided into low and high risk depending on their oncogenic potential
- High risk are associated with cervical sq. cell carcinoma
- HPV often transient and self limiting, but can persist and progress into high grade lesions and cancer
What else contributes to HPV related cancer?
- Additional factors such as viral loads, HPV variants, multiple HPV infections, genetic predisposition
What risks contribute to someones likelihood of developing HPV related cancer?
- Sexual behaviour
- Smoking
- Long term oral contraceptive use
- Immunosuppression
- Presence of other STI
