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Reproduction Week 2 > Lecture 20: Gynecologic Pathology 2 > Flashcards

Lecture 20: Gynecologic Pathology 2 Flashcards

1
Q

What are the key characteristics of endometrial hyperplasia?

A

Non-physiologic and non-invasive proliferation of endometrium
CAUSED BY TOO MUCH ESTROGEN…anything with too much estrogens are at risk
Clinical presentation: abnormal bleeding
Perimenopausal years
Protective factors = progesterone

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2
Q

What are the histological features of endometrial hyperplasia?

A 
Increased gland to stroma ratio…MORE GLANDS
-irregularities in gland shape and size
-mitotic activity
Two types of classification
1. Hyperplasia WITHOUT atypia
-simple
-complex
2. Hyperplasia WITH atypia
-simple
-complex
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3
Q

What is simple hyperplasia of endometrium? Complex?

A

Glands are isolated from one another

Glands appear interdigitated

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4
Q

What is the risk of cancer after diagnosis of hyperplasia?

A

Complex hyperplasia + atypia has 30% chance of increase risk!!!
Everything else is less than 8%

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5
Q

What is the risk of cancer if hysterectomy is done right after hyperplasia is diagnosed?

A

Same percentage

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6
Q

How do you distinguish hyperplasia from carcinoma?

A

Myometrial invasion = cancer
Invasion of endometrial stroma
-irregular infiltration of glands associated with altered fibroblastic stroma (desmoplastic response)
-confluent glandular pattern uninterrupted by stroma (cribriform glands)
-extensive papillary pattern
Way more atypia than hyperplasia?

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7
Q

What is cribriform growth?

A

Honeycombing

There is no basement membrane in the glands

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8
Q

What is the most common malignant tumor of female genital tract?

A

Endometrial carcinoma

Risk factors are estrogen

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9
Q

What are the two types of endometrial carcinomas?

A

Type I

Type II

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10
Q

What is Type I endometrial carcinoma?

A

80-85%

  1. Estrogen dependent
  2. PREmenopausal
  3. Atypical hyperplasia is precursor lesion
  4. Endometriod type
  5. Low tumor grade, indolent
  6. Is caused by the mutations in
    i. PTeN
    ii. K-ras
    iii. microsatellite instability
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11
Q

What is Type II endometrial carcinoma?

A

15-20%

  1. Estrogen INdependent
  2. POSTmenopausal
  3. intraepithelial carcinoma is precursor
  4. Serous subtype (clear cell)
  5. High grade, AGGRESSIVE
  6. Caused by p53 mutation
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12
Q

What does papillary growth signify?

A

Carcinoma marker
Could also be indicative of Type II endometrial carcinoma
Goes along with psammoma bodies

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13
Q

What is the genetic alteration for Type II endometrial cancer?

A

P53 mutation

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14
Q

What is endometrioid type of cancer?

A

Type I endometrial carcinoma

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15
Q

What is the role of pap smear?

A

Used to screen for cervical cancer

HPV

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16
Q

What are signs/symptoms of cervical cancer?

A
  1. Abnormal vaginal bleeding

2. post-coital bleeding

17
Q

What are the risk factors for cervical cancer?

A

HPV infection by HPV 16 and HPV 18strains
More than 6 partners or partner with multiple partners
Smoking
Early age of sexual intercourse!

18
Q

What is SIL?

A

Squamous intraepithelial neoplasia

19
Q

What are the most common types of cervical cancer?

A

Squamous cervical cancer

Diagnosed by pap smear

20
Q

What is the most common oncogenic subtypes of HPV?

A

HPV 16, 18, oncogenic, high risk

6 and 11  causes warts, low risk

21
Q

How do you get HPV infection?

A

Mucosal to mucosal contact

Does not need penetration

22
Q

What is the goal of looking for HPV?

A

It is not to stop HPV but stop invasive carcinoma!!

23
Q

How can you tell if HPV will progress to cervical cancer?

A

HPV 16 and 18
Viral E6 and E7 genes of high risk HPVs can cause cellular transformation
HPV persistence is necessary for progression to cancer
Fucks with p53 so that you get proliferation

24
Q

What are the histological signs the show the HPV is getting close to carcinoma in situ?

A

The more stromal cells that replace the epithelial cells, the worse the grade

25
Q

Where does cervical cancer take place?

A

At the squamocolumnar junction (transformation zone
Site of preneoplastic lesions
Gradual progression from CIN1 to CIN3
-low grade lesions are often reversible
-takes months to years for neoplastic cells to acquire invasive potential

26
Q

What does CIN stand for?

A

Cervial Intraepithelial neoplasia

27
Q

What is LSIL?

A

Low grade squamous intraepithelial lesion
Halo enlarged nuclei
Coilocytic change
Abundant cytoplasm!

28
Q

What is HSIL?

A

High grade squamous intraepithelial lesion
Loss of cytoplasm, lots of nuclei
Chromatin is nastier
Higher N/C ratio

29
Q

What is ASC-US?

A

Atypical squamous cells of undetermined significance
Abnormal cells
Grade right below LSIL

30
Q

When do you start screening for cervical cancer?

A

Starting at 21

Reproduction Week 2 (14 decks)

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