Lecture 20: Gynecologic Pathology 2 Flashcards
What are the key characteristics of endometrial hyperplasia?
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
What are the histological features of endometrial hyperplasia?
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
What is simple hyperplasia of endometrium? Complex?
Glands are isolated from one another
Glands appear interdigitated
What is the risk of cancer after diagnosis of hyperplasia?
Complex hyperplasia + atypia has 30% chance of increase risk!!!
Everything else is less than 8%
What is the risk of cancer if hysterectomy is done right after hyperplasia is diagnosed?
Same percentage
How do you distinguish hyperplasia from carcinoma?
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?
What is cribriform growth?
Honeycombing
There is no basement membrane in the glands
What is the most common malignant tumor of female genital tract?
Endometrial carcinoma
Risk factors are estrogen
What are the two types of endometrial carcinomas?
Type I
Type II
What is Type I endometrial carcinoma?
80-85%
- Estrogen dependent
- PREmenopausal
- Atypical hyperplasia is precursor lesion
- Endometriod type
- Low tumor grade, indolent
- Is caused by the mutations in
i. PTeN
ii. K-ras
iii. microsatellite instability
What is Type II endometrial carcinoma?
15-20%
- Estrogen INdependent
- POSTmenopausal
- intraepithelial carcinoma is precursor
- Serous subtype (clear cell)
- High grade, AGGRESSIVE
- Caused by p53 mutation
What does papillary growth signify?
Carcinoma marker
Could also be indicative of Type II endometrial carcinoma
Goes along with psammoma bodies
What is the genetic alteration for Type II endometrial cancer?
P53 mutation
What is endometrioid type of cancer?
Type I endometrial carcinoma
What is the role of pap smear?
Used to screen for cervical cancer
HPV
What are signs/symptoms of cervical cancer?
- Abnormal vaginal bleeding
2. post-coital bleeding
What are the risk factors for cervical cancer?
HPV infection by HPV 16 and HPV 18strains
More than 6 partners or partner with multiple partners
Smoking
Early age of sexual intercourse!
What is SIL?
Squamous intraepithelial neoplasia
What are the most common types of cervical cancer?
Squamous cervical cancer
Diagnosed by pap smear
What is the most common oncogenic subtypes of HPV?
HPV 16, 18, oncogenic, high risk
6 and 11 causes warts, low risk
How do you get HPV infection?
Mucosal to mucosal contact
Does not need penetration
What is the goal of looking for HPV?
It is not to stop HPV but stop invasive carcinoma!!
How can you tell if HPV will progress to cervical cancer?
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
What are the histological signs the show the HPV is getting close to carcinoma in situ?
The more stromal cells that replace the epithelial cells, the worse the grade
Where does cervical cancer take place?
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
What does CIN stand for?
Cervial Intraepithelial neoplasia
What is LSIL?
Low grade squamous intraepithelial lesion
Halo enlarged nuclei
Coilocytic change
Abundant cytoplasm!
What is HSIL?
High grade squamous intraepithelial lesion
Loss of cytoplasm, lots of nuclei
Chromatin is nastier
Higher N/C ratio
What is ASC-US?
Atypical squamous cells of undetermined significance
Abnormal cells
Grade right below LSIL
When do you start screening for cervical cancer?
Starting at 21
