Lecture 22: Gynae pathology case studies

Question 1

What is pathological examination?

Answer 1

Macroscopic description
- Cysts. mass etc

Histological assessment

• Light microscope
• paraffin embedded tissue
• mounted on glass slides
• etc etc

Question 2

What is a teratoma?

Answer 2

Teratoma = dermoid cyst
(Need 3 components)

• All ages
• Derived from post meitotic germ cells
• Composed of a variety of mature tissues derived from ectoderm, mesoderm and endoderm
• Usually benign, occasionally malignant

Question 3

What is mucinous cystadenoma?

Answer 3

• Benign cystic tumour lined by mucinous epithelium
• Unilateral

= Ovary can become extremely large

Question 4

Breakdown the classification of ovarian epithelial tumours?

Answer 4

• Mucinous (Mucinous epi) vs serous (tubual type epi)

- Benign vs malignant vs borderline (Carcinoma in situ)

Question 5

What can cause dilation/pus filling of the female tract?

Answer 5

• Usually bacterial (i.e STI)
• TB
• Parasites i.e pinworm, schistosomiasis

Question 6

How does female tract infections present?

Answer 6

• Abnormal bleeding (endometrial bleeding)
• Vaginal discharge
• Acutely unwell with fever and pain
• Asymptomatic
• Infertility
• Cysts
• Pain

Question 7

What are the common types of inflammation infection can lead to?

Answer 7

Inflammation

• Endometritis
• Salpingitis (FT)
• Oophoritis
• Peritonitis

Abscesses
Cysts

Inflammation can lead to the marked destruction of tissues

Question 8

What happens in salpingitis?

Answer 8

Inflammation of mucosa leads to destruction of the architecture.

Ovum/blastocyte no longer able to travel down FT lumen (chronic cases)

Question 9

What is the most common site of ectopic pregnancy and what can happen?

Answer 9

95% implant in FT

Often results in rupture of FT and infertility

Question 10

What are the tumours of the myometrium?

Answer 10

Leiomyoma (Fibroid)
- Benign SM tumours, common, HORMONE RECEPTIVE

Leiomyosarcoma
- Malignant tumour of SM

Question 11

Whats a chocolate cyst?

Answer 11

Benign haematorhagic cyst as a result of endometriosis

Question 12

What is endometriosis? where does it commonly occur?

Answer 12

Presence of endometrial tissue outside of the uterus

Common in:

• Uterine lig and rest of gynae tract
• Bowel
• Peritoneum
• Urinary tract
• Rarely lungs

All these bleed coinciding with menstural cycle

Question 13

Why is endometriosis a problem?

Answer 13

Bleeds into adjacent tissues in response to hormone cycle, this can cause:

• Pain
• Cysts
• Tissue inflammation
• Infertility / ectopic preg.

Can give rise to malignancy

Question 14

How can you biopsy a uterus with abnormal endometrial thickness?

Answer 14

Pipelle biopsy

Curettage

Question 15

What can be seen on endometrial tissue that is cancerous?

Answer 15

Endometrial carcinoma

- Glands proliferate and become increasingly crowded and complex

Question 16

What is the treatment for endometrial carcinoma?

Answer 16

Total abdominal hysterectomy

OR

Bilateral salpino-oophorectomy

Question 17

What can cause the endometrium to become too thick?

Answer 17

Estrogen

Question 18

What can cause too much estrogen?

Answer 18

Over a lifetime

• Obesity
• Hormone replacement therapy
• PCOS
• Hormone secreting tumours
• Late menopause

Question 19

What does too much estrogen do?

Answer 19

Overstimulates endometrium which becomes too thick and outstrips blood supply

Can lead to: irregular bleeding
Can undergo mutation and develop into neoplasia

Question 20

What are risk factors for endometrial cancer?

Answer 20

• Westernised diet, lifestyle and obesity

- Whatever stimulates estrogen

Question 21

What is cytology?

Answer 21

Diagnosis by examining the structure of individual or groups of cells

• Usually no architecture present
• Cytology specimens obtained by:
• > Cervical smear / brushings
• > Fine needly aspiration

Question 22

Whats the difference in outcomes between a smear that is CIN 2 vs CIN 3?

Answer 22

CIN 2: Smear in 12 months, if normal then infection is cleared

CIN 3: Referral to gynae for treatment i.e surgical removal of abnormal area or (lletz biopsy, (removal of cells) (confirm all abnormal cells are removed and that there is no invasion/cancer

Question 23

In NZ what is the highest risk factor for cervical cancer?

Answer 23

In NZ, the most important risk factor for developing cervical cancer is never having a smear or not having cervical smear tests regularly.