Lecture 22: Gynae pathology case studies Flashcards
What is pathological examination?
Macroscopic description
- Cysts. mass etc
Histological assessment
- Light microscope
- paraffin embedded tissue
- mounted on glass slides
- etc etc
What is a teratoma?
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
What is mucinous cystadenoma?
- Benign cystic tumour lined by mucinous epithelium
- Unilateral
= Ovary can become extremely large
Breakdown the classification of ovarian epithelial tumours?
- Mucinous (Mucinous epi) vs serous (tubual type epi)
- Benign vs malignant vs borderline (Carcinoma in situ)
What can cause dilation/pus filling of the female tract?
- Usually bacterial (i.e STI)
- TB
- Parasites i.e pinworm, schistosomiasis
How does female tract infections present?
- Abnormal bleeding (endometrial bleeding)
- Vaginal discharge
- Acutely unwell with fever and pain
- Asymptomatic
- Infertility
- Cysts
- Pain
What are the common types of inflammation infection can lead to?
Inflammation
- Endometritis
- Salpingitis (FT)
- Oophoritis
- Peritonitis
Abscesses
Cysts
Inflammation can lead to the marked destruction of tissues
What happens in salpingitis?
Inflammation of mucosa leads to destruction of the architecture.
Ovum/blastocyte no longer able to travel down FT lumen (chronic cases)
What is the most common site of ectopic pregnancy and what can happen?
95% implant in FT
Often results in rupture of FT and infertility
What are the tumours of the myometrium?
Leiomyoma (Fibroid)
- Benign SM tumours, common, HORMONE RECEPTIVE
Leiomyosarcoma
- Malignant tumour of SM
Whats a chocolate cyst?
Benign haematorhagic cyst as a result of endometriosis
What is endometriosis? where does it commonly occur?
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
Why is endometriosis a problem?
Bleeds into adjacent tissues in response to hormone cycle, this can cause:
- Pain
- Cysts
- Tissue inflammation
- Infertility / ectopic preg.
Can give rise to malignancy
How can you biopsy a uterus with abnormal endometrial thickness?
Pipelle biopsy
Curettage
What can be seen on endometrial tissue that is cancerous?
Endometrial carcinoma
- Glands proliferate and become increasingly crowded and complex
What is the treatment for endometrial carcinoma?
Total abdominal hysterectomy
OR
Bilateral salpino-oophorectomy
What can cause the endometrium to become too thick?
Estrogen
What can cause too much estrogen?
Over a lifetime
- Obesity
- Hormone replacement therapy
- PCOS
- Hormone secreting tumours
- Late menopause
What does too much estrogen do?
Overstimulates endometrium which becomes too thick and outstrips blood supply
Can lead to: irregular bleeding
Can undergo mutation and develop into neoplasia
What are risk factors for endometrial cancer?
- Westernised diet, lifestyle and obesity
- Whatever stimulates estrogen
What is cytology?
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
Whats the difference in outcomes between a smear that is CIN 2 vs CIN 3?
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
In NZ what is the highest risk factor for cervical cancer?
In NZ, the most important risk factor for developing cervical cancer is never having a smear or not having cervical smear tests regularly.
