Lecture 26: Cervical screening and pathology Flashcards

1
Q

Metaplasia

A

replacement of one differentiated cell type with another, mature differentiated cell type

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2
Q

Dysplasia

A

abnormality of development or an epithelial anomaly of growth and differentiation

not invasive!

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3
Q

Neoplasia

A

New and abnormal development of cells that may be benign or malignant

Intraepithelial neoplasia = dysplasia (not invasive)

Invasiveneoplasia (neoplasm) = cancer

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4
Q

What could cause this mass in the myometrium

A
  1. Benign Leiomioma see pic*
    - benign SM tumours
    - common
    - Hormone receptive; regress following menopause
  2. Leiomyosarcoma (invasive SM cancer)
    - Malignant smooth muscle tumour
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5
Q

How can a benign leiomioma cause menorrhagia

A

If you get a sub-endometrial leiomyoma you increase the surface area of the uterine cavity → increased bleeding and shedding.

Pain as uterus contracts around large fibroids

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6
Q

Whats the macroscopic difference between a leiomyosarcoma and a leiomyoma/fibroid

A

Leiomyoma: ovoid/round, circumscribed, solid creamy

Leiomyosarcoma: necrotic core/area, haemorragic areas, larger. It is heterogenous

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7
Q

Whats the microscopic description of a leiomyoma

A

Leiomyoma : collection of smooth muscle cells, arranged in a new growth formation (different to SM of uterus). Cigar shaped nuclei, and pink elongated cytoplasms.

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8
Q

cyclical abdominal pain indicates issues with?

A

Her period

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9
Q

Potential causes of painful heavy periods

A

Leimyoma (fibroids)

Endometriosis

Primary endometrial pathology

Leiomyosarcoma unlikely

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10
Q
A

A chocolate (haemorrhagic) cyst of the ovary

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11
Q

What is endometriosis? What does it cause?

A

Endometrial tissue outside the lining of the uterus.

It responds to menstrual cycle hormones, leading to:

  • pain
  • cysts
  • Tissue inflammation
  • fibrosis
  • infertility/ectopic pregnancy
  • POTENTIALLY malignancy
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12
Q

What are you looking for macroscopically to diagnose Endometriosis

A

Cyst formation, many that are ‘chocolatey’ due to haemorrhage.

Changes the structure/function of normal tissues

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13
Q

What do we suspect from this?

A

-polycystic ovarian syndrome: underlying endocrine disorder cause her to be obese/infertile. Ovaries/follicule never ovulate so continued production of oestrogen.

This can cause excessive proliferation and shedding of the endometrium → heavy and irregular periods. (the irregularity makes you think she is not ovulating cyclically)

-leiomyoma

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14
Q

Age variation in a thickened endometrium?

A

-Postmenopausal: no oestrogen production so there shouldn’t be proliferating/shedding at all.

If there is this is a BAD SIGN,

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15
Q

How do you do a biopsy of the endometrium? What are the issues?

A

Pipelle Biopsy: little tube in uterus, suck out some endometrium. Not done under direct vision so can be incredibly difficult in obese patients.

D and C ‘Dilation and Curettage’: under direct vision in theatre under anaesthetic. Endometrium viewed and abnormal tissue scraped out.

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16
Q

What is this and what would it look like microscopically

A

Endometrial adenocarcinoma.

Shaggy, thickened, heterogenic, invading into the myometrium.

Glands proliferate and become increasingly crowded and complex

17
Q

What can lead to too much eostrogen

A
  • Obesity
  • Exogenous oestrogen (HRT)
  • Polycystic ovarian syndrome (PCOS)
  • Hormone secreting tumours
  • Early menarche, late menopause
  • Nulliparity (pregnancy is a progestogenic state)
18
Q

cervical/PAP smear

A
  1. Conventional smear: scraping spatula
  2. Cytobrush (liquid based cytology): brush, send to lab, do liquid based tests
19
Q

What is cytology? Issues?

A

Diagnosis by examining the structure of individual or groups of cells.

Usually no architecture present

20
Q

What sort of things is the cytologist looking for in the cervical smear specimen

A
  • Nuclei:cytoplasm ratio
  • Nuclei enlargement
  • Nuclei variation

Is it normal, low grade dysplasia or high grade dysplasia

21
Q

What happens if you have a smear, and see high-grade dysplastic lesion??

A
  1. Abnormal smears are refered to gynaecologist for colposcopy (examination of cervix with a specialised microscope).
  2. Cervix can be ‘painted’ with acetic acid to highlight abnormal areas
  3. A biopsy is taken of the suspicious areas and sent to the lab
22
Q

What happens to the biopsy of the high-grade dysplastic region?

A

It is looked at microscopically (histology) and it is decided/confrimed what CIN stage the tissue is at.

CIN I: some cytoplasm still present, most of the issue down further below.

CIN III: Full thickness abnormality, lots of cytoplasm lost, darker nuclei

23
Q

Whats the treatment for the abnormal area? Follow up?

A

Area is surgically removed (Iletz or cone biopsy)

Followup: regular or annual cervical smears

24
Q

What is this? why is this so bad?

A

Cervical Cancer. Because of its anatomical location it can easily invade into important surrounding structures (rectum, bladder etc)

25
Q

What are the important risk factors asosociated with developing cervical cancer

A
  • Not have cervical smear tests regularly (3years)
  • Smoking can increase risk of persistant HPV
26
Q

What is a Mucinous Cystadenoma

A

Epithelial tumours of the ovaries

27
Q

How can we classify Ovarian Epithelial Tumours

A
  • Mucinous vs Serous
  • -Serous = tubal type epithlium (pseudostratified ciliated)
  • Mucinous = mucinous epithelium*
  • Benign
  • Borderline
  • Malignant