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Sita GenitoUrinary System > Lecture Cervical Screening and Pathology > Flashcards

Lecture Cervical Screening and Pathology Flashcards

1
Q

Metaplasia

A

“meta” = change
“plasia” new formation
change/replacement of one differentiated cell type toanother mature differentiated cell type (normal –> normal)
- Barrets oesophagus (squamous –> mucinous (to block reflux acid))
- Chronic smoker (glandular –> squamous epi)

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2
Q

Dysplasia

A

“dys” bad
“plasia” new formation
abnormality of development or epithelial abnormality of growth and differentiation
= Not invading past BM –> therefore cannot spread –> cannot metastasize –> remains “intra epithelial”
- Want to find on cervical smears

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3
Q

Neoplasia

A

“neo” new
“plasia” formation
New and abnormal development of cells that are benign OR malignant
- Intra (within) epithelial neoplasm (dysplasia)
- Invasive neoplasia (cancer)

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4
Q

Menorrhagia

A

heavy periods

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5
Q

Dysmenorrhoea

A

painful periods

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6
Q

Benign Lyomoyoma/Fibroid uterus

A

Circumscribed (well defined outline) myometrial masses
- lyomyoma (beingin) or lyomyosarcoma (malignant)
Nodular + cream + solid
Lyomyoma –> well circumsribed –> submucosal/subepithelial –>
1. Increased surface area of endometiral cavity –> excessive bleeding and shedding –> menorrhagia
2. contraction around defined nodules –> painful periods –> dysmenorrhea

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7
Q

Tumours of the Muscular Uterine Wall

A
  1. Leiomyoma (fibroid) –> Benign Smooth muscle tumour:
    - common.
    - hormone receptive –> shrinking/regressing after menopause
    - oval/round, solid, cream, clear cut surface
  2. Leiomyosarcoma : Malignant Tumour of smooth muscle
    - heterogenous cut surface –> necrotic core
    - haemorhagic, softer, bigger, protrudes into endometrial cavity
    Histology: pink + elongated cells with Cigarette shaped nuclei
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8
Q

Potential causes of cyclical abdominal pain

A

Fibrosis/Lyomyoma
Lymomyosarcoma
endometriosus
Primary endometrial pathway

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9
Q

Endometriosis

A

Cherry red/dark brown nodules on peritoneal surface –> slightly cystic bleeding in tissues
Chocolate cyst –> expanded ovary due to a cystic structure which contains brown material –> replaces the ovary
Endometriosis is a problem when it starts reacting to menstrual hormones
Endometriosis –> endometiral tissue lining uterus found outside of uterus –> continues original cellular functions –> responds to ovarian hormones in foreign location –> starts “proliferating and shedding” like normal cyclical ovarian lining during menstruation–> creates nodules of bleeding and fibrosis in perineum –> pain, inflammation and destruction –> structures can stick together (fallopian tubes) –>
1. potential risk of inferitility with stuck fallopian tubes
2. endometrial tumours outside of uterus
Histology:
- 3x components (glands, stroma, changes in surroundign tissue)

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10
Q

What do chocolate cysts suggest?

A

Endometriosis

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11
Q

Three Histological components of Endometriosus

A
  1. Endometrial type glands
  2. Endometrial type stroma
  3. Changes in surrounding tissues –> responding to foreing endometrial tissue
    - Fibrosis (inflammatory reaction of local tissue to foreign tissue)
    - Haemocyderin-containing macrophages (containing blood which has been shed around)
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12
Q

Where does endometriosis commonly occur

A

Most commonly in ovaries
Also in uterine ligaments, rest of gynae tract, bowel, peritoneum, urinary tract
Rarely lungs, pleura, bone, upper GIT

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13
Q

When is endometriosis a problem?

A 
Endometriosis is a specific problem when it responds to menstrual hormones --> Bleeds into adjacent tissue during menstruation --> causes:
1. Pain
2. Cysts
3. Tissue inflammation --> fibrosis
4. Infertility/ectopic pregnancy
Can give rise to malignancy
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14
Q

Potential causes of abnormal bleeding

A
  1. Polycycstic ovaries due to excessive oestrogenic signal stimulation –> proliferation fo endometrium –>
    a) outgrow blood supply –> regularly sheds
    b) hyperplasia (preneoplastic state) –> endometrial carcinoma
  2. incidental endometriosis (not related to obesity(
  3. Lyomyomas
  4. Underlying endocrine disorder –> causes obesity/non-ovulation –> problem with endometrium
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15
Q

Endometrial investigations

A
  1. US: good for solid and cystic structures (can observe nodules and compare relative thickness of endometrium of uterine walls)
    - age dependant –> post menopausal woman should have thick endometrial wall –> as no proliferative hormones being released
  2. Biopsy
    a) pipelle –> no direct vision –> suction tube takes sample of uterus
    Note: difficult in obese –> often end up in getting cervical sample
    b) Dilation and Curettage –> in operating theatre –> dilate cervix –> insert instrument into uterus –> direct vision to look at uterus –> take sample of specific area
    - more information and large tissue sample size
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16
Q

Difference b/w proliferative endometrium and endometrial carcinoma

A
  1. Proliferative endometrium: activity occurring in bottom third. hasn’t broken the BM
    -hyperplasia pre-invasive –> neoplastic due to over stimulation of oestrogen 00> slightly thickened but no extension into myometrium
  2. Endometrial Carcinoma: Actiivty occuring througout entire 3/3 of endometrium
    - glands proliferated –> increasingly crowded, irregular and complex glandular structures
    - lined by cells with cytological features
    Note: Large irregular complex glandular structures of endometrial carcinoma –> clump into large clusters –> likely to break off –> Youth: abnormal bleeding. 50+: post menopausal bleeding
17
Q

Surgically removed specimen of total abdominal hysterectomy and bilateral salphino-oophorectomy

A

Normal myometrium: about 0.5 cm thick endometrium
Endometrial carcinoma: shaggy, cream, irregular endometrium –> spikes illustrate it starting to invade into underlying myometrium

18
Q

What is the primary endometrial pathology for younger woman?

A

Oestrogen driven pathology

19
Q

Consequences of excessive oestrogen exposure over a lifetime

A

Note: Oestrogen exposure changes with lifetime

  1. Obestiy
  2. Exogenous oestrogen (hormone replacement therapy –> HRT or Tamoxifen for breast cancer)
  3. Polycystic ovarian syndrome (PCOS)
  4. Hormone secreting tumours
  5. Early menarche, late menopause –> someone with late menarche
  6. Nulliparity (as pregnancy is a progestogenic state)
20
Q

Oestrogen in relation to cell cycle

A
  1. Oestrogen drives Proliferative stage (first half of the cycle
    MENSTRUATION
  2. Progesterone drives Secretory stage
    - too much oestrogen causes over stimulation of endometrium –> endometrium becomes to thick –> outgrows blood supply –> endometrium breaks down –> irregular/non/cyclical bleeding –> may develop mutation –> neoplasia (hyperplasia or cancer)
21
Q

Cytology

A 
Diagnosis: examine the structure of individual or groups of cells (e.g. nucleus size)
No architecture present
Specimens obtained via:
- cervical smear brushings
- fine need aspiration
22
Q

Smear process for low grade neoplasm (CIN)

A
  1. PAP smear (conventional or cytobrush for cytology)
  2. Cytology
    If low grade:
  3. smear in 12 months
23
Q

Cytological changes in tumorous cells

A 
nuclear:cytoplasmic ratio
enlargement of nucleus
hyper-chromatic
variation b/w nucleuses of the group
irregularly shaped nucleus
pleomorphic
different size and shape
***Look at pics
24
Q

Another name for Low grade dysplasia CIN I

A

CIN I cervical intraepithelial neoplasia grade I

Low grade squamous intraepithelial lesions

25
Q

Smear process for high grade neoplasm

A
  1. PAP smear (conventional or cytobrush)
  2. cytology
  3. referred to gynaecologist for colposcopy–> painted with acetic acid –> biopsy sent to lab
  4. Pathologist reads biopsy
  5. Treatment/removal of area (LLETZ/CONE biopsy)
  6. Annual smears
26
Q

Colposcopy

A
  1. paint cervix with vinegar/acetic acid

2. abnormal areas highlighted

27
Q

Where does HPV infection occur?

A

Transformation zone

Glandular endocervical epi –> squamous ectocervical epi.

28
Q

Histological Biopsy of high grade squamous intraepithelial carcinoma CIN III

A

full thickness abnormality
cytoplasm lost
darker nuclei
- check for invasion past BM

29
Q

Lletz cone biopsy

A

lazer removal of transformation zone of cervix

30
Q

histology of malignant nests of squamous cells

A

pink
lots of cytoplasm
form keratin

31
Q

What is the most important risk factor for cervical cancer

A
  1. Never having a smear!!
    or not having smears regularly
  2. smoking: increase risk of persistent HPV + cervical cancer + immunosupression
32
Q

Teratoma/Dermoid cyst

A

germ cell tumour
composed of a variety of cells from endo, ecot and mesoderm
- solid, cystic structure, containing hair and sebaceous material
- yellow, cream ares (adipose tissue), fatty, slimy,

33
Q

Ovarian neoplasm

A

can be some of the biggest tumours in the body

34
Q

Mucinous cyst adenoma

A 
benign
cystic tumours
pain or mass lesion
unilateral
can be very large
35
Q

Mucinous vs serous

A 
mucinous = mucinous epithelium
serous = TUBAL epithelium (pseudostratified ciliated)
36
Q

Necrotic tumoues

A

large and necrotic
uglier
solid/cream/firm/partially necrotic

37
Q

Serous Carcinoma

A
  1. Sporadic cancers

2. BRCA mutation

Sita GenitoUrinary System (28 decks)

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