Microanatomy Flashcards
What does CIN refer to
- this refers to the spectrum of epithelial changes the take place in the squamous epithelium as the precursors of invasive squamous carcinoma
how is CIN graded
- severity of the lesion is graded as 1, 2 and 3, this is according to the level in the epithelium at which the cytoplasmic maturation is taking place
what is squamous neoplasia of the cervix associated with
Sexual activity
- early age of first intercourse
- frequency of intercourse
- number of sexual patterns
- sexual behaviour of male partner
- HPV infection
what increases the risk of probability of HPV infection
- family history of cervical neoplasia
- wives of men with carcinoma of the penis
- urban areas
- cigarette smoking
How many different types of HPV are there
greater than 100
what types of HPV are associated with genital warts
HPV 6 and 11
what HPV types are associated with carcinoma
HPV 16, 18, 31, 33,
How does HPV cause cancer
- Papillomavirus DNA is incorporated into the host genome
- this produces the proteins E6 and E7 which form complexes with anti-oncogenes such as p53 and retinoblastoma thereby inactivating the normal cellular response to DNA damage
- this results in accumulation of genetic abnormalities
what type of cancer does HPV cause
vulval and vaginal intraepithelial neoplasia
what investigations should be carried out in breast cancer diagnosis
- mammogram
- ultrasound
- fine needle aspiration cytology
- core biopsy
How do negating Masses differ in appeared from malignant ones
- growth rate
- shape
- edge/border
- relation to neighbouring structures
- resemblance to normal
- morphology
- invasion
- metastasis
Benign
- growth rate = slow
- shape = rounded/ovoid
- edge/border = smooth
- relation to neighbouring structures = pushing growth, easy to shell out
- resemblance to normal = close
- morphology = no, atypia/necrosis, low mitotic activity
- invasion= no
- metastasis = never
malignant
- growth rate = rapid
- shape = irregular
- edge/border = infiltrative
- relation to neighbouring structures = tethered to surrounding structures
- resemblance to normal = variable can be good to poor
- morphology = atypia, necrosis, high mitotic activity
- invasion = yes
- metastasis = frequent
What are the different types of benign and malignant tumours
- squamous epithelium
- glandular epithelium
- transitional epithelium
- smooth muscle
- striated muscle
- adipose tissue
- cartilage
- bone
- blood vessels
Benign
- squamous epithelium = squamous cell papilloma
- glandular epithelium = adenoma
- transitional epithelium = transitional cell papilloma
- smooth muscle = leiomyoma
- striated muscle = rhabdomyoma
- adipose tissue = lipoma
- cartilage = chondroma
- bone = osteoma
- blood vessels = angioma
Malignant
- squamous epithelium = squamous cell carcinoma
- glandular epithelium = adenocarcinoma
- transitional epithelium = transitional cell carcinoma
- smooth muscle = leiomyosarcoma
- striated muscle = rhabomosacroma
- adipose tissue = liposarcoma
- cartilage = chondrosarcoma
- bone = osteosarcoma
- blood vessels = angiosarcoma
what is breast cancer common age
before age of 30
what is the most commonest being tumour of the breast and where does it arise
Fibroadenoma
- arises in the breast lobule
what are the clinical features of a breast tumour/ fibroadenoma
- present as a mobile mass in the breast
- multiple in 20% of cases
what is the treatment of a fibroadenoma
- no Treatment in some cases if it is small
- surgical excision this can usually be shelled out easily
what does a fibroadenoma look like
circumscribed tumour
lobulated appearance
what is the prognosis of an ovarian adenocarcinoma
- very poor
- 5 year survival of about 25%
describe adenocarcinoma facts
- 90% of all ovarian malignancy s
- 6th in frequency of cancer in women, disproportionate number of fatal malignancies
- asymptomatic until they have reached a large size
where does the adenocarcinoma come from
fallopian tube origin is most of ovarian carcinoma
what is the function of the ovary
To produce gametes or ova
- develop from special sperm germ cells called oocytes
- present within the ovary from birth
To produce the female sex hormones oestrogen and progesterone
- causes development of female sexual characteristics
- support development of the early embryo in early pregnancy
- produced by the specialises stomal cells of the ovary
how do you classify ovarian tumours
– three major types are classified according to their cell of origin
what are the three major categories of ovarian tumours
Epithelial tumours
germ cell tumours
sex cord stromal tumors
give example of epithelial tumours in the ovary
- serous
- mutinous
- endometroid
give example of germ cell tumours in the ovary
- teratoma
- yolk sac tumour
- dysgerminoma
- embryonal carcinoma
- choriocarcinoma
give example of sex cord stomal tumours in the ovary
- granulose cell tumour
- thecoma-fibroma
- sertoli-leydig cell tumour
what type of epithelium lines the cervix
- simple columnar epithelium with deep invagination called cervical glands
What is the part of the cervix that projects into the vaginal cavity
ectocervix
what is the epithelium of the ecotcervix
- striated squamous epithelium
what epithelium is in the vagina
- striated squamous epithelium
the cervical epithelium responds….
differently to sex steroids than that of the uterine body (the endometrium) and is not shed at menstruation
what do the hormonal factors do to the shape and volume of the cervix
- they alter the shape and volume of the cervix
what happens to the cervix at puberty and pregnancy
- changes occur with the eversion (turning inside out) of then endocervical columnar epithelium onto the ectocervix
- the protrusion of the endocervical epithelium forms what is referred to as the endocervical columnar ectropion
- thus at punters the original squamous-columnar junction becomes relocated outside the external os
- in response to the acidic conditions of the vaginal vault areas of ectropion are replaced with stratified squamous epithelium by metaplasia involving stages of reverse cell hyperplasia and immature metaplastic epithelium
what is the region of metaplastic epithelium called
transformation zone
where do the majority of cervical cancers arise
the transformation zone of the cervix
how do you screen for cervical cancer
- take a sample of epithelial cells at the transformation zone using a brush or spatular
- apply the to a slide
- stain with papanicolaou stain followed by microscopy for cellular abnormalities
how does liquid base cytology work for cervical cancer screening
- it improves the effectiveness of analysis
- LBC involves transferring the collected cells into a liquid preservative and centrifuging to remove obscuring materials such as pus or blood before reconstituting the cells
- deposit them thinly onto a slide for staining and analysis
what are the types of cervical cancers
80% of being squamous cell carcinoma
15% adenocarcinoma
- the remainder are Aden-squamous and neuroendocrine carcinomas and these are caused by high oncogenic risk GPV
what HPV is the most common in squamous cell carcinomas and adenocarcinomas
Squamous cell carcinomas HPV16
adenocarcinomas HPV18
how does HPV infects
HPV infect immature basal cells through epithelial breaks caused by damage
- this can directly infect metaplastic squamous epithelium but it cannot infect mature superficial squamous epithelial cells
what occurs in the mature superficial squamous epithelial cells
- infection does not occur in maturing cells but replication does
- virus needs to activate cellular mitosis to accomplish DNA synthesis
what are the characteristic signs of HPV
- nuclear atypia
- pronounced clearing of cell cytoplasm forming a perinuclear halo = cells showing this effect are called koilocytes
what do dyskaryotic changes to the nucleus consist of
- disproportionate nuclear enlargement
- irregularity in form and contour
- hyperchromasia
- irregular chromatin condensation
- abnormalities in number, for, and size of nucleoli
- multinucleate
- nucleus to cytopaslm ratio increases as dyskaryosib prowesses so exfoliated cells with severe dysplasia most resemble immature basal cells
describe the grading system to cancers in epithelum
Dyplasia limited to lower third of epithelium
- mild dysplasia
- CNI
- mild dykaryosis
- Low grade SIL
dysplasia limited to lower 2/3 of epithelium
- moderate dysplasia
- CIN 2
- moderate dsykaryosis
- high grade SIL
Dysplasia extend into upper third of the epithelium
- severe dysplasia
- CIN3
- severe dyskaryosis
- High grade SIL
what do invading cells have an appearance of
typically they have an appearance of squamous cell carcinoma instead of a overlying dysplastic epithelium
what is HPV 2 and 7 associated with
common warts
where do most of the breast cancers originate from
the terminal duct lobular unit (TDLU)
within the breast how many glands form lobes
15-25 compound areolar mammary glands form lobes
what is the functional secretory unit of the breast
Terminal duct lobular unit
- comprised of lobules with an secretory acing arising from an extra lobular terminal duct
describe anatomy of the breast
15-25 compound areolar mammary glands form lobes
distally large lactiferous ducts dilate forming the lactiferous sinuses before exiting at the nipple
Terminal duct lobular unit
- comprised of lobules with an secretory acing arising from an extra lobular terminal duct
what two types of connective tissue is the storm of the breast made up of
1, interlobular stroma = this is comprised of a dense fibrocollagenous tissue mixed with adipose tissue
2, intra lobular stroma - this is comprised of a looser fibrocollagneous tissue contains hormonally responsive breast-specific fibroblasts important in mammary gland remodelling for example in pregnancy
what is the difference between interlobular stroma and intra lobular stroma
1, interlobular stroma = this is comprised of a dense fibrocollagenous tissue mixed with adipose tissue
2, intra lobular stroma - this is comprised of a looser fibrocollagneous tissue
- contains hormonally breast specific fibroblasts
What two types of cells line the ducts and lobules
- secretory and duct epithelium
- myopeithelial cell
what do the secretory and duct epithelium produce
- they produce milk which is transported to larger excretory ducts
what to the myoepthelial cells do
- they are on the same basement membrane as the epithelial cells
- form a mesh like complex
- stimulated to contract by oxytocin released from the posterior pituitary gland as a result of suckling
- milk is propelled through the duct system and released
what stimulates the development of the breast at puberty
- oestrogen
what happens to the breast in the follicular phase and then after ovulation
- oestrongen stimulates growth of ductule components
- after ovulation progesterone causes growth of secretory alveoli and the interlobular stroma which becomes oedematous
- then epithelial apoptosis ensues at the end of the cycle
when do women experience an increase in breast massive
- they experience a progressive increase in breast mass during the luteal paste and tenderness about 7-14 days after ovulation
what happens to TDLUs in pregnancy
- oestrogen and progesterone cause a dramatic increase in TDLUs
- prolactin, human placenta lactose and adrenal steroids are also important hormones in this growth
falling levels of estrange and progesterone following birth enable prolactin to stimautle milk production
what happens to the breast tissue with ageing
- with ageing from approximately age 30 and through menopause the breast lobules involute and can nearly complete atrophy in the elderly
- adipose is more prominent
- lobules decrease in size and in number
where do benign tumours originate from
specialised fibroblasts of the TDLU
- looks liked specialised stream fibroma with entrapped glands
what is the ovary a common site for
it is a common site for metastatic carcinoma arising from the gut or other parts of the reproductive system
where do epithelial tumours of the ovary arise from
- they arise from the mesothelial cell layer covering the peritoneal surface of the ovary and associated inclusion cysts
- there is incorporation of these overlying cells at ovulation when the surface rupture heals and the cells are believed to de-differentiate toward fetal precursor coelomic epithelium
describe what epithelial tumours of the ovaries can resemble
differentiate to resemble tubal mucosa(serous tumours), endocervical mucosa(mutinous tumours) or endometrium(endometriosis tumours)
describe what epithelial tumours are like and where they project
- cystic with solid components
- smooth surface or be covered in papillary projections
- spread is often into the peritoneal cavity
what are ovarian epithelial tumours divided into
Benign
boderline
malignant
what distinguished between the different types of ovarian epithelial tumours
- extend of epithelial proliferation distinguishes between benign and borderline ( borderline tumours also exhibit nuclear atypia)
- cells in malignant tumours have marked nuclear atypia, loss of glandular architecture and differentiation
what are malignant tumours by definition
tumours that show invasion of the underlying stroma
what makes up 40% of ovarian carcinomas
- serous adenocarcinoma
- most common malignant ovarian tumour
what are most germ cell tumours
- most are benign mature cystic teratomas
- remainder are malignancy
describe what mature teratomas look like
- Cystic structure
- contains well differentiated ectodermal components (skin and appendanges including hair_
- sebaceous glands
- teeth
- neural tissue
What are dysgerminomas
these are germ cell tumours that resemble seminomas in the male testis
Describe the anatomy of a dysgerminoma
- these undifferentiated germ cell tumour is composed of sheet or cords of cells separated by a scant fibrous stroma that shows inflammatory infiltration by lymphocytes
where are sex cord stroma tumours derived form
they are derived from ovarian stroma that originates from the sex cords of the embryonic gonad
- tumours may diffenriate towards sertoli and Leydig structures int he male
- or granulose and theca cells in the female
what do sex cord stomal tumours produce
- they produce hormones including excessive oestrogen in the case of thecfmas and grnaulosa cell tumours
- or androgen in sertoli-leydig cell tumours
what is the most common type of sex cord stomal tumour
thecomas (Benign) most common class
- cells show a foray cytoplasm due to large number of lipids droplets in their cytoplasm
what are Granulose cell tumours composed of
- grnaulosa cell tumours are composed of cells with morphology like normal grnaulosa cells
- sometimes look like clusters that resemble immature follicles
- granulose cell tumours have distinct potential for malignancy and make up about 5% of malignant ovarian tumours
