O&G Pathology Flashcards
How do gynaecological neoplasias differ to other sites?
- hormone related (endometrium)
- borderline category (ovary)
- intraepithelial lesions
- oncogenic viruses
- syndromes (e.g. Lynch and BRCA)
Terminology differences between pre-invasive and invase cancers? How do you stage it?
Pre-invasive
- Intraepithelial neoplasia = LOOK UP - premalignant
- Intraepithelial lesions
- In situ
Invasive
- Squamous
- Adeno
- Sarcoma
Staging:
- surgical
- Histology (type, grade, other variables - size, site, vascular invasion, margins)
What are some common benign patholgies of the vulva? How about neoplastic?
- lichen sclerosus
- Unknown aeteology (BSO in males)
- peri/postmenopausal women, also children
- Pruritic white scaly lesion, thin skin
- Ass. w. different VIN
- dermatitis
- lichen simplex chronicus
- lichen planus
- condyloma (benign wart)
Neoplastic
- HPV
- LGSIL
- HSIL
- Full thickness abnormality (basal layer → top)
- Ø breached BM
- younger age group than non-HPV related VIN
- Non-HPV related = differentiated VIN
- Related to lichen sclerosis
- Looks v. differentiated at the top - but v. abnormal at the bottom
- Easy “drops little cancers”
- Squamous cell carcinoma
- Extramammary Paget’s = often non-invasive. Abnormal glandular cells invade epithelium, similar to breast. Small round cells in epidermis.
- Melanoma
- Less common skin lesions
What are some things that occur in the vagina?
- Developmental disorders
- Cysts
- Benign tumours = v. rare
- Most common = SIL / squamous carcinoma. Often ass. w. cervical lesions as well
- Glandular lesions rare b/c no normal glandular tissue
What are the ways you differentiate neoplasia in the cervix?
- CIN terminology = old terminology
- High / low grade = newer terminology
- Pap smear (pic is high grade)
- high grade squamous intraepithelial lesion (HSIL)
- glandular lesions in cervix - ACIS precursor
- gland forming but abnormal cells.
- stromal reaction with basal cells.
What are some pathological findings in the uterine body?
Normal:
- Proliferative = has mitoses, fairly sparsely spaced in stroma
- Secretory = coiled glands – if late will have secretory material in lumen (may see vacuoles of forming secretions in early)
- Shedding = shedding endometrium
- Exogenous hormones create v. different looking endometrium
Abnormal:
- Chronic endometritis
- Plasma cells in endometrium
- Endometrial polyp
- e.g. postmenopausal bleeding
- irregular glands - crowding think hyperplasia
- Endometrial Hyperplasia = gland crowding, hyperplasia w or w/o
- w. atypia = 1-3% progression rate
- w/o atypia = high risk of progression / current carcinoma (30% chance of concurrent malignancy)
- Endometrial Cancer
What are some types of endometrial cancer? What are the types?
- Endometrioid - most common
- grade - prognostic, based on solid growth % (over 50% then its grade 3).
- Serous - high grade, nasty
- Clear cell - high grade, nasty
- Mucinous
- Squamous
- Mixed
- Undifferentiated
Risk Factors:
- Oestrogens
- Obesity
- Smoking
- Lynch syndrome
What smooth muscle neoplasias are present in the uterus? What is the risk of these? What are other diagnoses to consider?
- Fibroids = leiomyoma
- STUMP = smooth muscle tumour of uncertain malignant potential - watch carefully for recurrence
- Most ass. w. local recurrence
- More often need to just be watched more closely
- Leiomyosarcoma = malignant
Mixed Mullerian tumours and stromal tumours are also possible in the uterus. Adenomyosis = endometrial glands + stroma in the myometrium, not neoplastic - similar to endometriosis but not outside uterus.
What can be found in the fallopian tubes? When is it a concern?
- Salpingitis = epithelium is expanded w. neutrophils
- Tumours
- Benign = ↑↑↑↑rare
-
Malignant = increasingly recognised
- Serous tubal intraepithelial neoplasia = most common
- *STIC = STI carcinoma -** site of many ovarian carcinomas. Seed into ovary.
* Adeno = usually serous
What sort of pathological considerations should you have in the ovaries? What differentials should you consider?
- Functional cysts
- Endometriosis
- PCOS
- 3-6% women of reproductive age
- Persistent anovulation
- Obesity, infertility, insulin resistance, hirsutism
- Stromal hyperplasia
- Infx (Abscess = uncommon)
- Tumours (see other card)
What kind of Tumours can you have in the ovaries?
- Epithelial tumours Types
- Serous - common - can slowly progress
- Mucinous
- Endometrioid - less common (uncommon ones can occur in endometriosis)
- Clear cell - less common
- Brenner
- Can be
- Benign
- Borderline = usually more locally recurrent - may progress to low grade malignant
- Malignant
- serous e.g. (low - younger and borderling tumour associated, high grade - older, aggressive, related to fallopian tube stick).
- mucinous - more common metastasis from gut, primary though should be considered (pancreas, gut, appendix)
- Mesenchymal tumours
- Sex cord stromal (hormone related often - fibroma, granulosa, sertoli)
- Germ cell (e.g. teratoma)
- teratoma - mature (usually the case - in kids), immature in adults need chemo.
- other rare ones
- Metastatic
- Often bilateral + large
What sort of conditions do you expect to see in the Peritoneum?
- Inflammatory
- peritonitis and PID
-
Endometriosis
- debated aetiology - retrograde menstruation one theory,
- normal endometrium out of place - glands, stroma, haemorrhage
- common sites (ovaries, pouch of douglas, uterosacral ligaments)
- uncommon (fallopian tubes, uterine serosa)
- DDx - glands, haemorrhage, endometrial
- can have hyperplasia and neoplasia within endometriosis.
- Neoplastic
- mesothelial neoplasms
- primary serous tumours (decreasingly recognised - more likely fallopian tube)
- peritoneal implants (areas with serous borderline, associated with other sites).
How do you interpret cervical histology results? What are the possible outcomes?
- LSIL - lowgrade squamous intraepilelial lesion - HPV infection
- HSIL - highgrade “” - referred for colposcopy
- atypical endocervical cells of undetermined significance
- nature is unclear - no evidence of cancer
- adenocarcinoma in situ - inside canal of the cervix
- SCC - specialist oncologist
- adenocarcinoma - rare cancer - specialist
Treatments:
- laser ablation (burning abnormal cells off)
- wire loop excision
- radical diathermy (no longer used - more tissue damage)
What is an acronym that differentiates the causes of postmenopausal bleeding?
PALM COEIN
Structural:
- Polyp
- Adenomyosis
- Leiomyoma (fibroid)
- Malignancy
Non-structural:
- Coagulopathy
- Ovulatory
- Endometrial
- Iatrogenic
- Not specified
