Ovarian/ Cervix/ Fallopian tube/ Vaginal Pathology Flashcards
What are the broad types of ovarian neoplasms?
Surface Epithelium
Germ cell
Sex chord- stroma cells
What are the most common mutations that cause ovarian cancer?
p53 mutations
KRAS mutations
What are the sub-categories of epithelial ovarian tumours?
Serous
- resembles tubal mucosa
Mucinous
- resembles endocervix
Endometroid
- resembles endometrium
What are the mutations that always cause High Grade Serous carcinomas?
p53
BRCA1
Mucinous tumours may be mistaken by a tumour from the G.I tract, what is this tumour called?
Krukenberg tumour
Ovarian endometroid carcinomas are usually caused by which type of mutation?
loss of the tumour suppressor called:
Phosphatase Tensin Homolog
What are the typical germ tumours?
Teratomas
What is a medical emergency regarding teratomas?
Torsion
Name three tumours that are sex chord - stroma type:
Thecoma
- benign
- produce oestrogen
Granulosa Cell tumours
- oestrogen producing
Ovarian Fibroma:
- benign and large
What is a complication of ovarian fibromas and what are the symptoms?
Meig’s Syndrome
- Ascites
- Pleural effusion
What is a mixed tumour?
Brenner’s tumour
What is a major worrying symptom of any cancer in the female reproductive system?
Post menapausal bleeding
What is common symptoms of ovarian cancer?
Bloating
Pain
Abnormal Bleeding
Hirsutism
When carrying out Cervix examination, what instrument is used to view the cervix?
Colposcopy
If cells are affected by HPV, what are they called and what is a defining characteristic?
Koilocytes
- hollow around the nucleus
What chemical is added to the cervical tissue to highlight the potentially cancerous tissue?
Acetic acid 5%.
stains proteins white - so higher protein producing cells will stain white.
If a slide contains tissue that is probably cancer, what would you expect to see?
Very dyskarotic cells
- dark nucleus
- irregular nucleus
Strange shaped cells
High volume of lymphocytes
When would CIN3 be diagnosed?
When more than 2/3rd of the epithelial layer is dyskarotic
What is the most common type of ovarian tumour in children?
Yolk Sac germ cell tumours
What is a histological features sometimes seen on serous adencarcinomas?
Psammoma bodies
- calcified plaques
What is the most common type of cancer seen in the Fallopian tubes?
Papillary serous carcinoma - form the endometrium
What is the term used for inflammation to the Fallopian tube?
Salpingitis
Name some common infections that cause salpingitis:
Chlamydia Tachomatis
Mycoplasma
Nieisseria Gonorrhoeae
Streptococci
What are some symptoms of Salpingitis?
Fever
Lower abdominal pain/ Pelvic pain
Pelvic mass - if tubes are distended
High grade carcinomas of the Fallopian tubes are usually proceeded by lesions occurring at the distal portion. what are these called?
Serous Tubal Intraepithelial Carcinomas
STIC
Primary cancers of the Fallopiian tubes usually result due to which mutation?
BRCA1
What are some key symptoms of endometrosis?
Dysmenorrhoea
Dysuria
Dyspareunia - painful sex
Dyschezia
Pelvic pain
What are the two theories of endometrosis ?
Metastatic theory:
- due to retrograde menstruation or surgical procedures the tissue outwith undergo metastatic changes
Metaplastic theory:
- endometrium derives directly off the peritonium which may originate back.
What is the term given when uterine tissue develops inside the myometrium of the uterus?
Adenomyosis
- type of diverticulitis of the myometrium
What can endometrial Polyps be triggered to grow by?
Tamoxifen
Histologically what do polyps have an increased ratio off? and what other pathology does this differ to?
Increased stroma to gland ratio.
Differs from endometrial hyerplasia and Adenocarcinomas of the endometrium which have increased gland to stroma ratio.
What is a benign tumour of the muscle wall of the uterus? and how is it treated?
Leiomyoma
- progesterone
- tranexamic acid
Surgical - hysterctomy
What is a malignant tumour of the muscle of the uterus and how does this differ from the leiomyoma?
Leiomyosarcoma
Resembles a polyp
necrosis present
tumours will bleed
What is it called when there is cancer of the stroma of the uterus?
Endometrial stroma sarcoma
very slow growing cancer
What serious pathologies of the female genital tract can lead to abnormal bleeding?
Endometrial polyps
Endometrial hyperplasia / adenocarcinoma
leiomyoma
Leiomyosarcoma
Molar Pregnancies
Ectopic pregnancies
(Endometrorosis can cause irregular bleeding but usually during period)
What are some key characteristics of a molar pregnancy?
Non Tender Large for date uterus.
Vaginal bleeding
Bloods will show high levels of hCG.
What type of infection is always associated with inter uterine coil device?
Actinomyces
What disease can be associated with the vulva?
Anything that can affect skin - melanomas, inflammation etc.
What non effective inflammation can occur on the Vulva? and whats it associated with?
Lichen Plannus
- Ano-rectal cancers
What types of Cancers are associated with the vulva and who do they affect?
Squamous Cell Carcinoma associated with Vulva Intraepithlial Neoplasia (VIN) and CIN
- <60
Squamous Cell Carcinoma associated with Dermatomes. Not associated with CIN or VIN
- >60
How many vulva cancers are thought to be HPV related?
20%
What condition typically produces chocolate cysts?
Endometrosis
What is Menorrhagia?
Very heavy periods consisting of more than 80mls of blood
normal is 40mls
What disorders can cause menorrhagia?
Hypothyroidism
Obesity
Polycystic ovarian syndrome
List some treatments of Menorrhagia:
mefenamic acid and tranexamic acid
- stops bleeding
NSAIDS - pain
Surgical
- remove uterine artery
- Burn surface of endometrium
What is an important blood marker for ovarian tumours?
Ca125
Define Amenorrhea:
3 or more consistent periods missed
No period by age 15 years
What are the most common ovarian masses in young women?
Ovarian cysts:
Physiological ovarian cysts - non -rupture dominant follicles.
What is the most common tumour of the ovaries?
Serous Cystadenoma
When thinking about cervical biopsies, what things might we see in a cancerous sample?
CIN - grading
Koilocytosis
