Pathology

Question 1

Define dysplasia

Answer 1

Pre-cancerous change - cells are not normal but not autonomous yet

Question 2

Define neoplasia

Answer 2

Tumour

Question 3

What is a cancer

Answer 3

A malignant neoplasm

Question 4

Define anaplasia

Answer 4

Total loss of cell characteristics - lack of differentiation

Question 5

Define involution

Answer 5

Opposite of hyperplasia, ie. A decrease in the cell mass due to a decreasing number of cells

Question 6

Define metaplasia

Answer 6

Cell changes TYPE

Question 7

Define carcinoma and what is meant by a carcinoma in situ

Answer 7

an epithelial cancer/tumour

carcinoma in situ is a non invasive epithelial cancer/tumour

Question 8

What is an intraepithelial neoplasm

Answer 8

same as a carcinoma in situ (a non-invasive epithelial cancer/tumour)

Question 9

What is meant by ‘differentiation’ and why is it important in malignancy

Answer 9

It refers to the level of cellular characteristics. A lack of differentiation is a sign of malignancy, and a poor prognosis

Question 10

Why are death rates for ovarian cancers so much higher than uterine (despite them having a similar incidence)

Answer 10

Ovarian cancers tend to be relatively hidden and are therefore diagnosed much later

Question 11

What is the peak incidence of cervical cancer

Answer 11

CIN (cervical intraepithelial neoplasm): 30

Invasive carcinoma: 45-50

Question 12

How are cervical cancers staged?

Answer 12

CIN: stages I-III (based on degree of differentiation - CIN I = mild dysplasia, II = moderate, and III = severe)

Invasive carcinoma: stages I-IV (I = confined to cervix, II = beyond the cervix, but not to the pelvic wall, III = to pelvic wall, IV = involving bladder/rectum/beyond pelvis)

Question 13

Describe the types of tumours most likely to occur in the endocervix and the ectocervix

Answer 13

Endocervix (10%) has mucous secreting columnar epithelium (like the uterus), therefore ADENOCARCINOMA (of the glandular cells in the endocervix)

Ectocervix (90%) has stratified squamous epithelium (like the vagina), therefore SQUAMOUS CARCINOMA (in the transformation zone)

Question 14

The uterus consists of an endometrium, and a myometrium. Which cancers affect these two layers

Answer 14

Endometrium: cuboidal columnar shape arranged as glands - therefore ADENOCARCINOMA

Myometrium: smooth muscle, therefore fibroids (LEIOMYOMA)

Question 15

Which cancers (and tumours) can be found in the ovaries?

Answer 15

Carcinoma: in the outer covering of cuboidal epithelium
Serous tumour: arising from the outer serous layer
Mucinous tumour: arising from the other parts of the epithelium
Mesothelioma: arising from the coelomic mesothelium covering the ovary (very nasty tumour)
Stromal tumours: affect hormone production

Metastases from elsewhere

Question 16

Why is the cervix vulnerable to cancer?

Answer 16

There are normal cellular changes that occur (especially at puberty and during pregnancy, but also as part of the monthly cyclical changes).
Repositioning of the squamo-columnar junction (exposing the columnar cells to the low pH of the vagina) leads to:
- Squamous metaplasia of cells in the transformation zone
- these cells are more vulnerable to dysplasia and neoplasia

Cervical cancer is also linked to the human papilloma virus (HPV) types 16 and 18, which is sexually transmitted. Persistent infection leads to cytological changes

Question 17

Name and describe 2 common benign uterine neoplasms

Answer 17

Polyps - endometrial outgrowth with an associated stroma (not a problem unless they bleed)

Fibroids - smooth muscle tumour - very well encapsulated. Under the control of oestrogen (not a problem unless big and many of them)

Question 18

A uterine carcinoma can be associated with oestrogen, how does this affect prognosis?

Answer 18

A carcinoma with oestrogen receptors has a better prognosis as it is easier to target, and will be better differentiated

Question 19

What is a teratoma?

Answer 19

A neoplasm of germ cell origin
- mixture of mature tissues mainly derived from ectoderm (hair, skin, teeth, etc) - can occasionally have tissues derived from endoderm (respiratory and gut epithelium), and mesoderm (bone/cartilage)

90% are benign and occur in patients younger than 20
- presence of immature (less differentiated) tissues indicate malignancy, but this is more rare