Pathology Flashcards
what are the phases of the ovarian cycle
follicular phase
ovulation
luteal phase
what are the phases of the uterine cycle
menstrual phase
proliferative phase
secretory phase
what is the timeline for the phases of the uterine cycle
proliferative = day 1 - 14 secretory = day 16 - 28 menstrual = day 1 - 3
what hormone is mainly present during the proliferative phase
oestrogen
what hormone is mainly present during the secretory phase
progesterone
what are causes of abnormal uterine bleeding [AUB] in the young
DUB usually due to anovulatory cycles
Pregnancy/miscarriage
Endometritis
Bleeding disorders
what are causes of abnormal uterine bleeding [AUB] in the perimenopause
pregnancy/miscarriage DUB endometritis leiomyoma [fibroid - smooth muscle tumour] adenomyosis neoplasia [cervical, endometrial]
what are causes of abnormal uterine bleeding [AUB] in the post menopause
Atrophy Endometrial polyp Exogenous hormones: HRT Endometritis Bleeding disorders
Sarcoma
Endometrial carcinoma
what endometrial thickness in post menopausal women is taken as an indication for biopsy
> 4mm
what endometrial thickness in pre-menopausal women is taken as an indication for biopsy
> 16 mm
what is the required history needed before taking a endometrium sample
Age
Date of LMP and length of cycle
Pattern of bleeding
Hormones
Recent pregnancy
what phase of the uterine cycle is least informative
menstrual phase
what is the definition of DUB
irregular uterine bleeding that reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial lining (no organic cause for bleeding)
what are most cases of DUB caused by
anovulatory cycles
what happens in anovulatory cycles
Corpus luteum does not form
Continued growth of functionalis layer
what are causes of an anovulatory cycle
PCOS
hypothalamic dysfunction
thyroid disorders
hyperprolactinaemia
what else can cause DUB
Luteal phase deficiency
what happens in luteal phase deficiency
insufficent progesterone or poor response by the endometrium to progesterone.
Abnormal follicular development (inadequate FSH/LH) – poor corpus luteum
what are organic causes of AUB
endometritis polyp miscarriage adenomyosis leiomyoma
what are causes of endometritis
Neisseria, Chlamydia, TB, HSV
IUCD
post-partum
granulomatous
Chronic plasmacytic endometritis
what is endometritis associated with
leoimyomata
polyps
endometritis can either be chronic or acute - the presence of what indicated it is chronic
plasma cells in the stroma of the endometrium
i.e. Chronic plasmacytic endometritis
what is Chronic plasmacytic endometritis associated with
Pelvic inflammatory disease
what are features of endometrial polyps
common, almost always benign
usually asymptomatic
may present with bleeding or discharge
when do polyps tend to develop
around and after menopause
what can present as a polyp that you need to be aware of
endometrial carcinoma
what is a molar pregnancy
non-viable fertilized egg implants in the uterus (or tube)
either partial or complete
what type of disease is a molar pregnancy
gestational trophoblastic disease
what is the characteristics of a complete mole
caused by single or two sperm combining with an egg that had lost its DNA
»> only PATERNAL DNA is present
what is the characteristics of a partial mole
egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY (triploid).
»> have BOTH DNA
which moles have a higher risk of developing into choriocarcinoma
complete hydatidiform moles
what is adenomyosis
Endometrial glands and stroma within the myometrium
what are Sx of adenomyosis
menorrhagia/dysmenorrhoea
what is leiomyoma [fibroid]
Benign tumour of smooth muscle [found in other places than the uterus]
Sx of leiomyoma/fibroid
menorrhagia
infertility
pain
what is the growth of fibroids dependant on
oestrogen
what is the transformation zone [TZ] seen in the cervixq
Squamo-columnar junction between ectocervical (squamous) and endocervical (columnar) epithelia
what can alter the position of the TZ
menarche
pregnancy
menopause
what is cervical erosion
Exposure of delicate endocervical epithelium to acid environment of vagina
what does cervical erosion lead to
squamous metaplasia
what are Nabothian follicles/cyst
mucus-filled cyst on the surface of the cervix
what causes Nabothian follicles/cyst
caused when stratified squamous epithelium of the ectocervix (toward the vagina) grows over the simple columnar epithelium of the endocervix (toward the uterus)
what is inflammation of the cervix called
Cervicitis
what are Sx of cervicitis
often asymptomatic
vaginal discharge
urinary frequency
dysuria
intermenstrual/postcoital bleeding
what are the 2 time lines of cervicitis
non-specific acute
chronic inflammation
what can cause cervicitis
Chlamydia Trachomatis, HSV, gonorrhoeae, follicular cervicitis
what is follicular cervicitis also know as
Chronic Lymphofollicular Cervicitis
what is follicular cervicitis
inflammation of the sub epithelial reactive lymphoid follicles present in the cervix
what is a cervical polyp
localised inflammatory outgrowth
what HPV are associated with cervical cancer
HPV 16 and 18
what are risk factors for CIN/Cervical cancer
High risk HPV types
Smoking
Immunosuppression
Vulnerability of SC Junction in early reproductive life
- age at first intercourse
- long term use of oral contraceptives
- non-use of barrier contraception
what is the time line of progression from HPV infection to cancer
HPV infection → High grade CIN = 6 months - 3 years
High Grade CIN → Invasive Cancer = 5 -20 years
what is cervical intraepithelial neoplasia (CIN)
Pre-invasive stage of cervical cancer
where does CIN occur
at transformation zone
Sx of CIN
asymptomatic
what causes CIN
dysplasia of squamous cells
what is koilocytosis
squamous epithelial cell that has undergone a number of structural changes, due to HPV infection
what are the degress of CIN
- Normal squamous epithelium
- Koilocytosis
- CIN I
- CIN II
- CIN III
what are the histological changes seen in CIN
Nuclear abnormalities:
- hyperchromasia
- ↑ nucleocytoplasmic ratio
- pleomorphism
Excess mitotic activity above basal layers
Delay in maturation/differentiation»_space; more immature basal cells seen
what is hyperchromasia
dark staining nuclei which is usually due to increased DNA content
what is the criteria for CIN I
Basal 1/3 of epithelium occupied by abnormal cells
Raised numbers of mitotic figures in lower 1/3.
Surface cells quite mature, but nuclei slightly abnormal.
what is the criteria for CIN II
Abnormal cells extend to middle 1/3.
Mitoses in middle 1/3
Abnormal mitotic figures
what is the criteria for CIN III
Abnormal cells occupy full thickness of epithelium.
Mitoses, often abnormal, in upper 1/3.
what makes up the vast majority of cervical tumours
invasive squamous carcinomas
why is invasive squamous carcinomas preventable
develops from pre-existing CIN
can be picked up in screening
staging of invasive squamous cervical cancer goes from stage 1 to 4 - what is stage 1 [A1, A2, B]
Stage 1 A1 - depth up to 3mm, width up to 7mm
Stage 1 A2 - depth up to 5mm, width up to 7mm
Low risk of lymph node metastases
Stage 1B - confined to the cervix
staging of invasive squamous cervical cancer goes from stage 1 to 4 - what is stage 2
spread to adjacent organs (vagina, uterus)
staging of invasive squamous cervical cancer goes from stage 1 to 4 - what is stage 3
involvement of pelvic wall
staging of invasive squamous cervical cancer goes from stage 1 to 4 - what is stage 4
distant metastases or involvement of rectum or bladder
Sx of cervical cancer
abnormal bleeding [post coital/post menopausal/brownish or blood stained vaginal discharge/contact bleeding]
pelvic pain
haematuria/urinary infections
ureteric obstruction/renal failure
what is the spread of squamous carcinoma of the cervix
Local → uterine body, vagina, bladder, ureters, rectum
Lymphatic → early →pelvic, para-aortic nodes
Haematogenous → late → liver, lungs, bone
what is Cervical Glandular Intraepithelial Neoplasia (CGIN)
the pre-invasive phase of endocervical adenocarinoma
where does CGIN originate from
endocervical epithelium
what is Endocervical Adenocarcinoma
5-25% of cervical cancers
worse prognosis that squamous carcinomas
what is the epidemiology of adenocarcinoma
Higher S.E. Class
Later onset of sexual activity
Smoking
HPV = particularly HPV18.
what are the other HPV driven diseases that affect the female reproductive system
Vulvar Intraepithelial Neoplasia, VIN
Vaginal Intraepithelial Neoplasia, VaIN
Anal Intraepithelial Neoplasia, AIN
how does VIN present in young women
often multifocal, recurrent and persistent causing treatment problems.
how does VIN present in older women
greater risk of progression to invasive squamous carcinoma
what does VIN often occur with
CIN
VaIN
who normally gets Vulvar Invasive Squamous Carcinoma
usually elderly women
- can arise on normal tissue or VIN
where does vulvar invasive squamous carcinoma spread to
inguinal lymph nodes
Tx of vulvar invasive squamous carcinoma
radical vulvectomy
inguinal lymphadenectomy
how does vulvar pagets disease present
crusting rash
what do tumour cells in the epidermis in vulvar pages disease contain
mucin
where does the tumour arise from in Pagets
sweat glands in the skins
