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Reproduction SB > Pathology > Flashcards

Pathology Flashcards

1
Q

what are the phases of the ovarian cycle

A

follicular phase
ovulation
luteal phase

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2
Q

what are the phases of the uterine cycle

A

menstrual phase
proliferative phase
secretory phase

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3
Q

what is the timeline for the phases of the uterine cycle

A 
proliferative = day 1 - 14
secretory = day 16 - 28
menstrual = day 1 - 3
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4
Q

what hormone is mainly present during the proliferative phase

A

oestrogen

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5
Q

what hormone is mainly present during the secretory phase

A

progesterone

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6
Q

what are causes of abnormal uterine bleeding [AUB] in the young

A

DUB usually due to anovulatory cycles

Pregnancy/miscarriage

Endometritis

Bleeding disorders

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7
Q

what are causes of abnormal uterine bleeding [AUB] in the perimenopause

A 
pregnancy/miscarriage 
DUB
endometritis 
leiomyoma [fibroid - smooth muscle tumour]
adenomyosis 
neoplasia [cervical, endometrial]
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8
Q

what are causes of abnormal uterine bleeding [AUB] in the post menopause

A 
Atrophy
Endometrial polyp
Exogenous hormones: HRT
Endometritis
Bleeding disorders

Sarcoma
Endometrial carcinoma

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9
Q

what endometrial thickness in post menopausal women is taken as an indication for biopsy

A

> 4mm

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10
Q

what endometrial thickness in pre-menopausal women is taken as an indication for biopsy

A

> 16 mm

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11
Q

what is the required history needed before taking a endometrium sample

A

Age

Date of LMP and length of cycle

Pattern of bleeding

Hormones

Recent pregnancy

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12
Q

what phase of the uterine cycle is least informative

A

menstrual phase

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13
Q

what is the definition of DUB

A

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)

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14
Q

what are most cases of DUB caused by

A

anovulatory cycles

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15
Q

what happens in anovulatory cycles

A

Corpus luteum does not form

Continued growth of functionalis layer

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16
Q

what are causes of an anovulatory cycle

A

PCOS
hypothalamic dysfunction
thyroid disorders
hyperprolactinaemia

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17
Q

what else can cause DUB

A

Luteal phase deficiency

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18
Q

what happens in luteal phase deficiency

A

insufficent progesterone or poor response by the endometrium to progesterone.

Abnormal follicular development (inadequate FSH/LH) – poor corpus luteum

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19
Q

what are organic causes of AUB

A 
endometritis 
polyp
miscarriage
adenomyosis 
leiomyoma
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20
Q

what are causes of endometritis

A

Neisseria, Chlamydia, TB, HSV
IUCD
post-partum
granulomatous

Chronic plasmacytic endometritis

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21
Q

what is endometritis associated with

A

leoimyomata

polyps

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22
Q

endometritis can either be chronic or acute - the presence of what indicated it is chronic

A

plasma cells in the stroma of the endometrium

i.e. Chronic plasmacytic endometritis

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23
Q

what is Chronic plasmacytic endometritis associated with

A

Pelvic inflammatory disease

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24
Q

what are features of endometrial polyps

A

common, almost always benign

usually asymptomatic

may present with bleeding or discharge

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25
Q

when do polyps tend to develop

A

around and after menopause

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26
Q

what can present as a polyp that you need to be aware of

A

endometrial carcinoma

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27
Q

what is a molar pregnancy

A

non-viable fertilized egg implants in the uterus (or tube)

either partial or complete

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28
Q

what type of disease is a molar pregnancy

A

gestational trophoblastic disease

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29
Q

what is the characteristics of a complete mole

A

caused by single or two sperm combining with an egg that had lost its DNA
»> only PATERNAL DNA is present

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30
Q

what is the characteristics of a partial mole

A

egg is fertilized by two sperm or by one sperm which reduplicates itself yielding the genotypes of 69,XXY (triploid).
»> have BOTH DNA

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31
Q

which moles have a higher risk of developing into choriocarcinoma

A

complete hydatidiform moles

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32
Q

what is adenomyosis

A

Endometrial glands and stroma within the myometrium

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33
Q

what are Sx of adenomyosis

A

menorrhagia/dysmenorrhoea

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34
Q

what is leiomyoma [fibroid]

A

Benign tumour of smooth muscle [found in other places than the uterus]

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35
Q

Sx of leiomyoma/fibroid

A

menorrhagia
infertility
pain

36
Q

what is the growth of fibroids dependant on

A

oestrogen

37
Q

what is the transformation zone [TZ] seen in the cervixq

A

Squamo-columnar junction between ectocervical (squamous) and endocervical (columnar) epithelia

38
Q

what can alter the position of the TZ

A

menarche
pregnancy
menopause

39
Q

what is cervical erosion

A

Exposure of delicate endocervical epithelium to acid environment of vagina

40
Q

what does cervical erosion lead to

A

squamous metaplasia

41
Q

what are Nabothian follicles/cyst

A

mucus-filled cyst on the surface of the cervix

42
Q

what causes Nabothian follicles/cyst

A

caused when stratified squamous epithelium of the ectocervix (toward the vagina) grows over the simple columnar epithelium of the endocervix (toward the uterus)

43
Q

what is inflammation of the cervix called

A

Cervicitis

44
Q

what are Sx of cervicitis

A

often asymptomatic

vaginal discharge
urinary frequency
dysuria
intermenstrual/postcoital bleeding

45
Q

what are the 2 time lines of cervicitis

A

non-specific acute

chronic inflammation

46
Q

what can cause cervicitis

A

Chlamydia Trachomatis, HSV, gonorrhoeae, follicular cervicitis

47
Q

what is follicular cervicitis also know as

A

Chronic Lymphofollicular Cervicitis

48
Q

what is follicular cervicitis

A

inflammation of the sub epithelial reactive lymphoid follicles present in the cervix

49
Q

what is a cervical polyp

A

localised inflammatory outgrowth

50
Q

what HPV are associated with cervical cancer

A

HPV 16 and 18

51
Q

what are risk factors for CIN/Cervical cancer

A

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
52
Q

what is the time line of progression from HPV infection to cancer

A

HPV infection → High grade CIN = 6 months - 3 years

High Grade CIN → Invasive Cancer = 5 -20 years

53
Q

what is cervical intraepithelial neoplasia (CIN)

A

Pre-invasive stage of cervical cancer

54
Q

where does CIN occur

A

at transformation zone

55
Q

Sx of CIN

A

asymptomatic

56
Q

what causes CIN

A

dysplasia of squamous cells

57
Q

what is koilocytosis

A

squamous epithelial cell that has undergone a number of structural changes, due to HPV infection

58
Q

what are the degress of CIN

A
  1. Normal squamous epithelium
  2. Koilocytosis
  3. CIN I
  4. CIN II
  5. CIN III
59
Q

what are the histological changes seen in CIN

A

Nuclear abnormalities:

  • hyperchromasia
  • ↑ nucleocytoplasmic ratio
  • pleomorphism

Excess mitotic activity above basal layers

Delay in maturation/differentiation&raquo_space; more immature basal cells seen

60
Q

what is hyperchromasia

A

dark staining nuclei which is usually due to increased DNA content

61
Q

what is the criteria for CIN I

A

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.

62
Q

what is the criteria for CIN II

A

Abnormal cells extend to middle 1/3.

Mitoses in middle 1/3

Abnormal mitotic figures

63
Q

what is the criteria for CIN III

A

Abnormal cells occupy full thickness of epithelium.

Mitoses, often abnormal, in upper 1/3.

64
Q

what makes up the vast majority of cervical tumours

A

invasive squamous carcinomas

65
Q

why is invasive squamous carcinomas preventable

A

develops from pre-existing CIN

can be picked up in screening

66
Q

staging of invasive squamous cervical cancer goes from stage 1 to 4 - what is stage 1 [A1, A2, B]

A

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

67
Q

staging of invasive squamous cervical cancer goes from stage 1 to 4 - what is stage 2

A

spread to adjacent organs (vagina, uterus)

68
Q

staging of invasive squamous cervical cancer goes from stage 1 to 4 - what is stage 3

A

involvement of pelvic wall

69
Q

staging of invasive squamous cervical cancer goes from stage 1 to 4 - what is stage 4

A

distant metastases or involvement of rectum or bladder

70
Q

Sx of cervical cancer

A

abnormal bleeding [post coital/post menopausal/brownish or blood stained vaginal discharge/contact bleeding]

pelvic pain

haematuria/urinary infections

ureteric obstruction/renal failure

71
Q

what is the spread of squamous carcinoma of the cervix

A

Local → uterine body, vagina, bladder, ureters, rectum

Lymphatic → early →pelvic, para-aortic nodes

Haematogenous → late → liver, lungs, bone

72
Q

what is Cervical Glandular Intraepithelial Neoplasia (CGIN)

A

the pre-invasive phase of endocervical adenocarinoma

73
Q

where does CGIN originate from

A

endocervical epithelium

74
Q

what is Endocervical Adenocarcinoma

A

5-25% of cervical cancers

worse prognosis that squamous carcinomas

75
Q

what is the epidemiology of adenocarcinoma

A

Higher S.E. Class
Later onset of sexual activity
Smoking
HPV = particularly HPV18.

76
Q

what are the other HPV driven diseases that affect the female reproductive system

A

Vulvar Intraepithelial Neoplasia, VIN

Vaginal Intraepithelial Neoplasia, VaIN

Anal Intraepithelial Neoplasia, AIN

77
Q

how does VIN present in young women

A

often multifocal, recurrent and persistent causing treatment problems.

78
Q

how does VIN present in older women

A

greater risk of progression to invasive squamous carcinoma

79
Q

what does VIN often occur with

A

CIN

VaIN

80
Q

who normally gets Vulvar Invasive Squamous Carcinoma

A

usually elderly women

- can arise on normal tissue or VIN

81
Q

where does vulvar invasive squamous carcinoma spread to

A

inguinal lymph nodes

82
Q

Tx of vulvar invasive squamous carcinoma

A

radical vulvectomy

inguinal lymphadenectomy

83
Q

how does vulvar pagets disease present

A

crusting rash

84
Q

what do tumour cells in the epidermis in vulvar pages disease contain

A

mucin

85
Q

where does the tumour arise from in Pagets

A

sweat glands in the skins

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