Pathology Flashcards
what are the ovarian stages of the menstrual cycle
follicular (development of follicles)
ovulation
luteal phase (development of corpus luteum, end in pregnancy/ start of period)
what are the uterine phases of the menstrual cycle
menstrual phase
proliferative phase
secretory phase
how long does the proliferative (uterine) phase of menstruation usually last
14 days- is same in most women
what happens to the endometrium in the different uterine phases of menstruation - which hormones are in control in each phase
proliferative- grows, oestrogen
secretory- builds secretions, progesterone
menstrual- necrosis, sheds, withdrawal of progesterone
what happens to the endometrium after fertilisation- what hormones are in control
hypersecretion, decidualisation
progesterone and HCG
at what days in the cycle do the different uterine phases of menstruation happen
proliferative- D1-12
secretory- D16-28
menstrual D1-3
what happens to the endometrium post menopause
is inactive/ atrophic
non cycling
what secretes the porgesterone needed in the secretory phase
corpus luteum
what is a graafia follicle
mature vesicular follicles= ooctye + granulosa cells
what is seen histologically in the proliferative stage
glandular epithelium
glands are very circular
what is the corpus albicans
what happens when the corpus luteum degenerates
what is seen histologically in the secretory phase
increasing tortuosity of glands
lumenal secretions
what are the indications for endometrial sampling (biopsy)
abnormal uterine bleeding
investigation for infertility
spontaneous and therapeutic abortion (looking for molar pregnancy)
assessment of response to hormonal therapy
endometrial ablation
work up prior to hysterectomy for benign indications
incidental finding of thickened endometrium on scan
endometrial cancer screening in high risk patients
what increases your risk of endometrial cancer
obesity
what is menorrhagia
prolonged and increased menstrual flow
what is metrorrhagia
regular intermenstrual bleeding
what is polymenorrhoea
menses occurring at <21 day interval
what is polymenorrhagia
increased bleeding and frequent cycle
what is menometrorrhagia
prolonged menses and intermenstrual bleeding
what is amenorrhagia
absence of menstruation > 6 months
what is oligomenorrhoea
menses at intervals of > 35 days
what does DUB stand for
dysfunctional uterine bleeding
what is post menstrual bleeding
abnormal uterine bleeding after > 1 year of no bleeding
what can cause AUB in adolescence/ early reproductive life
usually caused by anovulatory cycles (ovum not released)
pregnancy/ miscarriage
endometritis
bleeding disorders
what is endomitritis
inflammation of the uterus lining, usually due to infection
what can cause AUB during reproductive age/ perimenopause
pregnancy/ miscarriage
DUB (anovulatory cycles, luteal phase defects)
endomitritis
endometrial/ endocervical polyp
leiomyoma (smooth muscle tumour- aka fibroid)
adenomyosis (endometrial tissues (glands and stroma) within the myometrium (muscle of uterus))
exogenous hormone effects
bleeding disorders
hyperplasia
neoplasia- cervical, endometrial
what are the causes of AUB post menopause
atrophy (will cause tiny amount on bleeding, only once)
endometrial polyp
exogenous hormones (HRT- causes some proliferation of endometrium, tamoxifen (taken in breast cancer, has proestrogenic effect))
endometritis
bleeding disorders
hyperplasia
endometrial carcinoma
sarcoma
what are the methods of assessing the endometrium
transvaginal US- endometrial thickness of >4mm in postmenopausal women (16mm in premenopausal) is indication for a biopsy
hysteroscopy
what are the methods of sampling the endometrium
endometrial pipelle (no dilatation/ anaesthesia, outpatient, safe but limited sample)
dilatation and curretage (most thorough sampling methods, can miss 5% hyperplasia/ cancers)
what history details are required on a endometrial sample
age date of LMP and length of cycle patterns of bleeding hormones recent pregnancy
when in menstrual cycle do you not want to take an endometrial cycle
in menstrual phase (as least informative sample)
what is dysfunctional uterine bleeding
irregular bleeding that reflects a disruption in the normal cyclic pattern of ovulatory hormonal stimulation to the endometrial linging
(= AUB but with no organic cause, is cause by hormone problem)
what causes the majority of dysfunctional uterine bleeding
anovulatory cycles
what are anovulatory cycles
when corpus luteum does not form
get continued disordered proliferation of functionalis layer of endometrium as a result as no progesterone
happens mostly in either end of reproductive age, due to e.g. PCOS, hypothalamic dysfunction, thyroid disorders, hyperprolactinaemia
what is luteal phase deficiency
insufficient progesterone or poor response by the endometrium to progesterone
causes abnormal follicular development (inadequate FSH/LH) = poor corpus luteum
what is seen histologically in the ednometrium in an anovulatory cycle
disorder proliferation
glands and stroma continue to grow
grands become wiggly shape and are not filled with any secretions
what are the organic causes of abnormal uterine bleeding
endometrium: endometritis, polyps, miscarriage
myometrium: adenomyosis, leiomyoma
what protects the endometrium from infection
cervical mucous plug
cyclical shedding
how is endometritis diagnosed histologically
abnormal pattern of inflammatory cells
what organisms commonly cause endometritis
neisseria chlamydia TB CMV actinomyces (fungal organisms associated with intrauterine contraceptive device) HSV
what are the causes of inflammation in endometritis without specific causative organisms
IUC device postpartum postaboral post curettage chronic endometritis granulomatous (sarcoidosis, foreign body post ablation) associated with leiomyomata or polyps
what is associated with plasmacytic endometritis
pelvic inflammatory disease:
- neiserria gonorrhoea
- chlamydia
- enteric organisms
will see plasma cell on histology
what do you get granulomatous endometritis is
TB, sarcoidosis
what are granulomas
balls of epithelial macrophages
what is the presentation of endometrial polyps
common
usually asymptomatic but may present with bleeding or discharge
often occur around and after the menopause
almost always benign
can tort or become ulcerated
what cancer can present as an endometrial polyp
endometrial carcinoma
what do you want to exlcude after miscarriage
a molar pregnancy
what is seen histologically of a miscarriage
chorionic villi - subunits of early placenta (these will have the DNA of the foetus)
can also have products of conception (foetal tissue, foetal RBCs)
what is a molar pregnancy
an abnormal form of pregnancy in which a non viable fertilised egg implants in the uterus (or fallopian tube)
a form of gestational trophoblastic disease which grows as a mass (characterised by swollen villi)
what are the types of molar pregnancy
complete- when one or two sperm combine with a egg that has lost its DNA, sperm then replicates to form a 46 chromosome set, only parental DNA is present
partial- when egg is fertilised by two sperm/ one sperm that reduplicates itself yielding the genotypes 69XXY (triploid), has both maternal and paternal DNA
which type of molar pregnancy is highest risk
complete hydatidiform moles have a higher risk of developing into choricarcinoma (a malignant tumour of trophoblast) which can grow and spread outwith the uterus
partial has low risk of complications
what is seen histologically in a molar pregnancy
abnormally proliferating trophoblast
chorionic villus
what does hydatid form mean
swollen
what is adenomyosis
when there are endometrial glands and stroma within the myometrium
what does adenomyosis cause
menorrhagia/ dysmenorrhoea
what is a leiomyoma
benign tumour of smooth muscle
found in locations other than uterus
what can leiomyomas present with
menorrhagia
infertility
mass effect
pain
what are the pathological features of a leiomyoma
can be single or multiple
mas distort uterine cavity
growth is oestrogen dependent
microscopically can see interlacing smooth muscle (spindle) cells
what is a leiomyosarcoma
malignant leiomyoma (rare)
what cells line the ectocervix (vaginal portion)
squamous epithelium
not keratinised
continuous with vaginal epithelium
what cells line the endocervix
glandular columnar epithelium
single layer of mucinous epithelium
what is the transformation zone
Squamo-columnar junction between ectocervical (squamous) and endocervical (columnar) epithelia
what happens to the position of the transformation zone throughout life
starts further out, moves towards cervix during menache as hormones make vagina more acidic = cervical erosion= physiological squamous metaplasia
what are nabothian follicles
dilated endocervical glands that form colloid structure when they dilate, benign
what is metaplasia
when one mature epithelium changes into another type of a mature epithelium
what are the features of cervicitis
often asymptomatic
can lead to infertility due to simultaneous fallopian tube damage
what can cause cervicitis
- non specific acute/ chornic inflammation
- follicular cervicitis- sub epithelial reactive lymphoid follicles present in cervix
- chlamydia trachomatis- sexually transmitted
- HSV infection
what are the features of a cervical polyp
localised inflammatory outgrowth
cause bleeding if ulcerated
not premalignant
usually always benign
what are the types of cervical carcinoma
squamous carcinoma
adenocarcinoma
what is CIN
cervical intraepithelial neoplasia- precursor lesion of cervical cancer, dysplasia of squamous cells
(pre invasive stage of cervical cancer)
how does HPV cause cancer
will infect basal cells
virus replicates within epithelial cells
intraepithelial hyperplasia
invasive cancer - virus integrated into host DNA
what are the high risk types of HPV
16,18
what are the risk factors for CIN/ cervical cancer
HPV infection (increased risk with increase no of sexual partners)
vulnerability of SC junction in early reproductive age (young age at first intercourse, long term use of oral contraceptives, non barrier contraception)
smoking
immunosuppression
what are the low risk types of HPV
6 and 11
what is the pathology of genital warts
HPV types 6 and 11
condyloma acuminatum:
-thicken papillomatous squamous epithelium with cytoplasmic vacuolation (koilocytosis)
what types of HPV cause genital warts
6 and 11
what is the pathology of cervical intraepithelial neoplasia due to HPV infection
types 16 and 18
infection epithelium remains flat
may show koilocytosis
what is koilocytosis
changes in epithelial cells due to HPV infection
normal -> koilocytosis -> CIN 1 -> CIN 2 -> CIN3
what happens to host DNA in invasive squamous carcinoma
HPV dna intergrated into host dna
when does cancer become cancer
when breaks away from/ through basal membrane
how long till HPV infection becomes high grade CIN and invasive cancer
high grade CIN= 6 months to 3 years
invasive cancer 5-20 years
what in the life process of HPV increases the risk of disease
persistence of the disease
what is the prevalence of HPV
15-25years 30-50%
25-35years 10-20%
>35years 5-15%
80% cumulative prevalence in a lifetime
what is dyskaryosis
abnormal cytologic changes of squamous epithelial cells characterized by hyperchromatic nuclei and/or irregular nuclear chromatin
seen in HPV
what changes happen to cells in HPV infection
big nucleus in relation to cytoplasm
where does CIN affect
transformation zone
can involve large area
how is CIN discorvered
asymptomatic
not visible to naked eye
detected by cervical smear
What are the histological features of CIN
Delay in maturation/differentiation: -immature basal cells occupying more of epithelium Nuclear abnormalities: -hyperchromasia -increased nucleocytoplasmic ratio -pleomorphism Excess mitotic activity -situated above basal layers -abnormal mitotic forms
Often koilocytosis (indicating HPV infection) also present
where should mitotic activity happen
on in basal layer
how is CIN graded
1-3 depending on histological factors
what are the features of CIN 1
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 are the features of CIN 2
Abnormal cells extend to middle 1/3.
Mitoses in middle 1/3
Abnormal mitotic figures
what are the features of CIN 3
Abnormal cells occupy full thickness of epithelium.
Mitoses, often abnormal, in upper 1/3.
when does dysplasia become cancer
when abnormal cells goes through basement membrane (stromal invasion)
what is the most common type of malignant cervical cancer
invasive squamous carcinoma
what does invasive squamous carcinoma develop form
CIN
preventable bu screening
what type of lesion is CIN
squamous
how common and severe is cervical cancer
2nd most common worldwide, 12th in scotland
70.1% 5 year survival
what are the stages of invasive squamous carcinoma
Stage 1A1 - depth up to 3mm, width up to 7mm
Stage 1A2 - depth up to 5mm, width up to 7mm
Low risk of lymph node metastases
Stage 1B - confined to the cervix
Stage 2 - spread to adjacent organs (vagina, uterus, etc..)
Stage 3 - involvement of pelvic wall
Stage 4 - distant metastases or involvement of rectum or bladder.
what does the treatment of invasive squamous carcinoma depend on
if spread outwith cervix- chemo + radio
if not then radical hysterectomy
what are the symptoms of invasive squamous cervical carcinoma
Usually none at microinvasive and early invasive stages (detected at screening) Abnormal bleeding: -Post coital -Post menopausal -Brownish or blood stained vaginal discharge -Contact bleeding – friable epithelium Pelvic pain Haematuria / urinary infections Ureteric obstruction / renal failure
how does squamous carcinoma spread
Local -> uterine body, vagina bladder, ureters, rectum
Lymphatic (early) -> pelvic, para-aortic nodes
Haematogenous (late) -> liver, lungs, bone
is squamous carcinoma or adenocarcinoma in cervix more common
squamous more common
what is CGIN
cervical glandular intraepithelial neoplasia - preinvasive phase of endocervical adenocarcinoma
what cells does CGIN originate from
endocervical epithelium (some are mixed)
why is CGIN harder to diagnose that CIN
more difficult to diagnose on a smear
screening less effective
what causes CGIN
HPV
what is CGIN sometimes associated with
CIN
what are the histological features of CGIN
Glands colonized by CGIN
Big nuclei, mitotic figures
does cervical squamous or adenocarcinoma have worst prognosis
endocervical adenocarcinoma has poorer prognosis
what is the epidemiology of cervical adenocarcinoma
Higher S.E. (socioeconomic) Class than CIN
Later onset of sexual activity
Smoking
HPV again incriminated, particularly HPV18.
what is VIN, VaIN, AIN
Vulvar Intraepithelial Neoplasia, VIN (aka pagets disease)
Vaginal Intraepithelial Neoplasia, VaIN
Anal Intraepithelial Neoplasia, AIN
what are the features of vulvar intraepithelial disease
variable behaviour- less predictable than CIN
Young women: often multifocal, recurrent or persistent causing treatment problems.
Older women: greater risk of progression to invasive squamous carcinoma.
often HPV related (non HPV related associated with lichen sclerosis/ planus - inflammatory conditions)
often also have CIN and VaIN
what are the features of vulvar invasive squamous carcinoma
Usually elderly women, ulcer or exophytic mass.
Can arise from normal epithelium or VIN.
Mostly well differentiated (verrucous are an extremely well differentiated type).
what is the most important prognostic factor for vulvar invasive squamous carcinoma
spread to inguinal lymph nodes
90% 5 year survival – node negative
<60% 5 year survival – node positive
what is the treatment for vulvar invasive squamous carcinoma
Surgical treatment – radical vulvectomy and inguinal lymphadenectomy.
what are the features of vulvar pagets disease
Crusting rash.
Tumour cells in epidermis, contain mucin.
Mostly no underlying cancer, tumour arises from sweat gland in skin (intrapeothelial)
can have underlying cancer
Spreads along the vulva and ometimes to anus, vaginal, thighs
Painful, itchy, weeping, oozing
what infection affect the vulva
Candida (Particularly diabetics)
Vulvar warts (HPV 6 & 11)
Bartholin’s gland abscess (blockage of gland duct)
are are non neoplastic vulval disorders
(inflammatory diseases) Lichen Sclerosis Other dermatoses Lichen planus Psoriasis
when do women get vulva atrophy
post menopausal
what do women with Vaginal intraepithelial neoplasia often have
cervical and vulval lesions
who gets vaginal squamous carcinoma
elderly women
Less common than cervical and vulval counterparts
can you get vaginal melanoma
yes
are primary cancers of the vagina common
Cancer of vagina has usually spread from somewhere near by
Primary cancers of vagina rare- but if it is will be squamous or melanoma
Pale nodules separate from each other, circular, whirled surface, round and well circumscribed, no areas of necrosis/ haemorrhage, in uterus= ?
leiomyoma (fibroid, benign tumour of smooth muscle)
when does a cancer become microinvasive
when it breaks through the BM
where do carcinomas almost always spread first
lymphatics
what are the symptoms of ovarian cancer
vague- abdo discomfort, bloating
are ovarian and testicular teratomas benign or malignant
ovarian almost always benign
testes almost always malignant
Endometrial glands and stroma outside the wall of the uterus= ?
endometriosis
what do complete molar pregnancies carry the risk of
choriocarcinoma
what are the causes of dysfunctional uterine bleeding
endometrial polyps endometrial hyperplasia (simple, complex or atypical - precursor of carcinoma)
are endometrial polyps common
yes
often occur around/ after the menopause
are endometrial polyps usually benign or malignant
typically benign, can be malignant
what causes endometrial hyperplasia
often unknown
can be persistent oestrogen stimulation
how does endometrial hyperplasia present
abnormal bleeding (dysfunctional uterine or postmenopausal)
what are the differences between simple, complex and atypical endometrial hyperplasia
simple- general distrubtion of stroma and (dilated but not crowded) glands, normal cytology
complex= focal distribution of crowded glands with normal cytology
atypical= focal distribution of crowded glands with atypical cytology (nuclei enlarged and no longer line along bases of cells, change in colour)
what is the management of atypical endometrial hyperplasia with no other risk factors
hysterectomy (high risk of progression to cancer)
what happens to endometrial glands in hyperplasia
become bigger, less circular, cystically dilated
loose stroma between glands
what hystological sign means endometrial hyperplasia has become cancer
when glands start to fuse
who gets endometrial cancer
Peak incidence 50 ‐ 60 years; uncommon under 40
In young women, consider underlying predisposition e.g. polycystic ovary syndrome or Lynch syndrome (HNPPC)
what cancers does lynch syndrome increase the risk of
colorectal
endometrial
ovarian
what are the two main types of endometrial cancer
endometriod carcinoma (most common) serous carcinoma
how does endometrial cancer generally present
abnormal bleeding (typically post menopausal)
what is the precursor lesion for endometrioid carcinoma
atypical hyperplasia
usually due to high levels of oestrogen stimulating the endometrium (obesity)
what is the precursor lesion for serous endometrial carcinoma
serous intraepithelial carcinoma = atrophic endometrium- occurs in older women
what does an endometrial carcinoma look like macroscopically
large uterus that is polypoid
what are the majority of endometrial carcinomas
well differentiated (grade 1) adenocarcinoma (endometrioid)
how do endometrial carcinomas spread
directly into myometrium and cervix
lymphatics
haematogenous
what biopsy for suspected endometrial carcinoma
pipelle
Tx for endometrial carcinoma
depends on grade: 1= surgery , 2-3= scan to see if spread, don’t want to remove uterus when tumour has already spread - chemo and radio
which type of endometrial carcinoma is more likely to spread
serous
what are the features of endometrioid and mucinous carcinomas
adenocarcinomas
80% of endometrial cancer
related to unopposed oestrogen
associated with atypical hyperplasia precursor lesion
PTEN, KRAS, PIK3CA mutations
microsatellite instability (short strands of DNA within cells, lynch syndrome)
what are the features of serous and clear cell endometrial carcinomas
not associated with unopposed oestrogen
affects elderly post menopausal women
TP53 often mutated and overexpressed (makes it more aggressive)
serous and clear cell phenotypes
precursor lesion serous endometrial intrapepithelial carcinoma
more aggressive than endometrioid/ mucinous carcinoma- surgery more extensive and adjuvant chemo/radio often used
why is obesity a risk factor for endometrial cancer
the endocrine and inflammatory effects of adipose tissue:
Adipocytes express aromatase that converts ovarian androgens into oestrogens, which induce endometrial proliferation.
Sex hormone-binding globulin levels are lower in obese women, and therefore the level of unbound, biologically active hormone is higher.
Insulin action is often altered in obese women: The level of insulin-binding globulins is reduced and free insulin levels are elevated. Insulin/insulin-like growth factors (IGF) exert proliferative effect on endometrium.
how can you reduce the risk of obesity and endometrial cancer
lose weight lol
what is lynch syndrome
hereditary non polyposis colorectal cancer
cancer predisposition syndrome (colorectal, ovarian and endometrial)
defective DNA mismatch repair gene
AD inheritance
how can tumour due to lynch syndrome be identified
Immunohistochemistry staining of the tumour for mismatch repair proteins
Lynch syndrome tumours also show microsatellite instability (MSI), a characteristic of defective mismatchrepair
how do serous/ clear cell carcinomas (endometrial) spread
along fallopian tube mucosa and peritoneal surfaces
can present with extrauterine disease
what are the characteristics histologically of serous carincoma
complex papillary and/or glandular architecture with diffuse, marked nuclear pleomorphism
why does endometrioid carcinoma usually have a good prognosis
as usually confined to
uterus at presentation
what does the prognosis of endometrial carcinoma depend on
Stage
Histological grade
Depth of myometrial invasion
what are the treatment options for endometrial carcinoma
hysterectomy
chemo/ radio
how are endometrial cancers graded
Endometrioid carcinoma are primarily graded by their architecture (how well differentiated they are)
Grade 1 5% or less solid growth
Grade 2 6-50% solid growth
Grade 3 >50% solid growth
Serous carcinoma and clear cell carcinoma are not formally graded
what are the stages of endometrial cancer
Stage I Tumour confined to the uterus
IA no or < 50% myometrial invasion
IB Invasion equal to or > 50% of myometrium
II Tumour invades cervical stroma
III Local and or regional tumour spread
IIIA Tumour invades serosa of uterus and/or adnexae
IIIB Vaginal and/or parametrial involvement
IIIC Metastases to pelvic and/or para-aortic lymph nodes
IV Tumour invades bladder and or bowel mucosa (IVA) and/or distant metastases (IVB)
where are the lymphatic and vessels of the myometrium
outer half
what are the less common endometrial tumours
Endometrial stromal sarcoma (Tumour arising from endometrial stroma)
Carcinosarcoma- (produces mesenchyma tissue- forms malignant cartilage, bone and neural tissue
Mixed tumour with malignant epithelial and stromal elements)
what are the features of endometrial stromal sarcoma
Rare, cells resemble endometrial stroma.
histologically looks like stroma separating the myometrium- destructive growth
Infiltrate myometrium and often lymphovascular spaces
Typically presents with abnormal uterine bleeding but initial presentation may be as metastasis (most commonly ovary or lung)
what is usually the outcome of a endometrial carcinosarcoma
usually poor
worse is phabdomyosarcomatous component present
what are the macroscopic characteristics of a carcinosarcoma
Large bulky tumour filling cavity, commonly protrudes through the cervical canal.
what are the smooth muscle tumours of the myometrium
Leiomyoma (fibroid)- very common
Leiomyosarcoma (rare)
what are leiomyomas associated with
menorrhagia
infertility
what is a leiomyosarcoma
A malignant smooth muscle tumour commonly displaying a spindle cell morphology
The most common uterine sarcoma
how do leiomyosarcomas present
Most occur in women >50 years
abnormal vaginal bleeding, palpable pelvic mass and pelvic pain
what is the prognosis of leiomyosarcoma
Poor prognosis even if confined to uterus at time of diagnosis
Overall 5 year survival rates 15-25%, stage is most powerful prognostic factor
what are the types of ovarian cyst
(can arise from any element of the ovary)
- follicular (PCOS)
- luteal (corpus luteum)
- endometriotic
- epithelial
- mesothelial
what are the features of a follicular ovarian cyst
very common
can form when ovulation doesnt occur (PCOS)- follicle doesnt rupture, grows until it becomes a cyst
thin walled lined by granulosa cells
usually resolve after a few months
what is endometriosis
endometrial glands and stroma outside the uterine body
what can endometriosis cause
pelvic inflammation
infertility (scarring and adhesions can affect petency of fallopain tube, compression of ovary can cause loss of normal parenchyma)
pain
what are the possible sites of endometriosis
ovary (chocolate cysts) pouch of douglas peritoneal surfaces (inc uterus) cervix vulva vagina bladder bowel
what is endometrioma
ovarian endometriosis
endometrial tissue on the ovary
what causes ovarian endometriosis
regurgitation of tissue
metaplasia
vascular or lymphatic dissemination
what is the macroscopic appearance of ovarian endometriosis
peritoneal spots or nodules
fibrous adhesions
chocolate cysts
what is the microscopic appearance of ovarian endometriosis
endometrial glands and stroma
haemorrhage, inflammation, fibrosis
what are the possible complications of endometriosis
pain
cyst formation
adhesions
infertility
ectopic pregnancy (caused by scarring and fusions of pilecae of tube- finger like processes in lumen)
malignancy (endometrioid carcinoma/ clear cell)
what are the types of ovarian tumours
epithelial- most common malignant (serous, mucinous, endometrioid, clear cell, brenner) -germ cell (teratoma) -sex-cord/ stromal -metastatic others
what are the types epithelial ovarian tumours
serous mucinous endometrioid clear cell brenner undifferentiated carcinoma
why do you get epithelial tumour of ovary when no epithelium in ovary (mesothelium covering stroma and eggs)
as when eggs break through mesothelium some cells get dragged back into ovary and under go metaplasia
how are epithelial ovarian tumours subdivided
benign: No Cytological abnormalities, proliferative activity absent or scant, no stromal invasion
borderline: Cytological abnormalities, proliferative, no stromal invasion
malignant: stromal invasion
how are serous ovarian carcinomas divided
into low or high grade as have different precursor lesion
-High grade serous carcinoma
Serous tubal intraepithelial carcinoma (STIC)
Most cases are essentially tubal in origin
-Low grade serous carcinoma
Serous borderline tumour
what are endometrioid and clear cell ovarian cancer associated with
endometriosis of the ovary
lynch syndrome
are endometrioid cancer usually good or bad
usually low grade and early stage
how is the diagnosis of endometrioid cancer of ovary usually made
cytology of ascitic fluid
what is a brenner tumour
tumour of ovary
transitional type epithelium
usually benign
borderline/ malignant variants rare
what makes up a teratoma
cystic, containing sebum and hair ectoderm, mesoderm and endoderm skin, respiratory epithelium, gut, fat common can rarely become malignant arises from germ cell in ovary
what is a dermoid cyst
mature teratoma
what is the most common germ cell tumour
mature teratoma
what are the other types of teratoma
Immature teratoma Dysgerminoma (most common malignant, almoat always in children and young women) Yolk sac tumour Choriocarcinoma Mixed germ cell tumour
what are the ovarian sex chord/ stromal tumour
Fibroma/Thecoma
Benign
-May produce oestrogen causing uterine bleeding
Granulosa cell tumour
- All are potentially malignant
- May be associated with oestrogenic manifestations (thickened endometrium and bleeding)
Sertoli-Leydig cell tumours
-Rare, may produce androgens
what cancers can metastasise to ovaries
stomach
colon
breast
pancreas
what do mets to the ovaries look like
bilateral and small
how is ovarian cancer staged
1A tumour limited to one ovaries
1B tumour limited to both ovaries
1C Cancer involving ovarian surface/
rupture/surgical spill/tumour in washings
2A Extension or implants on uterus/fallopian tube
2B Extension to other pelvic intraperitoneal
3A Retroperitoneal lymph node
Metastasis or microscopic extrapelvic peritoneal involvement
3B Macroscopic peritoneal metastasis beyond pelvis up to 2cm in dimension
3C Macroscopic peritoneal metastasis >2cm in dimension
4 Distant metastasis
what is salpingitis
inflammation of the fallopian tube due to infection
what cancer can you get in the fallopian tubes
Serous tubal intraepithelial carcinoma
what is an ectopic pregnancy
Implantation of a conceptus outside the endometrial cavity
where can ectopic pregnancies happen
Commonest site is Fallopian tube (often ruptures)
May occur in ovary, peritoneum, cervix, interstitial (myometrium)
how might an ectopic pregnancy be fatal for women
fatal haemorrhage
what is the presentation of an ectopic pregnancy
female of reproductive age with amenorrhoea and acute hypotension or an acute abdomen
