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RE > Pathology of the Female Reproductive Tract Part 2 > Flashcards

Pathology of the Female Reproductive Tract Part 2 Flashcards

1
Q

Clinical Features

A

insert diagram

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2
Q

What are the main risk factors for endometroid-type adenocarcinoma of the uterus?

A
  • unopposed oestrogen exposure = cause
  • EIN (endometrial intraepithelial neoplasia)
  • endometrial hyperplasia
  • PCOS, high BMI, nulliparity
  • younger women, perimenopausal
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3
Q

What are the main risk factors for non-endometroid type adenocarcinoma of the uterus?

A
  • aetiology = unsure
  • metaplastic/neoplastic change in atrophic
    endometrium
  • associated with p53 mutations
  • post-menopausal women
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4
Q

What are the main risk factors for Endometrial stromal Sarcomas?

A
  • aetiology = unsure
  • specific endometrial stromal (not
    glandular) invasion
  • rare
  • peri/post-menopausal women
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5
Q

What are the main risk factors for endometrial carcionsarcomas?

A
  • aetiology = unsure
  • progress quickly, can fill uterine cavity
  • poor prognosis
  • elderly
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6
Q

Overall risk factors for endometrial cancer:

A
  • obesity
  • nulliparity
  • late menopause
  • early menarche
  • tamoxifen

^all related to prolonged, unopposed
oestrogen exposure

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7
Q

Clinical Presentation of Endometrial Cancer:

A
  • abnormal vaginal bleeding
    • especially around menopause/post-
      menopause (5-10% = cancer)
  • abnormal vaginal discharge is rare
  • pain unusual till invasion and metastases
    are present
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8
Q

Which of the following are pre-invasive ovarian lesions?

  • non-neoplastic lesions/cysts
  • PCOS
  • epithelial neoplasm
  • ovarian hyperstimulation
  • ovarian hyperplasia/lutenisation
  • endometriosis
A

all but epithelial neoplasm

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9
Q

Ovarian Cysts:
- common or rare?
- non-neoplastic cysts include:

  • related to menstrual cycle
  • related to —–
  • presents with
A
  • common
  • non-neoplastic cysts include: mesothelial
    lined, epithelial inclusion, follicular, corpus
    luteum and endometriotic
  • follicular is common + linked to menstrual
    cycle
  • endometriotic cysts = chocolate cysts (dark
    blood)
  • present with pain due to inflammation
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10
Q

Why is PCOS a cause of ovarian adenocarcinoma in young woman, albeit rare?

A

ovarian hyperstimulation and hyperoestrogenism provide unopposed oestrogenic environment for metaplastic or neoplastic changes in the endometrium and ovaries

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11
Q

What is ovarian hyperstimulation syndrome?

A
  • serious side effect of fertility treatment
    and excess gonadotrophin
  • characterised by multiple follicular cysts
    and bilateral ovarian enlargement
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12
Q

Stromal hyperplasia and lutenised cells are seen in?

A
  • peri/post-menopausal women
  • reflects ovarian stromal proliferation
  • causes hyperandrogenic effects
  • hormonally-mediated association between
    endometrial hyperplasia and carcinomas
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13
Q

Endometriosis link to endometroid tumours of the ovary and adenocarcinoma?

A

endometriod tissue outside of the uterus

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14
Q

What are the four categories of ovarian neoplasms?

A
  • epithelial: serous, mucinous, clear cell,
    endometriod, transitional cell
  • germ cell: dysgermimoma, teratoma,
    extraembryonic, mixed germ cell
  • sex-cord stroma: theocoma granulosa cell,
    Sertoli-Leydig
  • metastatic: both genital and extragenital
    metastases to the ovary, but genital
    metastasis more likely
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15
Q

Ovarian Neoplasms: Epithelial Tumours:

A
  • arise from the mesothelial layer of the
    peritoneum covering the ovary
  • due to mesothelial origin, they are
    inherently metaplastic
  • serous tumours originate from tubal
    mucosae
  • mucinous tumors originate from
    endocervical mucosa
  • endometriod tumours originate from
    endometroid tissues outside uterus and
    ovary
  • clear cell tumours are a distinct
    histological type of epithelial ovarian
    cancer, characterised by HOBNAIL CLEAR
    CELLS
  • transitional cells are found in the bladder,
    hence strange but tumours still found
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16
Q

Ovarian Epithelial Neoplasms: Clear Cell Tumours:
- common or rare?
- young or old?
- associated with?
- recurrence?

A
  • rare, aggressive tumours
  • young people
  • association with endometriosis
  • high risk of recurrence
  • caught early strong survival rate, caught
    late survival is low as 30%
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17
Q

What are the characteristics of benign mucinous, serous and transitional cell tumours

A
  • smooth walled and cystic
  • transitional cell tumours are solid but may
    show cystic areas
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18
Q

Mucinous ovarian tumours and the relations to the intestine.

A
  • often have intestinal type cells as part of
    their makeup
  • often represent intestinal metastases
  • intestinal metastases can secrete a lot of
    mucous and cause intestinal obstruction
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19
Q

Ovarian Neoplasms: Germ Cells: Dysgermimoma:

  • analogous to
  • arise from which cell types
  • associated with?
  • common or rare?
  • younger or older people?
A
  • analogous to seminomas
  • tumours arise from undifferentiated
    female germ cells
  • associated histological appearance of
    germ cells mixed with lymphocytes
  • rare, malignant
  • affect younger people
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20
Q

Ovarian Neoplasms: Germ Cell: Teratoma:
- arise from?
- histological elements?
- features
- young or old
- subtypes

A
  • tumours arising from the process of
    differentiation
  • have histological elements of all germ cells
    layers (ecto,endo and mesoderm)
  • contain hair, sebaceous material and teeth
  • most commonly seen in younger people
  • immature teratomas, mature cystic
    teratomas, monodermal teratomas
21
Q

What is the most common ovarian tumour?

A
  • mature cystic teratomas
  • benign
  • in older people malignancy is possible
22
Q

Germ Cell Ovarian Neoplasms: Mature Cystic Teratomas:

A
  • mature cystic teratomas
  • originate from an oocyte that has
    completed the first meiotic division
  • more commonly seen in young people
23
Q

Germ Cell Ovarian Neoplasms: Immature Teratomas:

A
  • immature tissues similar to those seen in a
    growing embryo
  • these include neural tissue
  • amount of neural tissue is directly related
    to malignant potential
  • tumours metastasise to the peritoneum
24
Q

Germ Cell Ovarian Neoplasms: Monodermal Teratomas:

A
  • derive from one germ cell layer = ONLY
    ONE
  • significant malignant potential including
    thyroid-type and carcinoid tumours
25
Q

Germ Cell Ovarian Neoplasms: Extraembryonic Germ Cell Teratomas:

A
  • arrive from non-embryonic parts of the
    overy eg primitive yolk sac, trophoblast
  • malignant
  • histologically mixed
  • histologically, presents with Duval-Schiller
    bodies which are central vesseled tumours
    with rosette tumour cells surrounding
    them
  • alpha fetoprotein is a serum marker for
    the condition

*choriocarcinomas of the ovary are more commonly of germ cell origin but can present as mixed

26
Q

Ovarian Neoplasms: Sex-Cord Stromal Tumours:
- arise from

A
  • arise the cell cords that grow down the
    surface epithelium of the ovary from the
    4th month of fetal life, and frequently
    produce steroid hormones
27
Q

Ovarian Neoplasms: Sex-Cord Stromal Tumours: Thecoma:
- common or rare?
- features?
- presents?
- benign or malignant?

A
  • most common sex cord tumour
  • cellular, spindle-celled tumour with lipid
  • produces oestrogen and presents during
    reproductive years
  • benign
28
Q

Ovarian Neoplasms: Sex-Cord Stromal Tumours: Granulosa Cell Tumour: Presentation/Features:

A
  • malignant
  • unilateral
    -multicystic
  • bleeding and necrosis is common
29
Q

Ovarian Neoplasms: Sex-Cord Stromal Tumours: Granulosa Cell Tumour:
- histological features
- serum markers?
- young or old?

A
  • nests and cords of granulosa ccells with
    characterstically ggrooved nuclei
  • central space around eosinophilic hyaline
    material = Call-Exner Body
  • produces oestrogen and inhibin = serum
    marker
  • occur at any age with late recurrence
    common
30
Q

Ovarian Neoplasms: Sex-Cord Stromal Tumours: Sertoli-Leydig Cell Tumours:
- common or rare?
- histological features (2)

A
  • rare
  • histologically include Reinke crystals within
    the cytoplasm of tumour cells
  • mix of cell types related to testis related
    anatomy, hence present androgenic
    features
31
Q

Ovarian Neoplasms: Sex-Cord Stromal Tumours: Gonadoblastomas:
- common or rare?
- affects?
- histological features?
- malignant?

A
  • rare
  • arise in individuals with phenotypic
    features of female, but carry Y
    chromosome
  • primitive germ cells, sex-stromal
    derivatives
  • undergo malignant changes
32
Q

Ovarian Neoplasms: Sex-Cord Stromal Tumours: Steroid Cell Tumours:
- benign or malignant?
- common or rare?
- unilateral or bilateral?
- histological features

A
  • benign
  • rare
  • unilateral
  • histologically, tumour cells include adrenal
    cortical cells and produce androgens
33
Q

Ovarian Neoplasms: Sex-Cord Stromal Tumours: Metastatic Tumours:
- most likely

A
  • both genital and extragential tumours
    metastasise to the ovary
  • most likely extragenital tumours to
    metastasise to ovary is L. intestine,
    stomach and breast adenocarcinomas
34
Q

A 40 year old patient presents to their GP with abdominal bloating and rapid, unintentional weight loss of 1 stone over the last 8 weeks. The patient has a history of polycystic ovarian syndrome with significant amenorrhoea as a consequence of this condition. The patient is nulliparous.

Differential diagnosis?

A
  • ovarian cancer esp genetic due to age
  • most likely is ovarian cancer or metastatic
    spread from endometrial cancer
35
Q

What is the link between ovarian cancer and PCOS?

A

PCOS increases the amount of unoppossed oestrogen a person is exposed to and there is also ovarian hyperstimulation

can lead to increased risk of ovarian cancer

rare but common in younger women -»>adenocarcinoma

36
Q

An 80 year old patient presents to their GP with whitening of their vulval skin, thinning and bleeding of the vulva and itching. Recently they have also noted an ulcer on their vulva. They want to know what is causing the problem.

Differential diagnoses?

A
  • squamous carcinoma of the vulva
    secondary to differentiated vulval
    intraepithelial neoplasms associated with
    lichen sclerosis
37
Q

A 65 year old woman presents to her GP with postmenopausal bleeding for 6 months, pain and bloating of her abdominal region. She said that the bleeding started as only a few drops but is now getting heavier and this is why she is attending today.

What pathology is extremely important to investigate as a priority?

A

Endometrial carcinoma

38
Q

A 65 year old woman presents to her GP with postmenopausal bleeding for 6 months, pain and bloating of her abdominal region. She said that the bleeding started as only a few drops but is now getting heavier and this is why she is attending today.

  • endometrial carcinoma

Which endometrial cell change is associated with this condition?

A

Endometrial hyperplasia with atypia, which is an important, pre-invasive condition associated with endometrial carcinoma

39
Q

A 65 year old woman presents to her GP with postmenopausal bleeding for 6 months, pain and bloating of her abdominal region. She said that the bleeding started as only a few drops but is now getting heavier and this is why she is attending today.

Endometrial carcinoma

What hormonal aetiology is associated with this pathology?

A

unopposed oestrogen exposure

40
Q

A 30 year old patient who has never had a smear test presents to their GP with unexplained weight loss and bleeding with sexual intercourse. The patient smokes 20 cigarettes a day but has no other past medical or surgical history of note.

What important pathology would you want to investigate?

A

Squamous neoplasia of the cervix

41
Q

A 30 year old patient who has never had a smear test presents to their GP with unexplained weight loss and bleeding with sexual intercourse. The patient smokes 20 cigarettes a day but has no other past medical or surgical history of note.

  • squamous neoplasia of the cervix

What pre-invasive risk factor is most commonly associated with this pathology?

A

The presence of HPV causing cervical intraepithelial neoplasia (CIN)

42
Q

A 30 year old patient who has never had a smear test presents to their GP with unexplained weight loss and bleeding with sexual intercourse. The patient smokes 20 cigarettes a day but has no other past medical or surgical history of note.

  • squamous neoplasia of the cervix
  • presenc of HPV causing CIN

How does this pre-invasive risk factor enact its effect on the cervix?

A

The virus can integrate itself into the host DNA, as well as episomal (extrachromosomal methods)

increases the likelihood of neoplastic changes

43
Q
A

Yes I am concerned the rapid increase in size twinned with the change in appearance and the patient’s PMH of endometriosis makes this more likely to be a neoplastic pathology.

Endometriosis connection and the cystic nature of the pathology makes it more likely to be a subtype related to endometroid-type ovarian cancers or clear cell carcinomas of the ovary.

Metastatic spread, local invasion from lymph nodes, endometrial origin through endometriosis.

44
Q

Ovarian Cancer: Subtypes and Discrete Biological Features:

  • epithelial
  • germ cell
  • sex-cord stroma
A
  • Epithelial: serous, mucinous (subtypes),
    clear cell, endometroid, transitional cell
  • Germ Cell: Dysgermimoma, teratoma
    (subtypes), extraembryonic, mixed germ
    cell.
  • Sex-cord Stroma: Thecoma, granulosa cell,
    Sertoli-Leydig cell, gonadoblastomas,
    steroid cell
45
Q

Vulva Cancer: Subtypes and Discrete Biological Features:

  • squamous carcinoma
  • Paget’s disease
  • Basal cell carcinoma
A
  • squamous carcinoma of the vulva is an
    epithelial vulval cancer associated with
    differentiated VIN and lichen sclerosis and
    with this hyperkeratosis of uncertain
    aetiology
  • Paget’s disease of the vulva incolves
    mucin-containing adenocarcinoma cells in
    the squamous epithelium of the vulva
  • Basal cell carcinoma and malignant
    melanomas are also seen in the vulva
46
Q

Vagina Cancer: Subtypes and Discrete Biological Features:

  • squamous carcinoma of the vagina
A
  • similar histologically to cervical squamous
    carcinoma
  • BUT invades locally and radical surgery
    often indicated
47
Q

Uterus Cancer: Subtypes and Discrete Biological Features:

A
  • majority arise from the endometrium
  • consists of both glandular and supporting
    (stromal) elements
  • to undergo malignant changes
  • adenocarcinomas arising from the
    endometrial glands

Sarcomas of the muscle of the uterus, myometrium or the stromal tissues of the endometrium are rare

48
Q

Cervix Cancer: Subtypes and Discrete Biological Features:

A
  • squamous neoplasia is the most common
  • associated with HPV and CIN
  • metastases to cervix are common
  • embryological origins of these cancers
    mean that there is a lot of interconnected
    elements

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