Repro 12 Flashcards
vulval tumours are most commonly what type of cancer?
squamous carcinomas, carcinoma= malignant neoplasm of epithelial cells, so squamous= malignant neoplasm of squamous epithelial cells, with malignant= ability to metastasise
most common cause of vulval tumours in pre-menopausal women?
HPV
where does a vulval tumour caused by HPV metastasise to? to
inguinal LNs
what is vulval carcinoma in older women related to?
chronic irritation and longstanding dermatoses e.g. lichen sclerosus and squamous hyperplasia
most carcinomas of cervix are what type?
squamous
common aetiology of cervical carcinomas?
HPV
aim of cervical screening programme?
detect pre-invasive lesion and excise involved area completely before a tumour can develop
cells of pre-invasive lesion detected in cervical screening?
dyskaryotic cells= cells with abnormally enlarged nuclei possessing abnormal chromatin
what is prognosis of cervical carcinoma affected by?
size of tumour
depth of invasion
where does cervical carcinoma spread?
iliac and then aortic LNs, before wider systemic dissemination
local spread involves ureters, bladder and rectum, and is very distressing with pain and fistula formation
most probable aetiology in perimenopausal women of endometrial adenocarcinoma?
unopposed oestrogen from obesity, exogenous oestrogen administration, or a hormone-secreting tumour
symptoms of fibroids?
menorrhagia and intermenstrual bleeding, pain, discharge and infertility
malignant counterpart of fibroids?
leimyosarcoma
where might a leiomyosarcoma metastasise?
blood to lungs and then systemically
what do ovarian tumours cause by spreading through the abdomen?
ascites
intestinal obstruction
perforation
death
useful tumour markers in malignant germ cell tumours?
beta hCG
alpha fetoprotein
examples of malignant germ cell tumours?
dysgerminoma
yolk sac tumour
choriocarcinoma
embryonal carcinoma
what is a thecoma?
benign tumour derived from ovarian stroma
examples of a sex cord tumour?
granulosa cell tumour
consequences of rare sex cord stromal tumours secreting androgens?
defeminisation
masculinisation
amenorrhoea
infertility
what is a hydatidiform mole?
results from a chromosomal defect in the conceptus causing oedema of the placetal chorionic villi. Assoc. atypical trophoblastic hyperplasia and tumours have the propensity for myometrial penetration. May persisit, invade, metastasise and kill. sig. risk of development of choriocarcinoma
what is a choriocarcinoma?
malignant tumour of placenta composed of syncytio and cytotrophoblast without villi.
RFs for cervical cancer?
smoking
multiple sexual partners
multiple births
low SE class
macroscopic cervical carcinoma appearance?
ulcer
cervical expansion
nodule
symptoms of squamous cell cervical carcinoma?
post-coital, intermenstrual bleeding or post menopausal bleeding
what is cervical intraepithelial neoplasia graded on?
mitotic activity
nuclear pleomorphism/hyperchromasia
nuclear to cytoplasmic ratio
when does cervical screening start?
age 25, then every 3 years till 50
5 years 50-65
Abnormal – referred for colposcopy- magnifying instrument to look at surface of cervix
malignant features of leiomyosarcoma?
mitoses
atypia
necrosis- as outgrows its blood supply
infiltration
what do granulosa cell tumours usually secrete?
oestrogen
granulosa cell tumour histological appearance?
coffee bean nuclei
call-exner bodies
histology of leygig/steroid cell tumour?
abundant cytoplasm in cells arranged in pink sheets
crystals of Reinke
which cells are affected in cervical intraepithelial neoplasia, and how does this progress?
all cells at all levels abnormal= important as screening only looks at the surface layer, exfoliative cytology wouldn’t work otherwise
CIN I, II and III= carcinoma in-situ= most likely to invade and so progress to cancer
risk factors for type I endometrial adenocarcinoma?
unopposed oestrogen: early menarche late menopause obesity iatrogenic nulliparous- continuous cycling of endometrium with SF breakdown every month
what is type II endometrial adenocarcinoma?
clear cell and uterine serous papillary, high grade and arises spontaneously, post-menopause, cancer doens’t have to grow very far to invade other structures as endometrium small and atrophied
endometrial adenocarcinoma macroscopic appearance?
soft, white, mushy
invades myometrium and cervix
spread to adnexa
glands
what determines endometrial adenocarcinoma prognosis?
depth- myometrial thickness
grade/type- hormone related tend to be better grade and prognosis
assoc hyperplasia
involvement of cervical stroma/adnexa
types of endometrial hyperplasia?
simple: cystic glands, abundant stroma
complex: crowded, branched or budded glands
complex with atypia: cytological features of malignancy of varying degrees
what are polyps in the uterus?
benign growths of endometrium
why can excessive bleeding and cramping occur with endometrial hyperplasia?
inflammatory response of uterus
why do fibroids cause menorrhagia?
increase area of endometrium that can bleed
what may ovarian neoplasms arise from?
metastases e.g. krukenberg tumour- from gastric cancer- virchow’s node
germ cells
sex cord components e.g. granulosa cell tumour
stroma
surface epithelium- simple cuboidal
clinical presentation of ovarian neoplasms?
presents late
no symptoms of precursor
symptoms later confused with IBS: abdominal pain, bloating after meals
hormonal: menstrual disturbances, inappropriate sex hormones
late: ascites, obstruction, perforation and DEATH- transcoelomic spread through peritoneum
types of epithelial ovarian carcinoma?
serous mucinous endometrioid clear cell Brenner (transitional) All can be benign, malignant or borderline- don't invade/spread but epithelial characteristics of malignant cells
where do mucinous ovarian tumours usually arise from?
usually metastasise from bowel and appendix
intestinal mucin secreting epithelium
why is combined OCP protective against ovarian cancer?
progesterone and oestrogen acting together inhibit ovulation and hence the destruction of the overlying epithelium of the ovaries and their subsequent regeneration process
what cancer might endometriosis increase the risk of?
endometrioid ovarian tumour- may occur in patient who has had a hysterectomy but is on HRT- oestrogen will allow growth of ectopic endometrial tissue
RFs for ovarian cancer?
BRCA1 and 2 genes in familial cases smoking obesity endometriosis prior cyst e.g. as a result of PID?
where do leydig cell tumours- a type of sex cord stromal tumour of the ovary arise?
hilum of ovary
symtpoms of a patient with an androgen secreting sex cord stomal tumour?
male pattern baldness
clitoromegaly
acne
what is meig’s syndrome?
occurs with a thecoma: stromal cell tumour, ascitic fluid accumulation, unilateral fluid in thorax
why is there increasing incidence of vulval tumours?
ageing population
increased HPV transmission
examples of vulval tumours?
squamous carcinoma
adenocarcinoma
basal cell carcinoma
malignant melanoma
why might a patient with a vulval carcinoma die from bleeding?
cancer involvement of femoral artery
characteristics of squamous vulval carcinomas?
keratotic
warty
ulcerated
characteristics of vulval intraepithelial neoplasia?
scaly red patch sore itchy white labia, perineum, perianal, incidental
histology of VIN?
abnormal maturation
mitotic activity above basal layer
characteristics of vulva basal cell carcinoma?
ulcerated pearly white or pigmented nodule mainly labia major- from LS folds deeply infiltrating if neglected doesn't metastasise
describe a hydatidiform mole
villous growth abnormality: villi swollen- oedema, as blood not being pumped by fetus through villi as fetus absent or abnormality
at risk groups of hydatidiform mole?
50 yr old women
where does a choriocarcinoma metastasise to?
genital tract, lungs and brain
