Repro 12: Gynaelogical Tumours

Question 1

Which types of HPV can predispose to cervical carcinoma/ CIN?

Answer 1

16 and 18

Question 2

Where in the cervix is most vulnerable to carcinoma/ HPV infection?

Answer 2

Transformation zone

Question 3

What does cervical screening involve?

Answer 3

From age 25 to 50 every 3 years
Then every 5 years from 50 to 65
Cells from the transformation zone are scraped off and Pap stained and examined microscopically

Question 4

What are the majority of invasive cervical carcinomas?

Answer 4

80% squamous cell carcinomas

15% adenocarcinoma

Question 5

How can invasive cervical carcinoma be treated?

Answer 5

Cervical cone excision
Hysterectomy
Lymph node dissection
Chemotherapy
Radiotherapy

Question 6

What age group does endometrial adenocarcinoma usually affect?

Answer 6

Older women, peri menopausal

Question 7

What is endometrial adenocarcinoma?

Answer 7

Usually presents with irregular post menopausal bleeding
Associated with unopposed oestrogen (obese, late menopause and early menarche, oestrogen secreting tumour)
Can spread to myometrium and other tissues

Question 8

What is a benign tumour in the myometrium?

Answer 8

Leiomyoma aka fibroid

Question 9

How can leiomyomas present?

Answer 9

Can be asymptomatic or cause heavy/ painful periods, urinary frequency and bladder compression
Oestrogen dependent so often regress after menopause

Question 10

What age category do ovarian carcinomas usually affect?

Answer 10

Most are benign, affecting young women (age 20-45)

Some malignant tumours generally affect older women (age 45-60)

Question 11

How do ovarian carcinomas generally present?

Answer 11

Have few symptoms, so often present late by which time they have already spread beyond the ovary, so have a poor prognosis
Some are associated with BRCA mutations

Question 12

What serum marker can be used for ovarian carcinoma diagnosis?

Answer 12

CA-125

Question 13

What is the most common germ cell tumour of the ovaries?

Answer 13

Benign cystic teratoma aka dermoid cyst

Question 14

What is a benign cystic teratoma?

Answer 14

Usually benign, germ cell tumour of the ovary
Usually in young women
Contain hair, teeth and sebaceous material

Question 15

What is struma ovarii?

Answer 15

Monodermal (= highly specialised) ovarian teratoma
Benign
Composed entirely of mature thyroid tissue
Capable of causing hyperthyroidism

Question 16

What are ovarian sex cord stromal tumours?

Answer 16

Can resemble Sertoli/Leydig cells or granulosa and theca cells
Therefore can be masculinising or feminising depending on the cells they form

Question 17

Which type of ovarian tumour is capable of causing precious puberty in pre-pubertal women?

Answer 17

Ovarian sex cord stromal tumour

(If it forms granulosa and theca cells it can be feminising. In adult women this would lead to endometrial hyperplasia/ breast disease/ endometrial carcinoma)

Question 18

What is VIN?

Answer 18

= vulval intra epithelial neoplasia
Collection of atypical squamous cells within the epidermis (no invasion)
In situ pre cursor to vulval squamous cell carcinoma
Associated with HPV 16 and 18

Question 19

Which type of carcinoma usually affects the vulva?

Answer 19

Squamous cell carcinoma

But they are uncommon

Question 20

How do vulval carcinomas present?

Answer 20

Warty lesions

Often spread locally and can metastases to lymph

Question 21

What are two gynaecological tumours of gestation?

Answer 21

Hydratidiform mole and choriocarcinoma

Question 22

What is a hydatidiform mole?

Answer 22

When a non viable egg implants in the uterus and will fail to come to term
Causes oedema of placenta, chorionic villi
Friable mass of transducer grape like structures
Associated with choriocarcinoma

Question 23

What is choriocarcinoma?

Answer 23

Malignant tumour of trophoblast of cells
No villi present!
Metastasises widely but responds well to chemotherapy
Usually presents with vaginal spotting and high hCG levels