repro 3

Question 1

lichen sclerosus

Answer 1

autoimmune, atrophy and fibrosis in response to inflammation
dysplasia
increase risk for VIN3 and squamous cell carcinoma
white and thick skin and wrinkled cigarette paper appearance

Question 2

VIN

Answer 2

valve intraepithelial neoplasia
VIN of usual type - more common, HPV driven
differentiated VIN - not related to HPV, high frequency of p53 mutations, related to lichen sclerosus

Question 3

vulvar SCC

Answer 3

more likely to metastasise if large size, deep invasion, LVSI - initially goes to nodes and eventually liver and lungs

Question 4

other in situ and invasive vulva lesions

Answer 4

extra mammary Paget’s disease

melanoma

Question 5

abnormal bleeding in prepuberty causes

Answer 5

precocious puberty

Question 6

adolescence abnormal uterine bleeding causes

Answer 6

anovulatory cycles

Question 7

reproductive abnormal uterine bleeding

Answer 7

complications of pregnancy 
organic lesions 
DUB - anovulatory cycles 
DUB - inadequate luteal phase 
iatrogenic - contraceptives, changes to the OCP, emergency contraception

Question 8

postmenopausal causes of abnormal uterine bleeding

Answer 8

atrophy

organic lesions - polyps, leiomyoma, hyperplasia, carcinoma

Question 9

DUB

Answer 9

dysfunctional uterine bleeding

bleeding that lacks an underlying organic cause

Question 10

DUB - anovulatory cycle

Answer 10

common around menarche/perimenopause

also can be due to PCOS, functional ovarian tumours and metabolic/endocrine problems

Question 11

anovulatory cycle

Answer 11

failure to ovulate
prolonged oestrogen with no progesterone
stimulation of endometrial growth
EITHER follicles eventually become atretic leading to a withdrawal bleed related to a rapid drop in oestrogen, OR follicles unable to meet the increasing oestrogen demands of the glandular proliferation leading to break through bleeding

Question 12

anovulatory cycle results in

Answer 12

usually self resolves, if not can lead to hyperplasia than on to cancer

Question 13

inadequate luteal phase

Answer 13

dysynchornous maturation
cause is believe to be inadequate progesterone production during the post ovulatory period
biopsy shows secretory features that lag behind those expected for that particular day of the cycle

Question 14

polyps

Answer 14

really common, sessile masses that project into the cavity, fibrous stroma, thick walled vessels and can rarely be involved by hyperplasia or malignancy

Question 15

adenomyosis

Answer 15

glands and stroma deep within the myometrium, can cause irregular and heavy periods

Question 16

endometriosis

Answer 16

affects serial uterus, ovaries, peritoneum
ectopic endometrial tissue outside the uterus
cause of infertility, pelvic pain, dysmenorrhoea
macro - chocolate cyst, powder burns
micro - endometrial glands and stroma, haemorrhage
associated with endometriosis and clear cell carcinoma

Question 17

2 theories for sources of endometriosis

Answer 17

• cells originate from shed uterine endometrium which spread either by regurgitation (retrograde flow through the tubes) or by benign metastasis (spread via blood vessels and lymphatics)
• cells originate from precursor cells either by metaplasia (endometriosis arises from mesonephric remnants or pelvic mesothelium) or extrauterine stem cells (stem cells from bone marrow differentiate into endometrial tissue

Question 18

endometrial hyperplasia is due to

Answer 18

due to prolonged oestrogen stimulation (menopause, PCOS, ovarian stromal hyperplasia, granuloma cell tumour of the ovary, oestrogen replacement therapy, obesity)

Question 19

endometrial hyperplasia pathogenesis

Answer 19

prolongues oestrogen causes bleeding
can lead endometroid carcinoma
microscopic appearance - increased gland to stroma ratio
divided into non-atypical hyperplasia and atypical hyperplasia
inactivation of PTEN tumour suppressor gene by deletion and/or inactivation

Question 20

non atypical hyperplasia

Answer 20

endometrial response to persistant oestrogen stimulation

glands are crowded together with less stroma in between but normal cells

Question 21

atypical hyperplasia

Answer 21

increased gland to stroma ration AND nuclear atypia
often need hysterectomy
some have adenocarcinoma at hysterectomy

Question 22

treatment for endometrial hyperplasia

Answer 22

hysterectomy of progesterone therapy e.g. mirena depending on age, fertility aspiration and risk factors

Question 23

endometrial endometriosis adenocarcinoma

Answer 23

occur in younger obese women 55-65 yr
stepwise progression of genetic alterations from hyperplasia to cancer
HNPCC/Lynch syndrome
better prognosis

Question 24

endometrial serous carcinoma, clear cell carcinoma and mixed mullarian tumour

Answer 24

poorly differentiated worse prognosis
65-75 yr
atrophy, thin physique

Question 25

endometrioid adenocarcinoma

Answer 25

generally well differentiated
obesity, DM, HTN, osteorgen
20% of sporadic timours show MMR defects. hereditary HNPCC/Lynch
macro-polypoid/ilfiltrative
micro - resembles endometrium but back to back, cribriform modules, with or whithout solid areas

Question 26

endometrial serous carcinoma

Answer 26

older women, atrophic endometrium, poorly differentiated
90% p53 mutations
may see precursor serous intraepithelial carcinoma
gets out tubules, LVSI, often outside uterus at diagnosis
micro - papillary or glandular, marked cytological atypia, hyperchromasia, prominent nucleoli

Question 27

CCC

Answer 27

clear cell carcinoma

• clear cells histologically
• poorly differentiated

Question 28

MMMT

Answer 28

malignant mixed mullarian tumour/carcinosarcoma

• bulky large polyps can go out os
• adenocarcinoma AND sarcomatous elements - spindle cells or heterologous elements eg. muscle/cartilage/bone
• metastases usually epithelial

Question 29

endometrial stroma

Answer 29

benign stromal nodules
endometrial stromal sarcoma - low grade look like stromal nodules but are infiltrative, high grade look like any sarcoma
adenosarcoma

Question 30

myometrium

Answer 30

muscle wall of the uterus

Question 31

benign leiomyoma

Answer 31

fibroid
very common
round, well circumscribed, from, white whorled cute surface
bland smooth muscle cells in bundles, low mitoses, variable cellularity/nuclear atypia/ no necrosis