Session 12

Question 1

Outline the pathology, diagnosis and principles of management of tumours of the endometrium

Answer 1

Hyperplasia - precursor to carcinoma, increased gland:stroma ratio
Associated with prolonged oestrogenic stimulation, anovulation, adipose tissue, tamoxifen
Treatment - hysterectomy
Adenocarcinoma - irregular or post menopausal bleeding
Endometrial or serous

Question 2

Outline the pathology, diagnosis and principles of management of tumours of the myometrium

Answer 2

Leiomyoma = fibroids - benign tumour
Presentation - asymptomatic, heavy/painful periods, infertility
Well circumscribed, round, firm, whitish
Histology - bundles of smooth muscle, well differentiated
Leiomyosarcoma - highly malignant, metastasise to lungs

Question 3

Outline the pathology, diagnosis and principles of management of tumours of the ovary

Answer 3

80% benign in 20-45 years
Malignant in 45-65 years
Presentation - symptoms when large and invade adjacent structures, metastasise –> abdominal pain, distension, ascites, menstruated disturbances, inappropriate sex hormones
Arise from mullerian epithelium, germ cell, sex cord-stromal cells, metastases

Question 4

Explain the ovarian tumour arising from mullerian epithelium

Answer 4

Three histological types:

1. Serous - spread to peritoneal surfaces –> ascites
2. Mucinous - large, cyst filled masses, filled with mucinous fluid, pseudomyxoma peritonei –> ascites
3. Endometriod –> tubular glands, resemble endometrial glands

Question 5

Explain the ovarian tumour arising from germ cells

Answer 5

Teratomas - benign in ovary, malignant in testes
Malignant - non-gestational choriocarcinoma, yolk sac tumour
1. Mature (benign) - dermoid cysts, contain hair, sebaceous material, teeth
2. Immature (malignant)
3. Monodermal (specialised) - struma ovarii –> mature thyroid tissue = hyperthyroidism, carcinoid –> 5HT –> carcinoid syndrome

Question 6

Explain the ovarian tumour arising from sex cord-stromal cells

Answer 6

Derived from ovarian stroma
Sertoli/Leydig, granulosa/thecal cells found in ovary
Feminising or masculinising
Granulosa cell tumour –> high oestrogen –> precocious puberty, endometrial hyperplasia, breast disease
Sertoli/Leydig tumour –> delayed puberty, breast atrophy, amenorrhoea, hair loss, hirsuitism, clitoral hypertrophy, voice changes

Question 7

Explain the ovarian tumour arising from metastases

Answer 7

Mullerian tumours - uterus, fallopian runs, contralateral ovary, pelvic peritoneum
GI tumours - Krakenberg tumour (GI within ovary)

Question 8

Outline the pathology, diagnosis and principles of management of tumours of the vulva

Answer 8

In 6th decade of age
Squamous cell carcinoma:
Cause - HPV 16 - 30%, unrelated to HPV - 70% e.g. longstanding inflammatory/hyperplasia condition (lichen sclerosis)
Vulvar intraepithelial neoplasia - accelerating lesions/polyploid within dermis, no invasion
Spread - lymph (inguinal, pelvis, iliac, paraaortic), lungs, liver
Treat - lesions

Question 9

Outline the pathology, diagnosis and principles of management of tumours of gestation

Answer 9

Proliferation of placental tissue
1. Hydatiform mole:
Complete (conceptus, no fetus), partial (increased parental chromosomes)
Cystic swelling of chorionic villi, trophoblastic proliferation
Treatment - curettage, hCG monitoring
2. Invasive mole
Penetrates/perforates uterine wall
Locally destructive –> uterine rupture
Treatment - hysterectomy, chemotherapy
3. Gestational choriocarcinoma
Malignant neoplasm of trophoblastic cells, no villi present
Increased hCG, uterine spotting
Treatment - uterine excavation, chemotherapy

Question 10

Outline the pathology, diagnosis and principles of management of tumours of the cervix

Answer 10

Cervical carcinoma:
HPV 16&18 produce viral proteins E6&E7 that interfere with tumour suppressor proteins –> unable to repair damaged DNA –> increased proliferation of cells
Infect immature meta plastic squamous cells in transformation zone
Risk factors - sexual intercourse, long term OCP, immunosuppresion
Screening - colposcopy, Pap test detects precursor lesions
Vaccination for young girls
Treatment - cervical cone excision, hysterectomy, lymph dissection, radio/chemotherapy
Cervix intraepithelial neoplasia (CIN):
Dysplasia of squamous cells
Treatment - cryotherapy, superficial excision
Presentation - intermenstrual, post coital, post menopausal bleeding