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Module 203, Theme 3- Gynaecological pathology, common gynaecological disorders and sexual health > T3, L1 & L2 Pathology of the Female Reproductive Tract 1 & 2 > Flashcards

T3, L1 & L2 Pathology of the Female Reproductive Tract 1 & 2 Flashcards

1
Q

What cell type is present in the vulva and the vagina?

A

Stratified squamous epithelium

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2
Q

What happens to the vagina at puberty?

A

Oestrogen secreted by the ovary stimulates maturation of squamous epithelial cells

Glycogen is formed within mature squamous epithelial cells

Glycogen inside cells shed from the surface, is a substrate for vaginal anaerobic organisms (dominated by lactobacilli)

Lactobacilli produce lactic acid keeping vaginal pH below 4.5

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3
Q

What are the layers of the cervix?

A

Ectocervix

Endocervix

Transformation zone

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4
Q

Describe the ectocervix

A

Covered by stratified squamous epithelium

Glycogen is produced in these mature cells

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5
Q

Describe the endocervix

A

It is lined by a single layer of tall, mucin producing columnar cells

Columnar epithelium lines tiny blind ending channels (‘clefts’)

These radiate out from the endocervical canal into the surrounding stroma (giving a bigger SA)

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6
Q

What is the junction between the ecto- and endocervix called?

A

The squamo-columnar junction

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7
Q

When and how is the transformation zone formed?

A

During puberty the cervix changes shape

The lips of the cervix grow

The distal end (closest to the vagina) of the endocervix opens, and becomes a funnel shape.

Endocervical mucosa becomes exposed to the acidity of vaginal environment

The distal endocervical columnar epithelium is exposed to the acidic vaginal environment

It is not suited to this, so undergoes an adaptive change called metaplasia

Reserve cells in this area proliferate and mature to form squamous epithelium: this process is called SQUAMOUS METAPLASIA.

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8
Q

Define metaplasia

A

A transformation of cell type from one kind of mature differentiated cell type to another kind of mature differentiated cell type.

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9
Q

What cell type are the reserve cell? What is their role?

A

Stem type cells

They form squamous cells of ectocervical cells.

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10
Q

What initially happens to the metaplastic squamous epithelium?

A

At first, the metaplastic squamous epithelium is thin and delicate (lots of proliferation & maturation is incomplete)

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11
Q

With time, what eventually happens to the metaplastic squamous epithelium?

A

With time, the metaplastic epithelium comes to be as strong and well formed as that on the ectocervix

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12
Q

Describe the microscopic features of the myometrium

A

Bundles of smooth muscle, vasculature and nerves

The muscle fibres have cigar shaped nuclei

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13
Q

Describe the microscopic features of the endometrium (in the proliferative (before ovulation) stage)

A
  1. Tubular glands
  2. Specialised stroma
  3. Blood vessels

Mitoses in glands

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14
Q

Describe the microscopic features of the endometrium (in the secretory (during ovulation) stage)

A
  1. Cork screw glands
  2. Specialised stroma
  3. Blood vessels

Secretions in glands

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15
Q

Define neoplasia

A

neoplasia:
‘new growth’ – abnormal, uncoordinated and excessive cell growth.
persists following withdrawal of stimulus and associated with genetic alterations

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16
Q

How are neoplasms classified?

A

Behaviour (benign or malignant)

Histogenesis (recognising the cell of origin)

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17
Q

What are the behaviours of benign neoplasms?

A

Remains localised and doesn’t invade surrounding tissues

Generally grow slowly

Good resemblance of parent tissue

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18
Q

I am a benign neoplasm of smooth muscle. I am localised and slow growing. What am I?

A

Leiomyoma of the myometrium

a.k.a “fibroid”

It closely resembles parent tissue

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19
Q

What are the consequences of benign neoplasms?

A

Pressure on adjacent tissue

Obstruction of lumen of a hollow organ

Hormone production

Transformation into a malignant neoplasm

Symptoms for the patient

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20
Q

Give examples of different clinical problems that benign neoplasms cause?

A

Pressure on adjacent tissue
-Bladder (frequency) Rectosigmoid (constipation)

Obstruction to lumen of a hollow organ
-Adjacent (ureters) Blocking endocervix

Hormone production
-Erythropoietin producing polycythaemia

Transformation into a malignant neoplasm
-Probably malignancy arises de novo

Can lead to abnormal uterine bleeding, pain

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21
Q

What are the behaviours of malignant neoplasms?

A

Invade into surrounding tissues

Spread via lymphatics to lymph nodes and blood vessels to other sites (metastasis)

Generally grow relatively quickly

Variable resemblance to parent tissue

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22
Q

How does malignant neoplastic tissue compare to normal tissue?

A

Looks different

loss of differentiation

loss of cellular cohesion

enlarged irregular dark nuclei (due to abnormally high chromosomal content)

increased numbers of mitoses

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23
Q

What are the consequences of malignant neoplasms?

A

Destruction of adjacent tissue

Metastasis

Blood loss from ulcerated surfaces

Obstruction of a hollow viscera

Production of hormones

Weight loss and debility

Anxiety and pain

24
Q

How is the histogenesis of neoplasms determined?

A

Classification by cell of origin

Determined by examining tissue under the microscope

Resemblance to parent tissue correlates with clinical behaviour

25
Q

What are the terminologies for neoplasias?

A

Neoplasms = suffix – oma
Malignant epithelial tumours = carcinomas

Carcinomas are named for the epithelial cell type which they resemble
Carcinomas of glandular epithelium = adenocarcinomas
Malignant stromal tumours = sarcomas

26
Q

What is a benign squamous tumour called? (epithelial)

A

Squamous cell papilloma

27
Q

What is a malignant squamous tumour called? (epithelial)

A

Squamous cell carcinoma

28
Q

What is a benign epithelial tumour called? (epithelial)

A

Adenoma

29
Q

What is a malignant epithelial tumour called? (epithelial)

A

Adenocarcinoma

30
Q

What is a benign and a malignant smooth muscle tumour called? (mesenchymal or stromal)

A

Benign: LEIOMYOMA
Malignant: LEIOMYOSARCOMA

31
Q

What is a benign and a malignant striated muscle tumour called? (mesenchymal or stromal)

A

Benign: RHABDOMYOMA
Malignant: RHABDOMYOSARCOMA

32
Q

What is a benign and a malignant adipose tissue tumour called? (mesenchymal or stromal)

A

Benign: LIPOMA
Malignant: LIPOSARCOMA

33
Q

What is a benign and a malignant blood vessel tumour called? (mesenchymal or stromal)

A

Benign: ANGIOMA
Malignant: ANGIOSARCOMA

34
Q

What is a benign and a malignant bone tumour called? (mesenchymal or stromal)

A

Benign: OSTEOMA
Malignant: OSTEOSARCOMA

35
Q

What is a benign and a malignant cartilage tumour called? (mesenchymal or stromal)

A

Benign: CHONDROMA
Malignant: CHONDROSARCOMA

36
Q

List the cell types present in each of the following:

1) Vulva
2) Vagina
3) Cervix
4) Endometrium
5) Myometrium

A

1) Squamous epithelium
2) Squamous epithelium
3) Squamous and glandular epithelium
4) Glandular and stroma
5) Smooth muscle

37
Q

Now list the malignant tumour types found in each of them

A

1) Vulva: squamous cell carcinoma
2) Vagina: squamous cell carcinoma
3) Cervix: squamous cell carcinoma, adenocarcinoma
4) Endometrium: adenocarcinoma, stromal sarcoma
5) Myometrium: leiomyosarcoma

38
Q

Define dysplasia

A

Disordered growth and differentiation characterised by increased proliferation (more mitoses), atypia of cells and decreased differentiation

It is also referred to as the pre-malignant state

NOTE: Dysplastic lesions may (but don’t always) progress to invasive malignancy. Recognising dysplastic lesions allows early treatment before invasion occurs.

39
Q

What are the different terminologies for dysplasia of the cervix?

A

Generic: Dysplasia

UK: Cervical intra-epithelial neoplasia (CIN)

US: Squamous intra-epithelial lesion (SIL)

40
Q

The degree of dysplasia may predict the likelihood of developing invasive malignancy

A

Grade % progress to CIN3 % progress to SCC
CIN1 11 1
CIN2 22 5
CIN3 - 40

41
Q

Where does dysplasia often occur?

A

Often occurs in sites where there is metaplasia

  • squamous metaplasia of the cervical transformation zone
  • squamous metaplasia of the bronchial epithelium (typically associated with smoking).
  • glandular metaplasia of the distal oesophagus
42
Q

What is the shape of the smear brush? How does its shape make it suited for its function?

A
  • It’s shape resembles the shape of the cervix
  • This makes it suited for its function, as the transformation zone (where malignancy are detected) is located in the cervix.
43
Q

What are the normal constituents of a smear?

A
  • Endocervical cells
  • Squamous cells
  • Metaplastic cells
44
Q

What are the characteristics of normal surface cells?

A
  • Large cytoplasmic volume

- Small nucleus

45
Q

What are the characteristics of dysplastic cells ?

A
  • Higher ratio of nuclear size to cytoplasmic volume

- Nuclei show the same features associated with malignancy

46
Q

What is the difference between a dysplasia and a carcinoma?

A

-Invasion through the basal membrane

a dysplasia is not invasive but a carcinoma is

47
Q

What can a HPV infection cause?

A
  • Cervical Intraepithelial Neoplasia (CIN)

- Cancer

48
Q

Describe the Human Papillomavirus (HPV)

A

Human Papillomaviruses (HPVs) infect epithelium

Double stranded DNA virus 7.9Kbp (small genome)

Confined to local site of infection without viraemia

Over 130 HPV types, some of which infect the anogenital mucosa

NOTE: People infected with HPV and may not even realise it

49
Q

Which HPV groups are associated with higher risk of malignancy?

A

16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68

NOTE: 16 and 18 are more common

50
Q

Which HPV groups are associated with reduced risk of malignancy?

A

6, 11, 40, 42, 43, 44, 54, 61, 72, 81

NOTE: 6 and 11 are more common. These HPV groups lead to the formation of warts which are hard to treat

51
Q

How does the HPV infect the host cell?

A

The virus’ genome become integrated into the host’s

The virus replicates at the basal layer and works its way to the top.

The viral genes alter the way in which cell cycle is controlled.

52
Q

What are HPV public health intervention measures?

A

HPV Vaccination

Population based screening

- Cervical sample cytology
- Cervical sample HPV test

Colposcopy (procedure to closely examine the cervix, vagina and vulva for signs of disease)

Treatment of high grade dysplasia

Large Loop Excision of the Transformation Zone

53
Q

What type of cancer is predominantly a disease of the developing world?

A

Cervical cancer

NOTE: The incidence of cervical cancer has been declining (in Europe). The reduction in incidence of cervical cancer has been paralleled by reduced mortality

54
Q

What type of cancer is predominantly a disease of the developed world?

A

Endometrial cancer

NOTE: It is most common in North America and Europe

55
Q

What do the results from the study show? pt 1

A

The separate peaks in cervical cancer incidence reflect a birth cohort effect

This happens when a group of people experience different circumstances to those born immediately before or after

An increase in cervical cancer incidence and mortality was seen in women reaching the age of sexual debut during WW1 and again in WW2

56
Q

What do the results from the study show? pt 2

A

The incidence and mortality of cervical cancer in the UK have decreased, particularly since the early 1980s

In the UK this follows the introduction of the NHS cervical screening programme

A birth cohort effect exists, believed to reflect the different exposure to HPV at the time women reached the age of sexual debut
HPV vaccination is creating new birth cohorts

Module 203, Theme 3- Gynaecological pathology, common gynaecological disorders and sexual health (8 decks)

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