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Y2 Clinical Pathology > Uterine & Ovarian Pathology > Flashcards

Uterine & Ovarian Pathology Flashcards

1
Q

What is endometriosis?

A

a painful disorder in which tissue that lines the inside of the uterus - the endometrium - grows outside of the uterine cavity

ectopic endometrium leads to bleeding into tissues and fibrosis

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2
Q

How many women are affected by endometriosis?

What types of symptoms do they tend to have?

A

affects 6-10% of women aged between 30 - 40

25% are asymptomatic

other symptoms include:

  • dysmenorrhoea
  • dyspareunia
  • pelvic pain
  • subfertility
  • pain on passing stool
  • dysuria
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3
Q

What is meant by dyspareunia and dysmenorrhoea?

A

dysmenorrhoea:

  • pain during menstruation

dyspareunia:

  • difficult or painful sexual intercourse
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4
Q

What investigations are performed in endometriosis?

What are the medical and surgical treatments available?

A

laparoscopy is performed

medical treatment:

  • COCP (combined oral contraceptive pill)
  • GnRH agonists / antagonists
  • progesterone antagonists

surgical:

  • ablation / TAH-BSO
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5
Q

What is endometriosis linked to?

A
  • ectopic pregnancy
  • ovarian cancer
  • IBD
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6
Q

What is a laproscopy?

A

it is a surgical diagnostic procedure used to examine the organs inside the abdomen

it is a low-risk, minimally invasive procedure that requires only small incisions

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7
Q
A
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8
Q

What is endometritis?

What causes it?

A

inflammation of the endometrium

chronic endometritis has a predominant picture of lymphocytes and plasma cells

it is caused by foreign bodies, chronic retained products and infection

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9
Q

What conditions are associated with endometritis?

A
  • pelvic inflammatory disease (associated with chlamydia)
  • retained gestational tissue
  • endometrial TB
  • IUCD (intrauterine contraceptive device) infection
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10
Q

What symptoms would someone with endometritis present with?

A
  • abdominal / pelvic pain
  • pyrexia
  • discharge
  • dysuria
  • abnormal vaginal bleeding
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11
Q

What investigations and treatments are available for endometritis?

A

investigations:

  • biochemistry / microbiology
  • USS

treatment:

  • analgesia
  • antibiotics
  • removal of the cause
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12
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A
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13
Q

What are endometrial polyps?

A

sessile / polypoid E2-dependent uterine overgrowths

they are small, soft growths on the inside of the uterus, or womb

they come from the endometrium

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14
Q

how many people are affected by endometrial polyps?

What investigations are performed?

A

affects < 10% of women (40 - 50s)

investigations performed are USS and hysteroscopy

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15
Q

What symptoms are present with endometrial polyps?

A
  • often asymptomatic
  • intermenstrual / post-menopausal bleeding
  • menorrhagia
  • dysmenorrhoea
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16
Q

What are the treatments for endometrial polyps?

What is the prognosis?

A

treatments:

  • P4 / GnRH agonists
  • curettage

prognosis:

  • <1% are malignant
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17
Q

What is curettage?

A

a surgical process used to remove tissue from inside the uterus

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18
Q

What is leiomyoma (uterine fibroids)?

A

benign myometrial tumours with E2 / P4 - dependent growth

this is a benign smooth muscle tumour

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19
Q

How many people are affected by leiomyoma?

What are the risk factors?

A

affects 20% of women aged 30 - 50

risk factors:

  • genetics
  • nulliparity
  • obesity
  • polycystic ovary syndrome
  • hypertension
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20
Q

What are the symptoms associated with leiomyoma?

A
  • it is often asymptomatic
  • menorrhagia - iron deficiency anaemia
  • subfertility / pregnancy problems
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21
Q

What is the investigations and prognosis for leiomyoma?

A

investigations:

  • bimanual examination
  • USS

prognosis:

  • menopausal regression
  • malignancy risk of 0.01%
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22
Q

What are the treatments for leiomyoma?

A

medical:

  • intrauterine system (IUS) contraceptive device
  • NSAIDs
  • oral contraceptive pill (OCP)
  • P4
  • Fe2+

non-medical:

  • artery embolisation
  • ablation
  • total abdominal hysterectomy (TAH)
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23
Q
A
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24
Q

What is endometrial hyperplasia?

A

excessive endometrial proliferation due to increased E2 and decreased P4

the endometrium becomes abnormally thick

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25
Q

What are the risk factors for endometrial hyperplasia?

A
  • obesity
  • exogenous E2
  • polycystic ovarian syndrome
  • E2-producing tumours
  • tamoxifen
  • HNPCC (PTEN mutations)
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26
Q

What are the different types of endometrial hyperplasia?

A

simple non-atypical , simple atypical

complex non-atypical , complex atypical

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27
Q

What are the symptoms and investigations for endometrial hyperplasia?

A

symptoms:

  • abnormal bleeding
  • intermenstrual bleeding (between periods)
  • postcoital bleeding
  • post-menopausal bleeding

investigations:

  • USS
  • hysterectomy +/- biopsy
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28
Q

what are the treatments and prognosis for endometrial hyperplasia?

A

treatments:

  • intrauterine system (IUS)
  • P4 (progesterone)
  • total abdominal hysterectomy

prognosis:

  • endometrial adenocarcinoma
  • regression
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29
Q
A
30
Q

What are the stages involved in the malignant progression of hyperplasia?

A

normal

non-atypical hyperplasia:

  • resembles normal proliferative endometrium

atypical hyperplasia:

  • EIN - endometrial intraepithelial neoplasia
  • this is the presence of cytological abnormality

endometrioid adenocarcinoma:

  • invasion into the myometrium
31
Q

What causes the malignant progression of hyperplasia?

A

it is caused by excess oestrogens from a variety of possible sources

32
Q

What histological features are present at each stage in the malignant progression of hyperplasia?

A

non-atypical hyperplasia:

  • there is an overgrowth of the whole endometrium revelaing a thick endometrium on ultrasound

complex hyperplasia:

  • the proportion of glandular epithelium increases
  • the epithelium can be folded into complex architectural patterns

atypical hyperplasia:

  • cells show architecural changes of neoplasia with increased nuclear cytoplasmic ratio (bigger nuclei, less cytoplasm)
  • irregular shapes
  • increased numbers of mitoses
33
Q

What is endometrial adenocarcinoma?

What are the symptoms it presents with?

A

it is the most common cancer of the female genital tract

it is a cancer that arises from the endometrium

it is the result of the abnormal growth of cells that have the ability to invade or spread to other parts of the body

34
Q

What are the 2 different types of endometrial adenocarcinoma?

A

type 1 - endometrioid:

  • more aggressive than serous or clear cell carcinomas

type 2 - serous:

  • this is very rare
35
Q

How is endometrial adenocarcinoma identified and staged?

A

investigations:

  • USS, biopsy, hysteroscopy

staging:

  • FIGO (stages 1 - 4)
36
Q

What are the treatments and prognosis for endometrial adenocarcinoma?

A

treatment:

  • progesterone (P4)
  • total abdominal hysterectomy
  • adjuvant therapy - chemo/radiotherapy

prognosis:

  • stage 1 - 90% 5 year survival
  • stage 2-3 - <50% 5 year survival
37
Q

What is polycystic ovary syndrome?

A

an endocrine disorder involving hyperandrogenism, menstrual abnormalities and polycystic ovaries

women with PCOS have infrequent of prolonged menstrual periods or excess androgen (male hormone) levels

the ovaries may develop small collections of fluid (follicles) and fail to regularly release eggs

38
Q

What is hyperandrogenism?

A

a medical conditions characterised by high levels of androgens in females

39
Q

How many women have polycystic ovary syndrome?

What investigations are conducted?

A

affects 6-10% of women but 20-30% have polycystic ovaries

investigations:

  • USS
  • fasting biochemical screen - decreased FSH, increased LH, testosterone & DHEAS
  • oral glucose tolerance test (OGTT)
40
Q

How is polycystic ovary syndrome diagnosed?

A

rotterdam criteria is used to diagnose PCOS

at least 2 of the following are required:

  • hyperandrogenism (hirsuitism / biochemical)
  • irregular periods for > 35 days
  • polycystic ovaries on ultrasound
41
Q

What are the treatments for polycystic ovary syndrome?

A

treatments:

  • lifestyle - weight loss
  • medical - metformin, OCP, clomiphene
  • surgical - ovarian drilling

links:

  • infertility
  • endometrial hyperplasia / adenocarcinoma
42
Q

What are the 3 origins of ovarian neoplasms?

A

sex-cord stromal tumours:

  • granulosa cell
  • thecomas and fibrothecomas
  • sertoli-leydig cell tumours

germ cell tumours:

  • teratomas
  • yolk sac tumours
  • embryonal carcinoma dysgerminomas

surface epithelial tumours:

  • serous, mucinous, endometrioid, transitional cell, clear cell
43
Q

What are the most common group of ovarian neoplasms?

What are the three different types?

A

epithelial tumours

  1. serous (tubal)
  2. mucinous (endocervical)
  3. endometrioid (endometrium)

each type contains benign / borderline / malignant variants

44
Q

How are benign tumours subclassified?

A

benign tumours are subclassified based on components

  • cystic - cystadenomas
  • fibrous - adenofibromas
  • cystic and fibrous - cystadenofibromas
45
Q

What are malignant epithelial tumours called?

A

cystadenocarcinomas

46
Q

What is a serous cystadenocarcinoma characterised by?

A

this tumour is characterised by complex, branching papillae and glands incorporating slit-like spaces

destructive stromal invasion is identified most conspicuouslt within the confluent solid growth pattern exhibited within the ovarian cortex

47
Q

Where is a serous cystadenocarcinoma usually found?

A

in the ovary

it is the malignant form of the ovarian serous tumour

48
Q

What % of ovarian tumours are germ cell tumours?

A

15-20%

49
Q

What are the 2 different types of germ cell tumours?

A

germinomatous:

  • dysgerminomas - malignant & chemosensitive
  • usually occurs in the ovary
  • seminoma in the testis and germinoma in the CNS

non-germinomatous:

  • teratomas - differentiation towards multiple germ layers
  • most mature are benign - 1% have malignant transformation
50
Q

What are teratomas?

A

a rare type of tumor that can contain fully developed tissues and organs, including hair, teeth, muscle, and bone

51
Q

What are yolk sac tumours and choriocarcinomas?

A

yolk sac tumours:

  • differentiation towards extraembryonic yolk sac
  • the cells that line the yolk sac would become the testis or ovaries
  • malignant & chemosensitive

choriocarcinomas:

  • trophoblastic cancer of the placenta
  • malignant
  • often unresponsive
52
Q

What are the treatments for all types of germ cell tumours?

A

surgical excision +/- chemo/radiotherapy

53
Q

Where do sex cord stromal tumours arise from?

A

they are rare

they arise from ovarian stroma, which was derived from the sex cord of the embryonic gonad

54
Q

What are the 3 different types of sex cord stromal tumours?

What characteristic do they all share?

A
  1. thecoma / fibrothecoma / fibroma
  2. granulosa cell tumours
  3. sertoli-leydig cell tumours

they can all generate cells from the opposite sex

55
Q
A
56
Q

What is the composition of thecoma/fibrothecoma/fibroma like?

What can they produce?

A

they are benign

thecomas and fibrothecomas produce E2 (and rarely androgens)

fibromas are hormonally inactive

they are comprised of spindle cells

57
Q

What syndrome is associated with thecoma/fibrothecoma/fibroma?

A

Meig’s syndrome

this involves ovarian tumour, right-sided hydrothorax (pleural effusion) and ascites

it resolves after resection of the tumour

58
Q

What are the properties of granulosa cell tumours?

A

they are low grade malignant

they produce E2

59
Q

What are the properties of sertoli-leydig cell tumours?

A

they produce androgens

10-25% are malignant

60
Q

What are the risk factors for ovarian cancer?

A

risk factors:

  • family history
  • increasing age
  • PMH of breast cancer
  • smoking
  • E2-only hormone replacement therapy
  • Lynch II syndrome
  • obesity
  • nulliparity
61
Q

What is nulliparity?

A

never having completed a pregnancy beyond 20 weeks

62
Q

What are the protective factors for ovarian cancer?

A
  • oral contraceptive pill
  • breastfeeding
  • hysterectomy
63
Q

What are the symptoms of ovarian cancer?

How is it staged?

A
  • non-specific symptoms such as pain, bloating and weight loss
  • PV bleeding (vaginal)
  • urinary frequency
  • anorexia

FIGO staging 1-4 is used

64
Q

What are the treatments for ovarian cancer?

What is the prognosis?

A

treatments:

  • stage <1C epithelial tumours - total abdominal hysterectomy
  • omentectomy
  • appendectomy
  • lymphadenectomy & adjuvant chemo
  • chemotherapy only in sensitive germ cell tumours

prognosis:

  • overall 5 years - 43% survival
65
Q

What are the most common type of ovarian metastatic tumours?

Where do they occur?

A

Müllerian tumours

  • uterus
  • fallopian tube
  • pelvic peritoneum
  • contralateral ovary
66
Q

Where do non-Müllerian tumours come from to become ovarian metastatic tumours?

A

lymphatic / haematogenous spread:

  • GI tract - large bowel, stomach, Krukenberg tumour, pancreatic
  • breast (lobular)
  • melanoma
  • less commonly - kidney and lung

direct extension:

  • bladder
  • rectal
67
Q

How are metastatic tumours confirmed?

What is the prognosis like?

A

ovarian metastatic tumours are confirmed histologically

the prognosis is typically poor

68
Q

In brief, what is endometriosis and endometritis?

A

endometriosis:

  • spread of endometrium into the pelvis

endometritis:

  • acute / chronic inflammation (usually due to infection)
69
Q

In brief, what are endometrial polyps and leiomyomata?

A

endometrial polyps:

  • local endometrial overgrowth

leiomyomata:

  • benign smooth muscle tumours of the myometrium
70
Q

In brief, what is endometrial hyperplasia and endometrial cancer?

A

endometrial hyperplasia:

  • oestrogenic stimulation of endometrial proliferation
  • continuous stimulation may lead to atypical hyperplasia and carcinoma

endometrial cancer:

  • commonest gynae cancer with increasing incidence
  • there are 2 types

Y2 Clinical Pathology (76 decks)

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