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Pathology by week > W26 - Gynae path > Flashcards

W26 - Gynae path Flashcards

1
Q

Which organisms typically cause PID?

A

1. Gonorrhoea

2. Chlamydia

  1. Enteric bacteria

sometimes staph, strept, coliform bacteira and clostridium perfringens (these typcially happen 2ndary to abortion)

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2
Q

Name 4 complications of PID

A
  1. Peritonitis
  2. Bacteraemia
  3. Intestinal obstruction due to adhesions
  4. Infertility
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3
Q

Name 6 complications that may arise from sapingitis (PID affecting fallopian tube)

A
  1. Adhesions to ovary
  2. Tubo-ovarian abscess
  3. Peritonitis
  4. Hydrosalpinx
  5. Infertility
  6. Ectopic pregnancy
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4
Q

The premalignant phase of cervical cancer is…

A

Cervical intraepithelial neoplasia (CIN)

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5
Q

cervical cancer - mean age?

A

45-50 y.o.

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6
Q

Cervical cancer - RF (5)

A
  1. HPV - present in 95%
  2. many sexual partners
  3. sexually active early
  4. Smoking
  5. Immunosuppression
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7
Q

low risk HPV strains:

  • most common types?
  • disease caused?
A
  • low risk HPV strains:
  • type 6 and 11
  • genital and oral warts
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8
Q

High risk HPV strains:

  • most common types?
  • disease caused?
A

High risk HPV strains:

  • types 16 & 18
  • cervical cancer (but also vulval, vaginal, penile, anal cancers)
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9
Q

Describe epithelium of endocervix and exocervix

A

Endocervix = columnar epithelium (mucinous)

Exocervix = squamous epithelium

and where they meet is the transformation zone (squamocolumnar junction)

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10
Q

This is a histo slide of the cervix - what pathology is there? point out the SC junction

A

left thicker portion = squamous

right thinner portion = columnar

where they meet in the middle = SCJ

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12
Q

CIN I, CIN II, CIN III, and carcinoma in situ - describe each

A

CIN I = mild dyskaryosis, abnormal cells limited to most superficial 1/3 of epithelium

CIN II = moderate dyskaryosis, abnormal cells affects up to 2/3 of epithelium

CIN III = severe dyskaryosis, abnormal cells >2/3 of epithelium

carcinoma in situ = abnormal growth involves full thickness of the epithelium but no prenetration to other tissues.

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13
Q

Low-grade squamous intraepithelial lesions (LSILs) are which CINs?

A

HPV infection with abnormal cells

CIN I

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14
Q

High-grade squamous intraepithelial lesions (HSILs) are which CINs?

A

CIN II

CIN III

Carcinoma in situ

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15
Q

Cervical carcinoma - definition, 2 types

A

Cervical carcinoma is invasion through the BM

2 types:

  1. squamous cell carcinoma (most common)
  2. Adenocarcinoma (20% of all invasive cases, HPV dependent or independent)
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16
Q

What are the 2 distinct biological states of HPV infection

A
  1. Non-productive, latent infection = no cellular changes, can only detect HPV via molecular methods
  2. Productive viral infection = viral DNA replicates independently of host DNA chromosome synthesis, cytological and histological features are seen
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17
Q

In 90%, HPV becomes undetectable within ______

A

2 years

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18
Q

How does HPV transform cells?

A

•Two proteins E6 and E7 encoded by the virus have transforming genes.

E6 and E7 bind to and inactivate two tumour suppressor genes:

Retinoblastoma gene (Rb) (E7)

P53 (E6)

=> increased proliferation, decreased apoptosis

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19
Q

HPV vaccination in the UK regimen

A

Girls and boys aged 12 to 13 years = 1st dose in Year 8, 2nd dose 6-24 months after.

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20
Q

The uterine body is made of the endometrium, which has _____ and _____, and the myometrium.

A

The uterine body is made of the endometrium, which has glands and stroma, and the myometrium.

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21
Q

Name 5 cases in which endometrial hyperplasia is common

A
  1. Perimenopause
  2. Persistent anovulation
  3. PCO
  4. Ovarian granulosa cell tumours
  5. Oestrogen therapy
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22
Q

When is enometrial hyperplasia concerning?

A

when it’s associated with atypia

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23
Q

4 RFs for endometrial carcinoma

A
  1. Nulliparity
  2. Obesity
  3. Diabetes mellitus
  4. Excessive oestrogen stimulation
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24
Q

Describe type 1 endometrial carcinomas and their characteristics

A

Type 1 (85%) - SEM = secretory, endometrioid, mucinos carcinomas

  • oestrogen dependent
  • often younger patients
  • low grade and high grade tumours possible
  • mutations must accumulate (>4) for development of these cancers)
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25
Q

Describe type 2 endometrial carcinomas and their characteristics

A

Type 2 (15%) = SC = Serous and clear cell carcinomas

  • less oestrogen dependent
  • older, postmenopausal women
  • higher grade, deeper invasion, high stage
  • serous (p53 mutation in 90%), Clear cell (PTEN)
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26
Q

Describe FIGO Stages I to IV for endometrial carcinoma

A

Stage I = no or less than half myometrial invasion

Stage II = invasion into cervical stroma

Stage III = local and/or regional spread of tumour +/- pelvic/para-aortic LN involvement

Stage IV = tumour invades into bladder +/- bowel mucosa +/- distant metastases

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27
Q

The Cancer Genome Atlas (TCGA) classification of endometrial carcinoma - name issue in each group: Group 1 to Group 4

A

Group 1: mutation in polymerase E

Group 2: microsatellite instability

Group 3: low copy number abnormality

Group 4: serous-like tumours show TP53 mutations + high copy number alterations

28
Q

SM benign tumours of myometrium are called…

A

Leiomyoma

29
Q

Leiomyoma are also known as…

  • how common are they?
  • describe the 3 types
A

Leiomyoma are also known as fibroids

  • how common are they = 20% of women >35y.o
  • describe the 3 types = submucosal, subserosal, intramural
30
Q

The malignant counterpart of leiomyoma is…

A

Leiomyosarcoma (RARE)

31
Q

Leiomyosarcoma

  • who is it common in?
  • survival?
A

Leiomyosarcoma

  • who is it common in = postmenopausal
  • survival = 5-year-survival 20-30%
32
Q

Endometriosis - what is it?

A

Presence of endometrial glands and stroma outside the uterus. This ectopic endometrial tissue is functional and bleeds at time of menstruation, causing pain, scarring, and possibility infertility

33
Q

Endometriosis:

  • how common is it?
  • malignant?
A

Endometriosis:

  • how common is it = common, 10% of premenopausal women
  • malignant = can develop hyperplasia and malignancy (but rare)
34
Q

Endometrial tissue in the myometrium is called…

A

Adenoma

35
Q

Ovarian tumours could be primary or secondary.

  • Name primary classification.
  • What are secondary ovarian tumours?
A

Primary:

1. Epithelial tumours (70%)

2. Sex cord-stromal tumours

3. Germ cell tumours

NB. 4th is miscellaenous tumours

  • What are secondary ovarian tumours = metastases
36
Q

The commonest type of ovarian tumour is…

A

epithelial tumours

(65% of all ovarian tumours, 95% of malignant ovarian tumours)

37
Q

Epithelial tumour age distribution

A

50% found in 45-65 age group

38
Q

Germ cell tumours age distribution

A

bimodal = 1st peak at 15-21 years old and 2nd peak at 65-69

39
Q

Sex cord stromal tumours age distribution

A

most commonly seen in post-menopausal women but some subtypes peak in 25-30 year age group

40
Q

Name 4 types of epithelial tumours of the ovary

A
  1. Serous (cystadenoma [benign] all the way to high-grade serous carcinoma
  2. mucinous
  3. endometrioid
  4. clear cell
41
Q

Name the commonest benign epithelial tumours

A

Serous Cystadenomas

Cystadenofibromas

Mucinous cystadenomas

Brenner tumour

42
Q

What are borderline epithelial tumours of the ovary?

A

Tumours whose biologic behaviour cannot be predicted on histologic grounds, have a very low but definite metastatic potential and their behaviour cannot be predicted reliably using histoloigcal or molecular grounds

43
Q

5 RFs for malignant epithelial tumours of the ovary

A
  1. Nulliparity
  2. Infertility
  3. Early menarche
  4. Late menopause
  5. Genetic predisposition (fhx of ovarian or breast ca)
44
Q

Name 3 familial syndromes that can cause ovarian cancer

mode of inheritance

A
  1. familial breast-ovarian cancer syndrome*
  2. site-specific ovarian cancer**
  3. cancer family syndrome (Lynch type II)

mode of inheritance: autosomal dominant

*, ** are both associated with mutations of the BRCA1 and BRCA2

45
Q

Lynch II syndrome is also known as…

A

hereditary nonpolyposis colorectal cancer (HNPCC)

46
Q

Lynch II syndrome causes 3% of ovarian carcinomas. Which 2 types of cancer is it moainly associated with?

A

Endometrioid

clear cell

47
Q

What is the most common type of malignant tumour?

A

High grade serous carcinoma (80%) - v aggressive

48
Q

High grade serous carcinoma - hallmark genetic mutation?

A

mutations in P53

49
Q

Give 4 reasons as to why high grade serous ovarian cancer patients undergo BRCA1 and BRCA2 testing

A
  1. check patient for other cancers (breast cancers)
  2. BRCA mutation status has a signficiant influence on response to chemo.
  3. BRCA2 mutation has overall survival advantgae to BRCA(-) or BRCA1 mutation
  4. Screen family members
50
Q

In low grade serous carcinoma of the ovary, the precusor is… + associated mutations?

In high grade serous carcinoma of the ovary, the precusor is… + associated mutations?

A

In low grade serous carcinoma of the ovary, the precusor is borderline ovarian tumours or it may arise de novo. KRAS, BRAF

In high grade serous carcinoma of the ovary, the precusor is high grade dysplasia. BRCA1, BRCA2

51
Q

Which cancer typically metastasizes to the ovary?

A

Colorectal carcinoma (4-10%)

52
Q

What are Krukenberg tumours?

A

Bilateral metastases to the ovaries composed of mucin-producing signet ring cells. The most common primary site for this tumor is the stomach (most common) or breast

53
Q

Is mucinous tumour in ovary always a primary tumour?

A

No - can be a Krukenberg tumour (metastases from stomach or breast ca)

54
Q

Endometrioid carcinoma in the ovary is often associated with ________

A

endometriosis in the ovary (10-20% are associated with endometriosis)

55
Q

Clear cell carcinoma - high or low grade?

A

High grade

56
Q

Which 2 carcinomas of the ovary are associated more strongly with endometriosis?

A
  1. Endometrioid carcinoma
  2. Clear cell carcinoma
57
Q

Sex cord stromal tumours of the ovary may be classified into (3)

A
  1. Pure stromal tumours
  2. Pure sex cord cell tumours
  3. Mixed sex cord-stromal tumours
58
Q

Sex cord-stroml tumours:

Subtypes 1) adult type granulosa cell tumour

2) microcystic stromal tumours

Name mutation associated with each

A

Sex cord-stroml tumours:

1) adult type granulosa cell tumour = FOXL2
2) microcystic stromal tumours = CTNNB1

59
Q

Name 2 hereditary syndromes associated with sex cord-stromal tumours and the mutation in each

A

DICER1 syndrome - germline mutation in DICER1

Peutz-Jeghers syndrome - germline mutation in STK11

60
Q

Germ cell tumours of the ovary:

  • how common are they?
  • benign or malignant?
  • when do they present?
A

Germ cell tumours of the ovary:

  • how common are they = 20% of ovarian tumours
  • benign or malignant = 95% benign
  • when do they present = 1st/2nd decade of life
61
Q

Mature teratoma of ovary:

  • benign or malignant?
  • what are they?
A

Mature teratoma of ovary:

  • benign or malignant = benign
  • what are they = cysts with teeth, hair (differentiated tissue)
62
Q

Immature teratoma of the ovary:

  • benign or malignant?
A

Aggressive + malignant (only about 2% of tetatomas)

63
Q

5 prognostic factors in ovarian tumours?

A
  1. Stage of Disease
  2. Tumour type
  3. Tumor grade
  4. Size of residual disease (post-surgery)
  5. Tumor response to therapy
64
Q

Which part of the female genital tract is the commonest site to receive metastatic tumours:

A) Vulva

B) Vagina

C) Cervix

D) Endometrium

E) Fallopian tube

F) Ovaries

A

F) Ovaries

Pathology by week (70 decks)

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