Week 3 - Female GU Flashcards
What are come microscopic appearances of fibrocystic change in the hyperplastic benign breast condition?
small and large cyst, adenosis (more glands and lobular tissue), more fibrous storm, epithelial hyperplasia, apocrine metaplasia, micro calcification.
What is the microscopic appearance of fibroadenoma, a benign breast neoplasm.
Giant lobules (all terminal duct lobular unit is expanded and distorted), ducts, glands and lots of variable cellular fibrosis. all are benign!
The stage before invasive malignancy is dysplastic lesions. What are the 2 types?
In situ lobular neoplasm and Ductal carcinoma in situ.
What is the grade of a tumour and how would you grade it?
The intrinsic aggressiveness of a tumour. Count tubules, mitosis and estimate nuclear size.
HPV causes >99% of cerivcal cancers, there are easy and late genes which have different effects with the same outcome. what are they?
Early: E1 - E7: interacts with IC molecules to interfere with cell proliferation machinery and to replicate the virus.
Late: L1, L2:encodes capsid proteins. Disruption of cell cycle checkpoints may contribute to accumulation of oncogenic mutations and carcinogenesis.
What may lead to Atrophic vaginitis?
Low oestrogen after menopause
Give 2 examples of non-infective inflammatory conditions of the vulva.
Lichen plants and Lichen sclerosus
What is a Leiomyoma?
Benign smooth muscle tumour of the myometrium.
What is Meig’s syndrome?
Ovarian fibroma with ascites and pleural effusion
Explain the microscopic appearance in Pelvic inflammatory disease.
Tubo-ovarian abscess
fusion of plicae
aggregates of neutrophils
What is a Koilocyte? (in cervix)
Squamous epithelial cell that has undergone a number of structural changes as a result of infection (e.g. HPV 16, 18)
Hollow cell or ‘clearing’ of cytoplasm around the nuclei
Where do most breast pathologies and most neoplasms arise?
Terminal duct lobular unit
What happens to the normal breast in puberty responding to hormones?
Ducts sprout from the breast bud. In females there is further development to form mammary glands
What happens to the breast tissue in menopause?
Lobules atrophy and these is less fibrous stroma
What happens to the breast in pregnancy/lactation?
Increase in number and size of lobular epithelial cells
What are the categories of benign breast conditions?
Inflammatory, Developmental/ congenital, Benign neoplasm, hyperplasia
What is the difference between hyperplasia and neoplasia?
Hyperplasia is the increase in cell number but ceases when the stimulus is removed
Neoplasia is the increase in cell number but does NOT cease when the stimulus is removed.
What are some examples of benign neoplasms of the breast?
Fibroadenoma - commonest, often asymptomatic but can cause a lump, firm but not hard, mobile (breast mouse)
Intraductal papilloma - Frond like growth usually in large ducts below the nipple. nipple bloody discharge
Give examples of hyper plastic benign breast conditions.
Fibrocystic change - abnormal response of normal breast tissue to cyclic hormone fluctuation. Lumpy, worse before** menstruation & usually resolves after
Radial scar - Important form of proliferative breast disease (they look like cancer on mammogram) fibrotic and elastic material at the centre, ‘star shaped’ or ‘flower head’
What is the difference between dysplasia and carcinoma?
Dysplasia is neoplastic but is NOT invasive and cannot metastasise
Carcinoma is neoplastic but CAN invade and metastasise
What is a phyllodes tumour?
It is similar to a fibroadenoma but more cellular, more mitotic, more atypical and larger. All fibroadenomas are benign, most phyllodes tumours are benign.
What may dyskaryotic cells lead you to do?
Nuclear abnormalities
Prompt referral to colposcopy for a biopsy to detect CIN
Describe the process of a colposcopy
Cervix is visualised
Washed with acetic acid. iodine is also added
Green filter light applied.
Area biopsied and treatment given if necessary
What are some pros and cons of fine needle aspiration (cytology)?
:) - immediate result, mild trauma, easy, faster test
:( - requires a trained cytologist, more false +ves and -ves, can’t tell if invasive or CIN
Tamoxifen can be given in breast cancer, what does it do?
Block hormone function in tumours with high levels of residual hormone receptors
What is wide local excision surgery?
Take the tumour and a rim of normal breast tissue, preserving the breast. Radiotherapy can be preformed after to decrease chance of recurrence. Chemo non-adjuvant can shrink it before surgery.
pathological assessment of margins.
What mode is breast cancer most likely to spread to?
Sentinel
The stage before invasive malignancy is dysplastic lesions, give its features.
Malignancy looking proliferation. Within BM, hasn’t extended into the breast stroma, no communication with BV or lymphatics. no possibility of metastases.
What type of breast cancer makes up 70-80%
Ductal carcinoma
What are most vulva cancers associated with?
Dermatoses well differentiated and keratinising.
Adjacent squamous hyperplasia or lichen sclerosis common
What are some Sx of cervical cancer?
Post-coital bleeding, intermenstrual bleeding, irregular vaginal bleeding, pain, none
What are the Tx options for a leiomyoma?
Medical - Progesterone secreting IUS, hormonal therapies, transexamic acid, GnRH agonist
Surgical - Uterine artery embolisation, myomectomy, hysterectomy
Define Salpingitis
Inflammation of the Fallopian tubes due to a bacterial infection
What is a serous tubal intraepithelial carcinoma (STIC)?
Abnormal epithelium in the distal Fallopian tube, limited by the BM. nuclear atypia. May have P53 mutation
Precursor lesion of high grade serous carcinoma
Give examples of alkylating agents and their action.
Form covalent bonds with DNA, interferes with transcription and replication.
Cysplatin and cyclophosphamide
What does the cytotoxic antibiotic Doxorubicin do?
Inserts itself between base pairs, local uncoiling, impairs DNA and RNA synthesis
What does the cytotoxic antibiotic Dactinomycin do?
Inserts itself into the minor groove in the DNA helix, disrupting RNA polymerase function
What is dyskaryosis? - enlarged nuclei, coarse chromatin, sometimes scattering of inflammatory cells
Abnormal nuclei, most likely due to cervical intraepithelial neoplasm - pre-malignant
further investigation with colposcopy and biopsy
What is the most appropriate treatment for a patient with koliocytes?
Loop excision of the transformation zone (LETZ) treats abnormal epithelium and allows full assessment
What is a ‘transit amplifying population’?
Cell proliferation for renewal of tissue
normally restricted to the lower 1/3 (from above basal layer)
Where is HPV infection and CIN most likely found?
Transformation zone
What is Cervical intraepithelial neoplasm?
Imbalance between the proliferating zone (which increased) and the differentiation zone (which is reduced). Bi and multinucleate cells are a feature of HPV infection
What HPV is genital warts associated with?
6, 11
What type of tumour is a fibroid?
Leiomyoma - benign smooth muscle tumour tumour.
may have trisomy 12.
!st line - Mirena coil
What would a leiomyosarcoma look like?
Necrosis, High, atypical or bizarre cells, unusually numerous and abnormal mitosis
What carcinoma has BRAF or KRAS mutation?
Low grade serous carcinoma
What is pagets disease of the nipple?
Eczema of the nipple, erythematous, scaly rash
What is an endometrioma?
A blood filled cyst caused by ovarian endometriosis
Where do most breast pathology and cancers arise?
Terminal duct lobular unit
Give some examples of benign inflammatory breast conditions.
*Fat necrosis - caused by trauma- damage to breast tissue. chronic inflammation and multinucleate giant cells
*Acute mastitis- breast feeding. fissuring of skin - access - stagnant milk- bacterial growth. Sx cellulitis, abscesses
Granulomatous conditions - granulomas
*Periductal mastitis/ mammary gland ectasia - central ducts become inflamed, blocked and dilated. Breast abscesses. chronic inflammation and scarring. link to smoking
What can you use in a breast cancer with high levels of residual hormone receptors?
Block hormone function - Tamoxifen (SE- Risk of developing endometrial cancer)
in Post- menopausal women you can use aromatase inhibitor - Letrozole, anastrozole
What tumours can be difficult to differentiate from metastasis from the GI tract?
Mucinous carcinomas
What is a Brenner tumour?
mixed surface epithelial-stomal tumours
What treatment could you use in prostate cancer?
Flutamide or bicalutamide - Testosterone antagonist
What do antimetabolics do and give some e.gs.
Interfere with nucleotide synthesis or DNA synthesis. Deprive the cell of metabolites needed for replication.
Methotrexate, Gemcitabine
What does the nucleotide analogue cytarabine do?
Inhibits DNA polymerase. Causes chain termination.
S-phase cycle specific
How do microtubule inhibitors work?
Bind to microtubular protein, block tubulin polymerisation, block normal spindle formation, disrupt cell division - Vincristine
