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Third year > Week 3 - Female GU > Flashcards

Week 3 - Female GU Flashcards

1
Q

What are come microscopic appearances of fibrocystic change in the hyperplastic benign breast condition?

A

small and large cyst, adenosis (more glands and lobular tissue), more fibrous storm, epithelial hyperplasia, apocrine metaplasia, micro calcification.

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2
Q

What is the microscopic appearance of fibroadenoma, a benign breast neoplasm.

A

Giant lobules (all terminal duct lobular unit is expanded and distorted), ducts, glands and lots of variable cellular fibrosis. all are benign!

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3
Q

The stage before invasive malignancy is dysplastic lesions. What are the 2 types?

A

In situ lobular neoplasm and Ductal carcinoma in situ.

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4
Q

What is the grade of a tumour and how would you grade it?

A

The intrinsic aggressiveness of a tumour. Count tubules, mitosis and estimate nuclear size.

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5
Q

HPV causes >99% of cerivcal cancers, there are easy and late genes which have different effects with the same outcome. what are they?

A

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.

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6
Q

What may lead to Atrophic vaginitis?

A

Low oestrogen after menopause

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7
Q

Give 2 examples of non-infective inflammatory conditions of the vulva.

A

Lichen plants and Lichen sclerosus

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8
Q

What is a Leiomyoma?

A

Benign smooth muscle tumour of the myometrium.

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9
Q

What is Meig’s syndrome?

A

Ovarian fibroma with ascites and pleural effusion

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10
Q

Explain the microscopic appearance in Pelvic inflammatory disease.

A

Tubo-ovarian abscess
fusion of plicae
aggregates of neutrophils

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11
Q

What is a Koilocyte? (in cervix)

A

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

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12
Q

Where do most breast pathologies and most neoplasms arise?

A

Terminal duct lobular unit

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13
Q

What happens to the normal breast in puberty responding to hormones?

A

Ducts sprout from the breast bud. In females there is further development to form mammary glands

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14
Q

What happens to the breast tissue in menopause?

A

Lobules atrophy and these is less fibrous stroma

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15
Q

What happens to the breast in pregnancy/lactation?

A

Increase in number and size of lobular epithelial cells

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16
Q

What are the categories of benign breast conditions?

A

Inflammatory, Developmental/ congenital, Benign neoplasm, hyperplasia

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17
Q

What is the difference between hyperplasia and neoplasia?

A

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.

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18
Q

What are some examples of benign neoplasms of the breast?

A

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

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19
Q

Give examples of hyper plastic benign breast conditions.

A

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’

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20
Q

What is the difference between dysplasia and carcinoma?

A

Dysplasia is neoplastic but is NOT invasive and cannot metastasise
Carcinoma is neoplastic but CAN invade and metastasise

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21
Q

What is a phyllodes tumour?

A

It is similar to a fibroadenoma but more cellular, more mitotic, more atypical and larger. All fibroadenomas are benign, most phyllodes tumours are benign.

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22
Q

What may dyskaryotic cells lead you to do?

A

Nuclear abnormalities

Prompt referral to colposcopy for a biopsy to detect CIN

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23
Q

Describe the process of a colposcopy

A

Cervix is visualised
Washed with acetic acid. iodine is also added
Green filter light applied.
Area biopsied and treatment given if necessary

24
Q

What are some pros and cons of fine needle aspiration (cytology)?

A

:) - immediate result, mild trauma, easy, faster test

:( - requires a trained cytologist, more false +ves and -ves, can’t tell if invasive or CIN

25
Q

Tamoxifen can be given in breast cancer, what does it do?

A

Block hormone function in tumours with high levels of residual hormone receptors

26
Q

What is wide local excision surgery?

A

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.

27
Q

What mode is breast cancer most likely to spread to?

A

Sentinel

28
Q

The stage before invasive malignancy is dysplastic lesions, give its features.

A

Malignancy looking proliferation. Within BM, hasn’t extended into the breast stroma, no communication with BV or lymphatics. no possibility of metastases.

29
Q

What type of breast cancer makes up 70-80%

A

Ductal carcinoma

30
Q

What are most vulva cancers associated with?

A

Dermatoses well differentiated and keratinising.

Adjacent squamous hyperplasia or lichen sclerosis common

31
Q

What are some Sx of cervical cancer?

A

Post-coital bleeding, intermenstrual bleeding, irregular vaginal bleeding, pain, none

32
Q

What are the Tx options for a leiomyoma?

A

Medical - Progesterone secreting IUS, hormonal therapies, transexamic acid, GnRH agonist
Surgical - Uterine artery embolisation, myomectomy, hysterectomy

33
Q

Define Salpingitis

A

Inflammation of the Fallopian tubes due to a bacterial infection

34
Q

What is a serous tubal intraepithelial carcinoma (STIC)?

A

Abnormal epithelium in the distal Fallopian tube, limited by the BM. nuclear atypia. May have P53 mutation
Precursor lesion of high grade serous carcinoma

35
Q

Give examples of alkylating agents and their action.

A

Form covalent bonds with DNA, interferes with transcription and replication.
Cysplatin and cyclophosphamide

36
Q

What does the cytotoxic antibiotic Doxorubicin do?

A

Inserts itself between base pairs, local uncoiling, impairs DNA and RNA synthesis

37
Q

What does the cytotoxic antibiotic Dactinomycin do?

A

Inserts itself into the minor groove in the DNA helix, disrupting RNA polymerase function

38
Q

What is dyskaryosis? - enlarged nuclei, coarse chromatin, sometimes scattering of inflammatory cells

A

Abnormal nuclei, most likely due to cervical intraepithelial neoplasm - pre-malignant
further investigation with colposcopy and biopsy

39
Q

What is the most appropriate treatment for a patient with koliocytes?

A

Loop excision of the transformation zone (LETZ) treats abnormal epithelium and allows full assessment

40
Q

What is a ‘transit amplifying population’?

A

Cell proliferation for renewal of tissue

normally restricted to the lower 1/3 (from above basal layer)

41
Q

Where is HPV infection and CIN most likely found?

A

Transformation zone

42
Q

What is Cervical intraepithelial neoplasm?

A

Imbalance between the proliferating zone (which increased) and the differentiation zone (which is reduced). Bi and multinucleate cells are a feature of HPV infection

43
Q

What HPV is genital warts associated with?

A

6, 11

44
Q

What type of tumour is a fibroid?

A

Leiomyoma - benign smooth muscle tumour tumour.
may have trisomy 12.
!st line - Mirena coil

45
Q

What would a leiomyosarcoma look like?

A

Necrosis, High, atypical or bizarre cells, unusually numerous and abnormal mitosis

46
Q

What carcinoma has BRAF or KRAS mutation?

A

Low grade serous carcinoma

47
Q

What is pagets disease of the nipple?

A

Eczema of the nipple, erythematous, scaly rash

48
Q

What is an endometrioma?

A

A blood filled cyst caused by ovarian endometriosis

49
Q

Where do most breast pathology and cancers arise?

A

Terminal duct lobular unit

50
Q

Give some examples of benign inflammatory breast conditions.

A

*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

51
Q

What can you use in a breast cancer with high levels of residual hormone receptors?

A

Block hormone function - Tamoxifen (SE- Risk of developing endometrial cancer)
in Post- menopausal women you can use aromatase inhibitor - Letrozole, anastrozole

52
Q

What tumours can be difficult to differentiate from metastasis from the GI tract?

A

Mucinous carcinomas

53
Q

What is a Brenner tumour?

A

mixed surface epithelial-stomal tumours

54
Q

What treatment could you use in prostate cancer?

A

Flutamide or bicalutamide - Testosterone antagonist

55
Q

What do antimetabolics do and give some e.gs.

A

Interfere with nucleotide synthesis or DNA synthesis. Deprive the cell of metabolites needed for replication.
Methotrexate, Gemcitabine

56
Q

What does the nucleotide analogue cytarabine do?

A

Inhibits DNA polymerase. Causes chain termination.

S-phase cycle specific

57
Q

How do microtubule inhibitors work?

A

Bind to microtubular protein, block tubulin polymerisation, block normal spindle formation, disrupt cell division - Vincristine

Third year (15 decks)

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