Week 4 - Female Reproductive Pathology Flashcards
What type of epithelium lines the endocervix?
Columnar
What type of epithelium lines the ectocervix?
Non-keratinising stratified squamous epithelium
Where do most cervical neoplasia develop?
Transformation zone
Which strains of HPV are prevalent in Scotland?
16
18
Where are patients who have dyskaryosis suggestive of Cervical Intraepithelial Neoplasia on a cervical smear referred to?
Colposcopy clinic
Who is eligible for cervical smear in Scotland?
Women aged 25-65
35-50 - 3 yearly
50-65 - five yearly
Which strains of HPV does the vaccine protect against?
6, 11, 16, 18
Describe the steps in a colposcopy
- Cervix visualised
- Washed with acetic acid
- Application of iodine
- Green light filter
- Abnormal area can be biopsied or treatment performed at time
How do early (E1-7) HPV genes cause cervical carcinoma?
Interact with intracellular molecules to interfere with cell proliferation machinery to replicate the virus
How do late (L1-2) HPV genes cause cervical carcinoma?
Encode capsid proteins and disrupt cell cycle checkpoints
What are the symptoms of cervical cancer?
Post-coital bleeding Intermenstrual bleeding Irregular vaginal bleeding Pain None?
What commonly causes atrophic vaginitis?
Low oestrogen after menopause
What are the symptoms of atrophic vaginitis?
Discomfort
Pain during intercourse
Bleeding
Name 3 non-infective inflammations of the vulva
Lichen planus
Lichen sclerosus
What proportion of vulval cancer is associated with HPV?
20%
What are the 2 different forms of vulval SCC?
Associated with vulval intra-epithelial neoplasm
Associated with dermatoses
Which embryonic structure do the gonads arise from?
Urogenital ridges
Which embryonic structure do the genital ducts arise from?
Mesonephric and paramesonephric ducts
Which ducts form female reproductive structures?
Paramesonephric i.e. Mullerian
Which ducts form male reproductive structures?
Mesonephric i.e. Wolffian
Which gene is responsible for sex determination?
SRY
Which cells are present in the testes?
Leydig
Sertoli
Why is testosterone essential for normal male development?
Stimulates development of mesonephric structures - without it, the ducts atrophy
What causes the paramesonephric ducts to regress in males?
Sertoli cells produce Anti-Mullerian Hormone
Which structures in males are formed from the urogenital sinus?
Bladder
Prostate gland
Bulbourethral gland
Urethra
Why do the mesonephric ducts regress in females?
They do not have testosterone
What type of epithelium lines the fallopian tubes?
Ciliated columnar
What are the symptoms of salpingitis?
Fever Lower abdominal pain Pelvic masses (if tubes distended with exudate or secretions)
Give some examples of complications of salpingitis
Abscess Adhesions Obstruction of lumen Infertility Ectopic pregnancy
What is the most common cancer of the fallopian tubes?
Papillary serous carcinoma
What is Serous Tubal Intraepithelial Carcinoma?
Abnormal epithelium in distal fallopian tube that is limited by BM therefore in situ, however nuclear atypia clearly seen
Likely precursor for high grade serous carcinoma
What are the 3 types of non-neoplastic cysts?
Inclusion
Follicular
Luteal cysts
What are the symptoms of PCOS?
Oligomenorrhoea
Hirtuism
Infertility
Obsesity
What are the hormonal changes seen in PCOS?
High androgens
High LH
Low FSH
What causes the symptoms seen in PCOS?
Multiple cystic follicles in the ovaries over-produce androgens
What is a potential complication of PCOS?
Type II diabetes
What are the 3 types of cell that make up the normal ovary?
Epithelium
Germ cells
Stromal cells
Name 2 risk factors for epithelial ovarian cancers
Nulliparity
Name common mutations found in sporadic ovarian cancer
BRCA (9%)
HER2 (35%)
KRAS (30%)
p53 (50%)
Name 2 benign lesions of the ovarian epithelium
Cystadenoma
Cystadenofibroma
Name the 5 types of ovarian carcinoma
High grade serous (70%) Endometrioid (10%) Clear-cell (10%) Low grade serous (5%) Mucinous (3%)
Which mutations are seen in HGSC of the ovary?
p53
BRCA1
What age do women get malignant serous ovarian tumours?
45-60
Which mutations are seen in LGSC?
BRAF
KRAS
Which ovarian cancers arise from ovarian endometriosis?
Endometriod
Clear cell
Where does HGSC of the ovary usually arise from?
Epithelial precursor lesions in the ovarian end of the Fallopian tubes
What are Psammoma bodies?
Concentrically laminated calcified concretions commonly found in the papillae of serous tumours
What type of disease can mimic primary ovarian mucinous carcnoma?
Metastatic cancer spread from the GI tract to the ovary
How many mucinous ovarian tumours are malignant?
10%
Which gene is involved in endometriod carcinomas?
PTEN tumour supressor gene
What is a teratoma?
Tumour that contains tissues of all 3 germ cell layers
What is a serious complication associated with a cystic teratoma?
Torsion
