0501 - Female Urogenital Lesions

Question 1

What is the constant layer of epithelium from the renal calyces to the end of the urethra? Describe it.

Answer 1

Urothelium.

Stratified - 3-7 layers, with umbrella cells at the surface. No more than 7 layers!!!

Able to distend, and forms an impermeable barrier above basement membrane and lamina propria.

Question 2

What are some non-neoplastic lesions of the ureter?

Answer 2

Congenital - diverticuli or duplication

Infection - secondary to vesico-uteric reflux

Inflammation - ureteritis cystica (cystic)

Deposits - Calculi, blood clots or fibrosis

Question 3

What are some non-neoplastic lesions of the urinary bladder?

Answer 3

Congenital - Diverticulae, exstrophy

Infection - Schistosomiasis

Inflammation - Eosinophilic, drug-related, radiation, or idiopathic

Deposits - Within the lumen (lithiasis), within the wall (amyloid)

Question 4

What are some non-neoplastic lesions of the urethra

Answer 4

Congenital - Hypospadias

Infection - Gonococcal, Chlamydia, E Coli

Question 5

What is a standard approach to categorising urothelial neoplasms?

Answer 5

Flat or Papillary, and then benign of malignant

Flat - Benign is regeneration following inflammation, malignant is carcinoma in situ or urothelial carcinoma.

Papillary - benign is papilloma, malignant is papillary urothelial carcinoma. Between these is papillary urothelial neoplasm of unknown malignant potential.

Question 6

Describe urothelial carcinoma in situ

Answer 6

Presentation - Asymptomatic or refractory UTI-like symptoms

Macro - Red, inflamed mucosa.

Micro - Classic features of malignancy, with more than 7 layers but no breach in the basement membrane.

Question 7

Describe micro appearance of flat urothelial carcinoma

Answer 7

Can be low grade or high grade

Characterised by invasion - into lamina propria or muscularis propria respectively.

Question 8

What is meant by papillary architecture?

Answer 8

A finger-like projection involving a fibrovascular core of blood vessels and connective tissue in the centre, surrounded by epithelium.

Physiologically normal only in the choroid plexus. Abnormal/tumour in other tissues.

Question 9

Briefly describe the three forms of papillary urothelial neoplasms

Answer 9

Benign - papilloma. Papilla lined by normal urothelium, of normal thickness, orderly and organised with no mitoses.

Papillary neoplasm of unknown malignant potential - lined by abnormally thick (>7 layers) urothelium, in mild disarray with occasional mitoses.

Papillary urothelial carcinoma - lined by malignant urothelium, very chick with complete loss of organisation and several mitoses.

Any level can break off, leading to haematuria. Outside a UTI, any haematuria is abnormal and must be investigated.

Question 10

Outline the normal histology of the fallopian tube.

Answer 10

Surrounding smooth muscle, with lumen containing plicae, leading to a folded appearance.

Question 11

What are the major possible tumours of the fallopian tube?

Answer 11

Infection - Salpingitis - acute, chronic, granulomatous, foreign-body type.

Obstructive - Ectopic pregnancy, endometriosis, paratubal cyst

Benign neoplasm - Adenomatoid tumour

Malignant neoplasm - Primary or secondary carcinoma.

Question 12

Briefly outline Salpingitis (aetiology, macro, micro, complications)

Answer 12

Aetiology - Infection (STI or post-instrumentation/pregnancy)

Macro - Adhesion and fusion of fimbriae, dilated tube filled with pus

Micro - Acute or chronic inflamation, plicae fused

Complications - Abscesses, ectopic pregnancy, infertility.

Question 13

Briefly outline ectopic pregnancy (aetiology, macro, micro, treatment)

Answer 13

Aetiology - chronic salpingitis (fused plicae), congenital abnormalities, endometriosis

Macro - Dilated, haemorrhagic, +/- foetus

Micro - Chorionic villi

Treatment - Salpingectomy.

Question 14

Describe the normal histology of the uterus.

Answer 14

Consists of endometrium and myometrium

Endometrium consists of glands and stroma - Glands grow from proliferative to secretory phase (ovulation)

Myometrium - smooth muscle.

Question 15

Briefly outline the histology of endometrial carcinoma

Answer 15

Complex glandular and papillary architecture.

Glands are arranged back to back without normal stroma in between, and glands and papillae are lined by multiple layers of cells.

Cells show typical neoplastic changes (N:C ratio, nucleoli, pleomorphism).

Question 16

Briefly outline leiomyoma

Answer 16

Macro - Homogenous, smooth tumours in myometrium

Histo - Smooth muscle proliferation with homogenous whorled appearance

Complications - Pain, menorrhagia, infertility, compressive symptoms.

Question 17

Briefly outline the histology of the cervix

Answer 17

Endocervix - Simple squamous with glands

Squamocolumnar junction

Ectocervix - non-keratinising stratified squamous.

Question 18

Briefly outline the macro and micro appearance of the vagina

Answer 18

Macro - Fibromuscular canal with rugae

Mucosal layer - stratified squamous

Lamina propria - elastic fibres

Smooth muscle

Adventitial layer

Question 19

What is leukoplakia? What are the two possible causes?

Answer 19

White, plaque like thickening of the mucosa at the vulva.

Benign - lichen sclerosus

Malignant - early SCC

Question 20

Briefly outline lichen sclerosus (pathogenesis, macro, micro)

Answer 20

Pathogenesis - autoimmune, genetic, or hormonal

Macro - Area of leukoplakia

Micro - Hyperkeratosis (main one), thinning of epidermis, loss of rete pegs, dermal collagen altered.

Not premalignant in itself, but associated with higher SCC risk.

Question 21

Briefly outline vulval SCC (age, risk factors, site, prognosis)

Answer 21

Age >60

Risk factors - HPV, cigarette smoking, immunodeficiency

Site - labia majora/minora, clitoris

Prognosis - 5 year survival 50-75%