Benign Gynaecological Pathology

Question 1

Define pelvic inflammatory disease

Answer 1

Infection ascending from the vagina and cervix up to the uterus and fallopian tubes, leading to inflammation and the formation of adhesions

Question 2

State the most common causes of pelvic inflammatory disease

Answer 2

UK: Chlamydia trachomatis, Neisseria gonorrhoea
ROW: Above plus TB, schisosomiasis

Question 3

Describe the clinical features of pelvic inflammatory disease

Answer 3

Lower abdominal pain, dyspareunia, vaginal bleeding and discharge, fever, adnexal tenderness, cervical excitation

Question 4

State at least 5 complications of pelvic inflammatory disease

Answer 4

Fitz-Hugh-Curtis syndrome, infertility, inc risk of ectopic pregnancy, intestinal obstruction, tubo-ovarian abscess, chronic pelvic pain, peritonitis, plical fusion

Question 5

What is Fitz-Hugh-Curtis syndrome?

Answer 5

A rare complication of PID causing liver capsule inflammation leading to the creation of adhesions (violin string peri-hepatic adhesions)

Question 6

Define endometriosis

Answer 6

The presence of endometrial glands or stroma in abnormal locations outside the uterus - e.g. ovaries, uterine ligaments

Question 7

State the 3 aetiological theories of endometriosis

Answer 7

1: implantation from retrograde menstrual flow
2: metaplastic transformation of coelomic epithelial cells
3: vascular or lymphatic dissemination of endometrial cells

Question 8

Describe the pathophysiology of endometriosis

Answer 8

Functional endometrial tissue outside of the uterus undergoes cyclical bleeding, leading to pain, scarring, and infertility

Question 9

Describe the clinical features of endometriosis

Answer 9

Pelvic pain, dysmenorrhoea, deep dyspareunia, decreased fertility. On examination, vaginal tenderness, vaginal nodules, immobile and retroverted uterus in advanced disease

Question 10

Describe the macroscopic appearance of endometriosis

Answer 10

Red-blue to brown nodules (powder burns)
Chocolate cysts (endometriomas) in ovaries

Question 11

Describe the microscopic appearance of endometriosis

Answer 11

Endometrial glands and stroma

Question 12

Define adenomyosis

Answer 12

Presence of ectopic endometrial tissue deep within the myometrium

Question 13

State the clinical features of adenomyosis

Answer 13

Heavy menstrual bleeding, dysmenorrhoea, deep dyspareunia. On examination, globular uterus

Question 14

Define leiomyoma

Answer 14

Fibroid - a benign tumour of smooth muscle origin

Question 15

State 3 possible locations for leiomyomas

Answer 15

Intramural, submucosal, subserosal

Question 16

What % of women >35 have a leiomyoma

Answer 16

20%

Question 17

Describe the macroscopic appearance of leiomyomas

Answer 17

Sharply circumscribed, discrete, round, firm, grey-white tumours of variable size

Question 18

Describe the microscopic appearance of leiomyomas

Answer 18

Bundles of smooth muscle cells

Question 19

State the clinical features of leiomyoma

Answer 19

Heavy menstrual bleeding, dysmenorrhoea, subfertility. Large leiomyomas may cause pressure effects (urinary frequency, tenesmus)

Question 20

State the risks of leiomyoma during pregnancy

Answer 20

Red degeneration (haemorrhagic infarction, presenting with severe abdominal pain), post-partum torsion

Question 21

Describe the histological appearance of the normal cervix

Answer 21

Outer cervix covered by squamous epithelium, endocervical canal lined by columnar epithelium - separated by squamocolumnar junction

Question 22

Define the transformation zone

Answer 22

The area where columnar epithelium transforms into squamous cells

Question 23

Define cervical intraepithelial neoplasia (CIN)

Answer 23

Dysplasia at the transformation zone as a result of infection by HPV 16, 18, or 33

Question 24

Define CIN 1

Answer 24

Dysplasia confined to the lower 1/3 of the epithelium

Question 25

Define CIN 2

Answer 25

Dysplasia confined to the lower 2/3 of the epithelium

Question 26

Define CIN 3

Answer 26

Full thickness dysplasia with an intact basement membrane

Question 27

What % of CIN 3 progresses to cervical cancer over 10 years?

Answer 27

30%

Question 28

State at least 3 risk factors for cervical intraepithelial neoplasia

Answer 28

Early age at first intercourse, multiple partners, multiparity, smoking, HIV, immunosuppression

Question 29

Define vulval intraepithelial neoplasia

Answer 29

Dysplasia of the normal squamous epithelium associated with HPV-16

Question 30

State the two types of vulval intraepithelial neoplasia

Answer 30

Usual type, differentiated type