Endometrium & Cervix Pathology

Question 1

MOST COMMON cause of Abnormal Uterine Bleeding; ovarian follicles develop but DON’T ovulate, continuing to produce Estrogen; causes endometrium to stay in proliferative state, outgrowing its structural support

Answer 1

Anovulatory Cycles

Question 2

Hyperplastic overgrowths of the endometrium; can be sessile or pedunculated

Answer 2

Endometrial Polyps

Question 3

Increased endometrial glands:stroma ratio; precursor to Endometrial Carcinoma (especially with cytologic ATYPIA); caused by unopposed Estrogen

Answer 3

Endometrial Hyperplasia

Question 4

Signs/Symptoms of Endometrial Adenocarcinoma

Answer 4

Postmenopausal Bleeding

Irregular/Heavy bleeding or discharge

Question 5

Treatment for Endometrial Adenocarcinoma

Answer 5

Hysterectomy
Radiation
Progesterone therapy

Question 6

___________________ cancer is the most common GYN malignancy

Answer 6

Endometrial

Question 7

Risk factors for Endometrial Adenocarcinoma

Answer 7

Obesity
Atypical Hyperplasia
Unopposed Estrogen
Lynch Syndrome
Pelvic Irradiation

Question 8

What is protective for Endometrial Adenocarcinoma

Answer 8

OCPs

Progesterone therapy

Question 9

What are the 2 general types of Endometrial Carcinoma

Answer 9

Type 1: Estrogen related, LESS aggressive, younger and HEAVIER; GLANDULAR histology
Type 2: Not Estrogen related, MORE aggressive, older and THINNER; SEROUS histology

Question 10

Type (1/2) Endometrial Carcinoma has a Glandular histology

Answer 10

Type 1

Question 11

Type (1/2) Endometrial Carcinoma has a Serous histology

Answer 11

Type 2

Question 12

Most common benign tumor of the female genital tract; smooth muscle tumor; well-circumscribed, white mass with whorled appearance; inc. risk in African Americans

Answer 12

Leiomyomas (“Fibroids”)

Question 13

Histologic appearance of Leiomyomas

Answer 13

Smooth muscle in fascicles

“Cigar” shaped nuclei

Question 14

Leiomyomas are precursors to Leiomyosarcomas (True or False)

Answer 14

False; are independent entities

Question 15

Cervical cancer is commonly caused by….

Answer 15

HPV

Question 16

____ ____________ testing can reduce a woman’s chance of dying from Cervical Cancer by almost 90%

Answer 16

Pap smear

Question 17

Risk factors for Cervical Cancer

Answer 17

Smoking
Immunosuppression (AIDS)
Multiple partners
Early age of intercourse

Question 18

Sexually transmitted virus; double stranded, circular DNA virus; infects epithelial cells; MOST common STD globally; most infections clear by 2 years

Answer 18

HPV

Question 19

HPV ______ and _____ are high risk types that can cause Cervical, Anal and other genital cancers

Answer 19

16 and 18

Question 20

HPV _____ and ____ are low risk types that may cause genital warts

Answer 20

6 and 11

Question 21

HPV genes that affect hos regulatory proteins, such as p53 and Rb (regulate cell divisions)

Answer 21

E6 and E7

Question 22

When should a women begin to have pap smears

Answer 22

age 21-65, for every 3 years

*given no risk factors or previous history

Question 23

Appearance of normal Ectocervic Squamous cells on a Pap Smear

Answer 23

Abundant cytoplasm

Nucleus is small/dense (pyknotic)

Question 24

Appearance of neoplastic Ectocervix Squamous cells on Pap Smear

Answer 24

Large nuclei, dark with irregular contours and coarse chromatin
Cytoplasmic clearing around nucleus (koilocytes)

Question 25

Cells with the combination of nuclear atypia and cytoplasmic halos; seen with HPV

Answer 25

Koilocytes

Question 26

________ ____________ is used in conjunction with Pap smears in the screening of women 30 years of age and older

Answer 26

DNA testing

Question 27

Procedure to observe the inside of the Cervix with a scope; apply Acetic Acid and Lugol's solution to dehydrate cells and measure uptake

Answer 27

Colposcopy

Question 28

Purpose of Acetic acid and Lugol's Solution during a Colposcopy

Answer 28

Acetic Acid: dehydrate cells (dec. glycogen makes white rim) | Lugol's: iodine is not taken up if little glycogen

Question 29

Most common type of Cervical Cyst; dilated endocervical glands filled with mucin; appear yellow or white

Answer 29

Nabothian Cysts

Question 30

Focal hyperplastic protrusions of Endocervical tissue composed of epithelium and stroma; can discharge and bleed; are rounded and can be smooth or lobulated

Answer 30

Endocervical Polyp

Question 31

Treatmetns for Cervical Intraepithelial Neoplasia (CIN)

Answer 31

Cryotherapy Biopsy/Excision Hysterectomy

Question 32

When would you decide to treat vs. observe Cervical Intraepithelial Neoplasia (CIN)

Answer 32

Old age Non-compliance Abnormal colposcopy CIN 2 and 3

Question 33

What are the chances of regression for the various CIN

Answer 33

CIN 1: 90% CIN 2: 50% CIN 3: 10%

Question 34

HPV Vaccines

Answer 34

Gardasil and Cervarix

Question 35

What HPV types do Gardisil vs. Cervarix protect against

Answer 35

Gardisil: HPV 6, 11, 16 and 18 Cervarix: HPV 16 and 18