Gynecology - Benign lesions of the cervix + screening

Question 1

What types of cysts are most common on the cervix?

Answer 1

Nabothian cysts (Clear to yellow-white elevations of the endocervix or proximal ectocervix, rarely more than 1cm, contain mucus.)

Question 2

What are Mesonephric cysts?

Answer 2

Remnants of the Wolffian ducts, extend deeper into the cervixal stroma and are more commonly found on the ectocervix.

Question 3

When do cervical cysts need to be removed?

Answer 3

When they are symptomatic or they interfere with Pap-testing.

Question 4

Cervical Polyps

Answer 4

Asymptomatic and almost always benign - detected on cervical exam performed for other purposes.

Sx: Postcoital or intermenstrual bleeding.

Mx: Removal, b/c you want to see if this is the cause of bleeding.

Question 5

Symptoms of Cervical Fibroids?

Answer 5

Depends on size.

- Intramenstrual bleeding is common. Large fibroids may cause dyspareunia, bladder/rectal pressure and OB complications.

Question 6

Management of Cervical Fibroids?

Answer 6

Mx is to screen for cervical cancer and elective removal if symptomatic. Monitor w/regular gynecologic visits.

Question 7

Cause of congenital Cervical stenosis?

Answer 7

Segmental Mullerian hypoplasia (cf. vaginal atresia)

Question 8

Cause of aquired cervical stenosis?

Answer 8

• Trauma (OB)
• Postoperative
• Infection
• Radiation
• Atrophy

Question 9

Sx of cervical stenosis?

Answer 9

• Cryptomenorrhea
• Secondary dysmenorrhea
• infertility
• ob complications

Question 10

What is diagnostic in cervical stenosis?

Answer 10

Inability to pass a 1-2mm probe into the uterine cavity.

Question 11

When should the first Pap smear take place?

Answer 11

At age 21. Cytology alone.

Question 12

When should the subsequent Paps take place?

Answer 12

Every three years until at least age 30.

Question 13

Descriptions of abnormal cytologies:

Answer 13

1. ASC-US: Atypical squamous cells of undetermined significance
2. LSIL: Low-grade squamous intraepithelial lesion
3. ASC-H: Atypical squamous cells, cannot exclude high-grade SIL
4. HSIL: High grade squamous intraepithelial lesion
5. AGC: Atypical glandular cells

Question 14

Which abnormal Paps in women will proceed to colposcopy and biopsy?

Answer 14

All abnormal Paps in women over the age of 24, except ASC-US, should proceed to colposcopy and biopsy.

Question 15

When do you also need to do biopsy of ASC-US?

Answer 15

Women with ASC-US who has a positive high-risk HPV -> Should get a colpo + biopsy. Otherwise, Pap and HPV DNA may be repeated in three years.

Question 16

If abnormal pap, you precede to colposcopy + biopsy, what are you looking for here?

Answer 16

1. Areas that stain white with acetic acid.
2. Areas that are “mosaic”-like in appearance
3. Areas that display punctuated vessels
4. Areas with abnormal vessel geography (from bizarre shapes, etc.)

Question 17

What “label” can a biopsy get, and what is it based on?

Answer 17

CIN 1
CIN 2
CIN 3
CIS 
Invasive cervical cancer

• These designations are based on the depth of the abnormal cells and, importantly, wheter or not the basement membrane is intact.

Question 18

What do you do if it comes back as CIN 1?

Answer 18

1. Get Pap + HPV test in one year
   - Abnormal results: Repeat colposcopy and biopsy
   - Normal result: may return to annual pap smears

Question 19

What do you do if it comes back as CIN1, CIN3 or CIS?

Answer 19

They all will necessitate surgical resection.
- There are various methods which may be chosen based on the location of the lesion and age of the patient. The most common procedure is the loop electrical excision procedure (LEEP).

Question 20

What is the spontaneous regression of CIN1, 2 and 3?

Answer 20

CIN 1 = 60%
CIN 2 = 40%
CIN 3 = 30%

Question 21

What is the percentage of risk for CIN1 and CIN 2 to progress to CIN3?

Answer 21

CIN 1 = 10%

CIN 2 = 20%

Question 22

What is the percentage risk for CIN 1, CIN 2 and CIN3 to progress to invasive cancer?

Answer 22

CIN 1 = < 1%
CIN 2 = 5%
CIN 3 = 12-22%