Histopathology

Question 1

What are the most causative organisms for ascending pelvic inflammatory diseases?

Answer 1

Neisseria gonorrhoea, Chlamydia trachomatis, enteric bacteria

Question 2

What is pelvic inflammatory disease?

Answer 2

Infection ascends from the vagina and cervix up to the uterus and fallopian tubes, leading to inflammation (endometritis, salpingitis) and the formation of adhesions.

Question 3

What are the common causative organisms that are secondary to abortion and TOP for PID?

Answer 3

S. aureus, Streptococcus, C. perfringens, Coliforms

Question 4

What are the most common causes of PID outside the UK?

Answer 4

TB and schistosomiasis

Question 5

What is the clinical presentation of PID?

Answer 5

Bilateral lower abdominal pain, deep dyspareunia, vaginal bleeding/discharge, fever, adnexal tenderness and cervical excitation

Question 6

What is Fitz Hugh Curtis Syndrome?

Answer 6

RUQ pain from peri-hepatitis + ‘violin-string’ hepatic adhesions

Question 7

What are the complications associated with PID?

Answer 7

Fitz Hugh Curtis Syndrome
-Infertility
-Risk of ectopic pregnancy
-Bacteraemia - sepsis
-Tubo-ovarian abscess
-Chronic PID
-Peritonintis
-Plical fusion

Question 8

What is plical fusion?

Answer 8

Fimbrial ends of fallopian tubes adhere together

Question 9

What is endometriosis?

Answer 9

Presence of endometrial glands or stroma in abnormal locations outside the uterus. E.g., ovaries, uterine ligaments, rectovaginal septum, pouch of Douglas, pelvis peritoneum

Question 10

What is the clinical manifestation of endometriosis?

Answer 10

Cyclical pelvic pain
Dysmenorrhoea
Deep Dyspareunia
Decreased fertility
Cyclic PR bleeding, haematuria, bleeding from umbilicus
Nodules/tenderness in vagina, posteior fornix or uterus in advanced disease

Question 11

What are the macroscopic features of endometriosis?

Answer 11

Red-blue to brown vesicles - powder burns
Endometriomas = Blood filled chocolate cysts on ovaries

Question 12

What is adenomyosis?

Answer 12

Presence of ectopic endometrial tissue deep within the myometrium.

Question 13

What is the clinical manifestation of adenomyosis?

Answer 13

Heavy menstrual bleeding
Dysmenorrhoea
Deep dyspareunia

Question 14

What is leiomyoma?

Answer 14

A benign tumour of smooth muscle origin - most common tumour of the female genital tract - occurs in 20% of women.

Question 15

What macroscopic features are associated with leiomyoma?

Answer 15

Sharply circumscribed, discrete, round, firm, gray-white tumours

Question 16

What are the microscopic features of leiomyoma?

Answer 16

Bundles of smooth muscle cells

Question 17

What are the clinical manifestations of leiomyoma?

Answer 17

Heavy menstrual bleeding
dysmenorrhea
Pressure effects (urinary frequency, tenesmus)
Sub-fertility
In pregnancy - red degeneration of fibroids (haemorrhagic infarction –> Severe abdominal pain), postpartum torsion.

Question 18

In a patient with post-menopausal bleeding, which cancer should be suspected?

Answer 18

Endometrial cancer

Question 19

What are the three types of endometrioid cancer?

Answer 19

Secretory
Endometrioid
Mucinous

Question 20

What type of mutation is present in endometrioid cancer?

Answer 20

PTEN mutation

Question 21

What is the pathophysiology of endometrial carcinoma?

Answer 21

Related to oestrogen excess- usually in peri-menopausal women

Question 22

What are the three most common types of non-endometrioid cancer?

Answer 22

Papillary
Serous
Clear cell

Question 23

What are the risk factors of endometrial cancer?

Answer 23

E2 excess - obesity, anovulatory amenorrhoea (PCOS), nulliparity, early menarche, late menopause, tamoxifen
DM, HTN

Question 24

What gene mutation is associated with serous endometrial cancer?

Answer 24

P53 mutation

Question 25

What is the pathophysiology of non-endometrioid endometrial cancer?

Answer 25

Unrelated to oestrogen excess - usually in elderly women with endometrial atrophy

Question 26

Which staging system is used for endometrial cancer?

Answer 26

FIGO system

Question 27

What are the four stages of FIGO?

Answer 27

Stage 1 – Cancer ONLY in uterus
Stage 2 – spread to CERVIX
Stage 3 – spread to PELVIC AREA
Stage 4 – METASTASIS to rectum/bladder/distal organs

Question 28

What is Cervical Intraepithelial Neoplasia?

Answer 28

Outer cervix (continuous with vagina) covered by squamous epithelium; endocervical canal lined by columnar glandular epithelium. The squamocolumnar junction (SCJ) separates them.

Question 29

What is the transformation zone?

Answer 29

The area where columnar epithelium transforms into squamous cells (=squamous metaplasia). This is a normal physiological process. This area is susceptible to malignant change due to high rates of cell turnover

Question 30

Which HPV serotypes are associated with cervical cancer?

Answer 30

HPV 16 & 18.

Question 31

How is CIN graded?

Answer 31

Graded mild, moderate or severe dyskaryosis on cytology, but graded CIN 1-3 on histology (from biopsy).
● CIN 1 = dysplasia confined to deepest 1/3 of epithelium
● CIN 2 = lower 2/3
● CIN 3 = full thickness, but basement membrane intact