Pathology of Vulva/Vagina/Cervix 2

Question 1

Describe the 3 phases of uterine cells.

Name 2 features of each.

Answer 1

1. Proliferative phase
   
   • Straight tubules
   • estrogen causes cells to proliferate
2. Secretory Phase
   
   • S-shaped turtuous glands
   • Secretory activity
3. Menstraul Phase
   
   • Low estradiol and progesterone
   • Inflammation/breakdown

Question 2

What is the pathologic term for Pelvic Inflammatory Disease?

Compare the cell type and outcome of acute v chronic

Answer 2

• PID = Endometritis
• Acute
  
  • PMN’s
  • Curable with curettage
• Chronic
  
  • Plasma cells
  • Treat with doxycycline, but infertility still

Question 3

Compare adenomyosis and endometriosis

Answer 3

• Adenomyosis = endometrial glands + stroma in myometrium
• Endometriosis = endometrial glands + stroma outside the uterus

Question 4

What would be described as a white, whorled, well circumscribed lesion with cigar shaped nuclei?

Answer 4

• Leiomyoma (aka fibroids)
• Benign smooth muscle tumor

Question 5

How would a leiomyoma change during menopause?

Answer 5

Leiomyoma are hormonally responsive (grow in response to estrogen), and so they will regress in menopause

Question 6

Does leiomyoma increase your risk of a malignant tumor?

Answer 6

No, it does not increase your risk of leiomyosarcoma (which is malignant)

Question 7

What age group gets Type I endometrial cancer?

What are risk factors?

Answer 7

ENDOMETRIOD Endometrial cancer = Type I

Pre-menopausal women

Risk factors: High estrogen levels for any reason (obesity, few pregnancies, early menarche)

Question 8

What is the treatment for adenomyosis?

Answer 8

GnRH agonists or surgical excision

Question 9

What is Asherman syndrome?

What are 3 symptoms?

Answer 9

• Adhesions/fibrosis of the endometrium due to instrumentation
• Decreased fertility, pain, abnormal bleeding

Question 10

What could be described as blood-filled “chocolate cysts”?

Answer 10

Endometriosis in the ovary

Question 11

What should perimenopausal bleeding make you think of?

Answer 11

Endometrial cancer

Question 12

What demographic gets Type II endometrial cancer?

What is the histology of this?

Answer 12

SEROUS endometrial cancer = Type II (papillary growth on histology)

Post-menopausal women

Question 13

Compare the mutation and demographic for

• Endometrial endometrioid carcinoma (type i)
• Endometrial serous carcinoma (type ii)

Answer 13

Endometrial endometrioid carcinoma (I): pre-menopausal women with high estrogen, BRAF/Lynch/beta catenin mutations

Endometrial serous carcinoma (II): post-menopausal women, p53 mutation