PC: pathology of female genital tract 1

Question 1

Why is a Caesarean section done at the lower uterine segment?

Answer 1

Much thinner and easier to suture than the fundus
Easier to control bleeding
Reduced risk of rupture in subsequent pregnancies

Question 2

What is the bikini line incision for a c-section known as?

Answer 2

Pfannenstiel incision

Question 3

What is the cell type of the ectocervical mucosa?

Answer 3

Non-keratinising stratified squamous epithelium

Question 4

What organs have non-keratinising stratified squamous epithelium?

Answer 4

Ectocervical mucosa
Oesophagus
Vagina
Anal canal
Oral cavity

Question 5

Describe the endocervical mucus

Answer 5

Columnar cells

Secretes mucus

Question 6

What can the endocervical mucosa differentiate into?

Answer 6

Squamous epithelium

Question 7

What is the cervical squamo-columnar junction?

Answer 7

Where stratified squamous epithelium meets columnar epithelium

Question 8

What is the transformation zone?

Answer 8

Area of changing cells

Question 9

Describe a nulliparous cervix

Answer 9

Smooth, round external os

Question 10

Describe a multiparous cervix

Answer 10

Transverse shaped external os

Question 11

What specimens are submitted to the path lab?

Answer 11

Smears for cytology
Colposcopic biopsies following abnormal smear
Loop excision biopsies for treatment of CIN
Hysterectomies for early cervical cancer

Question 12

What specimens from the uterus are submitted to the path lab?

Answer 12

Pipelle endometrial sample
Endometrial curettings
Subtotal hysterectomy
Vaginal hysterectomy
Hysterectomy, tubes and ovaries

Question 13

What are the most common types of high-risk HPV?

Answer 13

16 and 18

Question 14

What are the most common types of low-risk HPV?

Answer 14

6 and 11

Question 15

What is koilocytosis?

Answer 15

Presence of koilocytes, pathogenic feature of HPV

Question 16

What is CIN?

Answer 16

Cervical intraepithelial neoplasia

Question 17

What is CIN 1?

Answer 17

Precancerous or dysplastic cells which involve lower 1/3 of epithelium

Question 18

What is CIN 2?

Answer 18

2/3 of epithelium are involved by dysplastic epithelium

Question 19

What is CIN 3?

Answer 19

Dysplastic cells involve full thickness of epithelium

Question 20

What are the presenting symptoms of advanced cervical cancer?

Answer 20

Post-coital bleeding
Foul-smelling discharge
Intermenstrual bleeding
Weight loss when advanced

Question 21

95% of cervical cancers are what type?

Answer 21

Squamous cell carcinoma

Question 22

What is the transformation zone made up of in SCC?

Answer 22

Metaplastic squamous epithelium

Question 23

How is SCC of the cervix classified?

Answer 23

Depending on the amount of keratin produced

Question 24

What is the menstrual cycle under the influence of?

Answer 24

Hypothalamus - pituitary - ovarian axis

Question 25

Where are oestrogens produced from?

Answer 25

Ovaries Adrenal glands Subcutaneous fat

Question 26

What do obese women have a higher risk of developing breast and endometrial cancer?

Answer 26

The subcutaneous fat produces oestrogen

Question 27

What is the endometrium like in the follicular phase?

Answer 27

Proliferative phase endometrium Glands are tubular Cells show mitotic activity Stroma is dense

Question 28

What is the endometrium like when corpus luteum is present in the ovary?

Answer 28

Secretory phase endometrium | Cells show characteristic subnuclear vacuolation

Question 29

When is the best time to sample the endometrium when investigating infertility?

Answer 29

From day 16 | Can tell if patient has ovulated or not

Question 30

What are the indications for a hysterectomy?

Answer 30

``` Fibroid uterus Early cancer of the cervix Cancer of the endometrium Cancer of the ovary Uterine prolapse Dysfunctional uterine bleeding ```

Question 31

Give examples of dysfunctional uterine bleeding

Answer 31

Menorrhagia Intermenstrual bleeding Polymenorrhoea Metorrhagia

Question 32

What is the most common tumour of the uterus?

Answer 32

Fibroid tumour

Question 33

What is submucosal?

Answer 33

Under the endometrium

Question 34

What is intramural?

Answer 34

Within myometrium

Question 35

What is subserosal?

Answer 35

Under peritoneum

Question 36

What is a leiomyoma?

Answer 36

Smooth muscle tumour

Question 37

What is a leiomyosarcoma?

Answer 37

Malignant smooth muscle tumour

Question 38

How do leiomyomas present?

Answer 38

``` Asymptomatic Abnormal uterine bleeding Pain - may include dysmenorrhoea Bladder symptoms Impaired fertility, recurrent miscarriage ```

Question 39

How can leiomyomas present in pregnancy?

Answer 39

Preterm labour Abnormal lie Obstructed labour Pain if infarcted due to increase vascularity

Question 40

What are the presenting symptoms of a submucosal fibroid?

Answer 40

Dysmenorrhoea Abnormal uterine bleeding Signs and symptoms of anaemia Urinary symptoms

Question 41

How is cancer graded?

Answer 41

According to how close they resemble the cell of origin

Question 42

What is grade 1?

Answer 42

Well differentiated | Closely resemble cell of origin

Question 43

What is grade 2?

Answer 43

Moderately differentiated | Some areas resemble cell of origin, some don't

Question 44

What is grade 3?

Answer 44

Poorly differentiated No resemblance to cell of origin High rate of proliferation - invade BV, lymphatics and spread to lymph nodes and other organs

Question 45

What is used to stage gynaecological cancers?

Answer 45

FIGO

Question 46

How are cancers in the body stage?

Answer 46

TNM

Question 47

What is T in terms of staging cancer?

Answer 47

Tumour size or depth of invasion depending on organ T1, T2, T3, T4 Patients with T1 have 95% 5 year survival

Question 48

What is N in terms of staging cancer?

Answer 48

Lymph node spread Prognosis depends on number of lymph nodes involved N0, N1, N2

Question 49

What is M in terms of staging cancer?

Answer 49

Metastasis to liver, lung, brain, bone | M0, M1