PC uterus and cervix

Question 1

Cervical specimens submitted lab?

Answer 1

smears for cytology
colposcopic biopsies following abnormal smears
loop incision biopsies for treatment of CIN
hysterectomies for early cervical cancer

Question 2

where can you find stratified squamous epithelium?

Answer 2

Oral cavity
Oesophagus
Anal canal
Vagina

Question 3

what is koilocytosis?

Answer 3

clear cells on surface

Question 4

what are possiible presenting symptoms for advanced cervical cancer?

Answer 4

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

Question 5

when CIN3 progresses to invasive cancer what does it produce?

Answer 5

the cancer produces keratin , to resemble SCC of the skin. Therefore SCC of the cervix is classified as: well, moderate and poorly differentiated which depends on the amount of keratin produced and this resembles skin SCC.

Question 6

How is SSC differentiated?

Answer 6

Differentiation pertains to how closely the cancer resembles the cell of origin in this case how well the cancer produces keratin
Well differentiated – lots of keratin production
Moderately differentiation - half of the cells produce keratin; the other half do not
Poorly differentiated – the cells produce little or no keratin; associated with poor prognosis

Question 7

sources of oestrogen

Answer 7

ovaries
adrenal glands
subcutaneous fat - hence obese women higher risk of breast and endometrial cancers which are driven by oestrogens

Question 8

indications for hysterectomy?

Answer 8

ovarian cancer
dysfunctional uterine bleeding
endometrial cancer
fibroid uterus

Question 9

What is the best time to
sample the endometrium when
investigating infertility, follicular
or luteal phase ? Why?

Answer 9

The best time to sample the 
endometrium when investigating 
for infertility is from Day 16 
onwards because the Pathologist 
will be able to tell the 
Gynaecologist whether the 
patient has ovulated or not; 
therefore it is important to 
provide date of last menstrual 
period when submitting 
specimens to the lab

Question 10

dysfunctional uterine bleeding examples

Answer 10

Menorrhagia
Intermenstrual bleeding
Polymenorrhoea
Metrorrhagia

Question 11

clinical presentation for leiomyomas (SM CELL TUMOUR)

Answer 11

can be asymptomatic
Abnormal uterine bleeding
Pain which may include dysmenorrhoea
Bladder symptoms due to pressure effect
Impaired fertility, recurrent miscarriage
Fibroid in pregnancy: preterm labour, abnormal lie, obstructed labour, pain if infarcted due to increased vascularity

Question 12

Fibroid in pregnancy - problems

Answer 12

pre term labour
Complicated delivery due to abnormal presentation of the baby/or obstructing labour
Acute abdomen due to infarction of the fibroid

Question 13

An 68-year old woman presented with post-menopausal bleeding
The biopsy showed endometrial cancer
What radiological investigations would you order and why?

Answer 13

Hysteroscopy and biopsy
Ultrasound – to assess endometrial thickness; may detect polyp
MRI to assess local spread, i.e. depth of the tumour invasion of the myometrium
CT scan to assess for local spread and distant metastases → chest and abdomen

Question 14

Why is the lower uterine segment used for C-section?

Answer 14

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

Question 15

Causes of post partum haemorrhage

Answer 15

retained productions of conception

clotting abnormalities - low platelets