Repro - Pathology (Cervical & Endometrial Pathology)

Question 1

What is endometritis? What characterizes it on histology?

Answer 1

Inflammation of the endometrium (with plasma cells and lymphocytes)

Question 2

What typically causes endometritis?

Answer 2

Associated with retained products of conception following delivery (vaginal/C-section)/miscarriage/abortion or foreign body such as IUD.

Question 3

Why do retained products of conception cause endometritis?

Answer 3

Retained material in uterus promotes infection by bacterial flora from vagina or intestinal tract.

Question 4

What is the treatment for endometritis?

Answer 4

Treatment: gentamicin + clindamycin with or without ampicillin

Question 5

What is endometriosis?

Answer 5

Non-neoplastic endometrial glands/stroma outside of the endometrial cavity.

Question 6

Where can endometriosis be found? Which sites are most common?

Answer 6

Can be found anywhere; most common sites are ovary, pelvis, and peritoneum

Question 7

How does endometriosis appear in the ovary?

Answer 7

In the ovary, appears as an endometrioma (blood-filled “chocolate cyst”)

Question 8

What are 3 potential reasons for endometriosis?

Answer 8

Can be due to (1) retrograde flow, (2) metaplastic transformation of multipotent cells, or (3) transportation of endometrial tissue via the lymphatic system.

Question 9

What 7 symptoms/signs characterize endometriosis?

Answer 9

Characterized by cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia (pain with defacation), infertility; NORMAL-SIZED uterus

Question 10

What are 5 treatments for endometriosis?

Answer 10

Treatment: NSAIDs, OCPs, progestin, GnRH agonists, surgery

Question 11

What characterizes cervical dysplasia/carcinoma in situ on histology?

Answer 11

Disordered epithelial growth; begins at basal layer of squamocolumnar junction (transition zone) and extends outward

Question 12

What are the classifications of cervical dysplasia/carcinoma in situ? On what are these classifications based?

Answer 12

Classified as CIN 1, CIN 2, CIN 3 (severe dysplasia or carcinoma in situ), depending on extent of dysplasia

Question 13

With what pathogenic strains is cervical dysplasia/carcinoma in situ associated? Why do these strains cause cancer?

Answer 13

Associated with HPV 16 and HPV 18, which product both the E6 gene product (inhibits p53 suppressor gene) and E7 gene product (inhibits RB suppressor gene).

Question 14

What can happen with cervical dysplasia/carcinoma in situ if left untreated?

Answer 14

May progress slowly to invasive carcinoma if left untreated

Question 15

How does cervical dysplasia/carcinoma in situ typically present? How is it diagnosed?

Answer 15

Typically asymptomatic (detected with Pap smear) or presents as abnormal vaginal bleeding (often postcoital)

Question 16

What are the risk factors for cervical dysplasia/carcinoma in situ?

Answer 16

Risk factors: multiple sexual partners (#1), smoking, early sexual intercourse, HIV infection.

Question 17

What kind of cells are often involved in invasive cervical carcinoma?

Answer 17

Often squamous cell carcinoma

Question 18

Why is Pap smear such a useful test? What histological finding does it detect?

Answer 18

Pap smear can catch cervical dysplasia (koilocytes - wrinkled, “raisinoid” nuclei”, some of which have clearing or a perinuclear halo) before it progresses to invasive carcinoma

Question 19

What is a possible medical complication with regard to invasive cervical carcinoma progression, and what causes this?

Answer 19

Lateral invasion can block ureters, causing renal failure

Question 20

What is adenomyosis? What causes it?

Answer 20

Extension of endometrial tissue (glandular) into the uterine myometrium; Caused by hyperplasia of the basalis layer of the endometrium

Question 21

What symptoms/signs are associated with adenomyosis?

Answer 21

Dysmenorrhea, menorrhagia. Uniformly ENLARGED, SOFT, globular uterus

Question 22

What is the uterus like in endometriosis? How does that compare to the uterus in adenomyosis?

Answer 22

Endometriosis - Normal-sized uterus; Adenomyosis - Enlarged, soft, globular uterus

Question 23

What is the treatment for adenomyosis?

Answer 23

Treatment: Hysterectomy

Question 24

What is an adenomyoma (polyp)? What might it contain?

Answer 24

Well-circumscribed collection of endometrial tissue within the uterine wall; May contain smooth muscle cells

Question 25

Where can an adenomyoma extend, and how?

Answer 25

Can extend into the endometrial cavity in the form of a polyp

Question 26

What are 2 types of endometrial proliferation?

Answer 26

(1) Endometrial hyperplasia (2) Endometrial carcinoma

Question 27

What is endometrial hyperplasia, and what usually causes it?

Answer 27

Abnormal endometrial gland proliferation usually caused by excess estrogen stimulation

Question 28

How does endometrial hyperplasia relate to endometrial carcinoma?

Answer 28

Increased risk for endometrial carcinoma

Question 29

How does endometrial hyperplasia manifest clinically?

Answer 29

Clinically manifests as postmenopausal vaginal bleeding.

Question 30

What are 4 risk factors of endometrial hyperplasia?

Answer 30

Risk factors include anovulatory cycles, hormone replacement therapy, polcystic ovarian syndrome, and granulosa cell tumor.

Question 31

What is the most common gynecologic malignancy?

Answer 31

Endometrial carcinoma

Question 32

At what age range is the peak occurrence of endometrial carcinoma?

Answer 32

Peak occurrence at 55-65 years old

Question 33

How does endometrial carcinoma present clinically? What is typically in the patient’s history?

Answer 33

Clinically presents with vaginal bleeding. Typically preceded by endometrial hyperplasia.

Question 34

What are 6 risk factors for endometrial carcinoma?

Answer 34

Risk factors include (1) prolonged use of estrogen without progestins, (2) obesity, (3) diabetes, (4) hypertension, (5) nulliparity, and (6) late menopause.

Question 35

What feature worsens prognosis for endometrial carcinoma?

Answer 35

Increased myometrial invasion –> decreased prognosis

Question 36

What is the most common tumor in females?

Answer 36

Leiomyoma (fibroid)

Question 37

Which patient population has an increased incidence of leiomyoma (fibroid)?

Answer 37

Increased incidence in blacks.

Question 38

What is the a leiomyoma (fibroid)? Can it be malignant?

Answer 38

Benign smooth muscle tumor; malignant transformation is rare; Does not progress to leiomyosarcoma

Question 39

What is important to know about the nature of leiomyoma in the context of hormones? What are implications of this?

Answer 39

Estrogen sensitive - tumor size increases with pregnancy and decreases with menopause.

Question 40

What age range is the peak occurrence for leiomyoma (fibroid)?

Answer 40

Peak occurrence at 20-40 years old.

Question 41

How does leiomyoma (fibroid) typically present clinically? What are potential complications?

Answer 41

May be asyptomatic, cause abnormal uterine bleeding, or result in miscarriage. Severe bleeding may lead to iron deficiency anemia.

Question 42

How does leiomyoma (fibroid) typically appear on imaging/histology?

Answer 42

Often presents with multiple discrete tumors; Whorled pattern of smooth muscle bundles with well-demarcated boarders

Question 43

List gynecologic tumors in order of decreasing incidence in the US. How does this differ worldwide?

Answer 43

Endometrial > Ovarian > Cervical (data pertain to the United States; cervical cancer is most common worldwide)

Question 44

List gynecologic tumors in order of decreasingly worse prognosis.

Answer 44

Worst prognosis - Ovarian > Cervical > Endometrial