Female genital tract 1

Question 1

Occurs in women with intrauterine exposure to DES

Cells have distinct cell membranes,

large

moderate to abundant clear cytoplasm

cuboidal and sometimes hobnail type with nuclei protruding into the lumen

Nuclei are round to irregular, hyperchromatic with conspicuous nucleoli

Answer 1

Clear cell adenocarcinoma

Question 2

Proliferative/ secretory endometrium?

Gland architecture: straight, tubular

• Gland lining: regular, tall, pseudostratified columnar
• Secretory activity: no evidence of mucus secretion or vacuolation.
• Compact stroma

Answer 2

Proliferative Endometrium

Question 3

Type of cellular adaptation seen in the image

Answer 3

Squamous Metaplasia

Question 4

1. See the image provided and the clues below and formulate a diagnosis

38 year old female

dysmenorrhea

painful defecation at the time of menstruation

Answer 4

Endometriosis

Question 5

right upper quadrant pain following the transabdominal spread of infection from pelvic inflammatory disease

violin string adhesions of anterior liver capsule to anterior abdominal wall or diaphragm

liver capsular infection without affecting hepatic parenchyma

Answer 5

Fitz Hugh Curtis Syndrome

Question 6

most common cause of death in patients with advanced cervical carcinoma

Answer 6

local invasion of ureter, pyelonephritis and renal failure

Question 7

What’s your diagnosis?

56 year old female with post coital vaginal bleeding assoc with malodorous discharge

Colposcopy shows a fungating mass

Microscopy shown in the attached image.

Answer 7

Cervical Squamous cell carcinoma

Question 8

WHAT’S THE DIAGNOSIS?

TEMP >101 DEGREE FARENHEIT

ABNORMAL VAGINAL DISCHARGE

CERVICAL MOTION TENDERNESS

ADNEXAL TENDERNESS

Answer 8

PID

Question 9

Mechanism of carcinogenesis by HPV E6 and E7?

Answer 9

Learn this till you go blue in the face!

Question 10

1. Describe the microscopic findings seen in this benign condition caused by HPV 6 and 11.
2. What’s the diagnosis?

Answer 10

1. Papillary, exophytic, treelike cores of stroma covered by thickened squamous epithelium with koilocytic atypia
2. Condyloma acuminatum

Question 11

1. Diagnosis?

32 year old woman

menometrorrhagia

*Enlarged globular uterus, c/s trabeculated appearance

2. What finding do you see on microscopy?

Answer 11

1. Adenomyosis
2. presence of endometrial tissue within the uterine wall (myometrium)

Question 12

Unilateral painful labial swelling
Obstruction of gland duct
Cyst lining is transitional or squamous epithelium

Answer 12

Bartholin Cyst

Question 13

45 year old female
H/O pruritus, dyspareunia
Clinical exam: parchment like appearance of vulva
M/E : marked thinning of epidermis, sclerotic changes in the dermis with hyalinization and bandlike lymphocytic infiltrate

Answer 13

Lichen sclerosus

Question 14

Origin of this tumor?

<5 years of age

Gross: polypoid, round, bulky grapelike masses

Answer 14

Origin of the tumor is from Skeletal muscle cells

The tumor is embryonal Rhabdomyosarcoma.

Question 15

Gross appearance: sharply circumscribed, discrete, round, firm, gray-white

characteristic whorled pattern of smooth muscle bundles on cut section

Microscopic appearance: see attached image

What’s your diagnosis?

Answer 15

Leiomyoma

Question 16

List 6 morphologic lesions seen in the tubes and ovaries following PID

Answer 16

ACUTE SUPPURATIVE SALPINGITIS

SALPINGO-OOPHORITIS

TUBO OVARIAN ABSCESS

PYOSALPINX

CHRONIC SALPINGITIS

HYDROSALPINX

Question 17

1. Diagnosis?

Pruritic, red, crusted , maplike area over the labia majora

lateral spread of cells in singles/clusters within epidermis, the cell are large rthan normal keratinocytes

pale cytoplasm containing mucopolysaccharide

2. Special stain?

Answer 17

1. Extramammary Paget Disease
2. PAS/Alcian Blue/Mucicarmine

Question 18

Name the most frequent precursor to endometrial carcinoma

Answer 18

Endometrial hyperplasia

Question 19

Proliferative endometrium / secretory endometrium?

• Gland architecture: tortuous, serrated or “saw-toothed
• Gland lining: shows subnuclear secretory basal vacuoles that move progressively to the apex
• Secretory activity: prominent
• Loose stroma

Answer 19

secretory endometrium

Question 20

Diagnosis?

60 year old female

bulky, fleshy masses that invade the uterine wall

Tumor cells- irregular, hyperchromatic nuclei, Atypical mitoses and Foci of necrosis

Answer 20

Leiomyosarcoma

Question 21

Give one word that best describes this image:

Atypical, enlarged hyperchromatic nuclei with wrinkled, raisinoid appearance with perinucelar halo

Answer 21

Koilocytic atypia

Question 22

Consequence of rubbing of vulvar mucosa in response to pruritus
* acanthosis
* hyperkeratosis

Answer 22

Squamous cell hyperplasia

Question 23

Diagnosis?
* Homogeneous, white/gray non-inflammatory discharge that adheres to vaginal walls
* Presence of clue cells on wet mount
* Vaginal pH greater than 4.5
* A fishy odor after addition of KOH/whiff test

Answer 23

Bacterial vaginosis

Question 24

Diagnosis?
* Pruritic vaginitis with a white or thick (cottage cheese) discharge
* Vaginal pH>4.5
* Amine test (smell of vaginal fluid caused by release of amines) after mixing a sample of vaginal discharge with a few drops of KOH is negative (not malodorous).

Answer 24

Candidiasis

Question 25

Lining epithelium of the vagina in vaginal adenosis

Answer 25

columnar mucinous

Question 25

precursor lesion for vaginal clear cell adenocarcinoma

Answer 25

vaginal adenosis

Question 26

Why should the transformation zone be sampled while performing a Pap smear?

Answer 26

TZ is where squamous dysplasia and cancer develop because Immature squamous metaplastic epithelial cells in the transformation zone areimost susceptible to HPV infection

Question 27

Diagnosis? 50 year old woman, post coital bleeding Exam reveals reddish mass protruding from external os

Answer 27

Endocervical polyp

Question 28

Describe koilocytic atypia

Answer 28

nuclear enlargement, hyperchromasia (dark staining), coarse chromatin granules, and variation in nuclear size and shape + perinuclear cytoplasmic halo

Question 29

Appearance of low grade SIL (LSIL) on biopsy

Answer 29

immature squamous cells are confined to the lower one third of the epithelium

Question 30

Appearance of high grade SIL (HSIL) on biopsy

Answer 30

immature squamous cells expand to the upper two thirds of the epithelial thickness

Question 31

Percent cases of HSIL that will progress to carcinoma

Answer 31

10

Question 32

Percent cases of HSIL that will continue to persist

Answer 32

60

Question 33

10 percent casesof LSIL will progress to which lesion?

Answer 33

HSIL

Question 34

Criteria for microinvasive cervical squamous cell carcinoma

Answer 34

stromal invasion with a max depth of 5mm and horizontal spread of 7mm or less

Question 35

Structural causes of abnormal uterine bleeding

Answer 35

(PALM) Polyp Adenomyosis Leiomyoma Malignancy

Question 36

Non structural causes of abnormal uterine bleeding

Answer 36

Mnemonic: COEIN Coagulopathy Ovulatory dysfunction Endomterial Iatrogenic Not yet classified

Question 37

Endometrial biopsy finding in anovulatory AUB

Answer 37

abundant proliferative endometrium

Question 38

Physiologic conditions associated with anovulatory cycles

Answer 38

Perimenarchal Perimenopausal

Question 39

Clinical conditions associated with chronic anovulation

Answer 39

PCOS Thyroid disorders Obesity Unopposed estrogen tretament in post-menopausal women.

Question 40

Mechanism of anovulation in obesity

Answer 40

* decreased SHBG-->increased free T and E * Hyperinsulinemia-->increased ovarian production of androgens * Peripheral conversion of androgens to estrogen by aromatase

Question 41

2 causes for ovulatory DUB

Answer 41

A. Inadequate luteal phase defect B. Irregular shedding of the endometrium

Question 42

Endometrial biopsy findings in individuals with inadequate luteal phase

Answer 42

Poorly developed secretory phase

Question 43

endometrial biopsy findings in individuals who experience abnormal uterine bleeding due to irregular shedding of the endometrium

Answer 43

mix of secretory and proliferative endometrium

Question 44

History of delivery fever, abdominal pain with uterine tenderness on palpation, foul smelling vaginal discharge

Answer 44

acute endometritis

Question 45

Morphologic hallmark of chronic endometritis

Answer 45

Plasma cells in the endomterial stroma

Question 46

Pathogenesis of endomteriosis

Answer 46

The regurgitation theory proposes that endometrial tissue implants at ectopic sites via retrograde flow of menstrual endometrium.

Question 47

Sites for endometriosis

Answer 47

Ovaries - most common site rectal pouch, fallopian tubes, intestine

Question 49

Gross appearance of endometriotic implants

Answer 49

red-blue to yellow-brown nodules aka powder burn lesions

Question 50

Gross morphology of ovarian endometriosis

Answer 50

chocolate cyst - filled iwth brown fluid due to previous hemorrhage

Question 51

Main pathogenic factor for endometrial hyperplasia

Answer 51

prolonged estrogenic stimulation | Eg: Obesity, PCOS, functioning granulosa cell tumors of the ovary

Question 52

**Identify this complication of PID** * Fever * Leukocytosis * bilateral pelvic tenderness worse on one side during palpation +adnexal mass+ rectal discomfort

Answer 52

Tubo-ovarian abscess

Question 53

List 2 genes whose mutations are associated with Type 1 endometrial carcinoma

Answer 53

PTEN (30-80%) MSI (20%)

Question 54

Genetic basis of Lynch syndrome

Answer 54

autosomal dominant germline mutation of mismatch repair genes (MLH1, MSH2, MSH6, PMS2) leading to microsatellite instability

Question 55

Precursor for Type 1 endometrial carcinoma

Answer 55

endometrial hyperplasia

Question 56

2 complications of submucosal leiomyomas

Answer 56

1.Menorrhagia -->iron deficinecy anemia 2.Increased risk of spontaneous abortion

Question 57

Pattern of urinary incontinence associated with leiomyomas

Answer 57

Stress urinary incontinence.