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73 Cards in this Set

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What epithelium covers the Exocervix?
Squamous epithelium
Mucus-secreting Columnar Cells
What epithelium covers the Endocervix?
Squamo-Columnar Jxn = Transition Zone in the Cervix
What is this?
Normal Squamous Epithelium of the Exocervix
WHat is this?
Normal Endocervical Columnar epithelium that secretes mucus
What is this?
Pap Smear
-Left = normal Squamous cells

-Right = normal Endocervical cells
What are these?
Chronic Cervicitis
What is this picture showing?
Endocervical Polyp
What is this picture showing?
Cervical Intraepithelial Neoplasia:
1. CIN I = ?
2. CIN II = ?
3. CIN III = ?
1. Mild dysplasia = lower 1/3
2. Moderate dysplasia = lower 2/3
3. Severe Dysplasia / Carcinoma In situ = full thickness
Mild Squamous Dysplasia = CIN I

*basal layer is at the top
Cervix biopsy...what is it showing?
Moderate Squamous Dysplasia = CIN II
Cervix biopsy...what is the diagnosis?
Sever Squamous Dysplasia = CIN
Cervical biopsy...what is the diagnosis
Glandular epithelium has turned into Squamous epithelium which then turned into Dysplasia
Endocervix biopsy - what has happened?
Mild Squamous Dysplasia
- somewhat enlarged nuclei
Pap smear showing Cervical cells - what is the diagnosis?
Moderate Squamous Dysplasia
-nuclei:cytoplasm ratio is increased
Pap smear with Cervix cells...what is the diagnosis?
Severe Squamous Dysplasia = CIN III
Pap smear showing Cervix cells...what is the diagnosis?
Severe Squamous Dysplasia
The left is pap smear and the right is histology...what is the diagnosis?
What are the risk factors for Cervical Intraepithelial Neoplasia?
1. HPV infection (higher #'s)
2. multiple sex partners
3. Early age of first intercourse
What does Squamous Cell Carcinoma of the Cervix usually evolve from?
CIN
What is the histology of Squamous Cell Carcinoma of the Cervix?
Invasive Squamous cells in the Stroma
What are the clinical presentations of Squamous Cell Carcinoma of the Cervix?
1. Post-coital bleeding

2. painful intercourse

3. Malodorous discharge
Where does Cervical Carcinoma most typically occur?
Squamo-Columnar Jxn = Transition zone
What are the 3 treatment options for Cervical Carcinoma?
Conization
Radical hysterectomy
Radiation therapy
Cervical Cancer at the Squamocolumnar jxn
What is this showing?
Cervical Carcinoma
What is this showing?
Non-invasive Carcinoma In-situ = CIN III
What is this showing?
Cervical carcinoma that only invades < 3 mm with no vascular or lymphatic invasion
Microinvasive Squamous Cell Carcinoma
This comprises 10% of Cervical Carcinomas and is related to HPV 16 and 18
Adenocarcinoma
Cancer that has a 75% decrease in incidence and mortality over the past 50 years

However, it is the 2nd most common cause of cancer related morbidity and mortality among women in developing countries
Adenocarcinoma of the Cervix

**85% of cervical cancers are Squamous Cell Carcinoma
Types of HPV that account for 80% of Cervical Cancers?
16 & 18
Endocervical Adenocarcinoma
-back to back glands
-stromal invasion
-Anaplastic nuclei
What is this showing?
What affects the Proliferative Phase of the Menstrual Cycle?
Estrogen
What is the most variable phase of the Menstrual Cycle?
Proliferative phase
Describe the histology of the Proliferative Phase of the menstrual cycle
Tubular glands

Monomorphic stroma
What affects the Secretory Phase of the Menstrual Cycle?
Progesterone
Describe the histology of the Secretory phase of the Menstrual Cycle
Coiled Glands

Edematous Stroma
What are the causes of Dysfunctional Uterine Bleeding in:
1. New borns
2. Childhood
3. Adolescents
4. Reproductive age
5. Menopause
1. maternal withdraw of estrogen
2. tumors secreting estrogen
3. psychogenic, stress, nutritional, tumor
4. same as 3
5. Estrogen secreting tumors
What is the definition of Dysfunctional Uterine Bleeding?
Abnormal uterine bleeding due to Extra-Uterine causes
What are the typical causes of Acute Endometritis?
1. Ascending infection from Cervix
2. Abortion
3. Instrumentation
What are the typical causes fo Chronic Endometritis?
Intrauterine devices (IUDs)

Pelvic Inflammatory Disease

Abortion
How do you differentiate between Acute and Chronic Endometritis?
Acute = PMN's

Chronic = Plasma Cells
Acute Endometritis
What is this showing?
Chronic Endometritis

presence of Plasma cells
Endometrium biopsy:

What is this showing?

How do you know?
Where do Endometrial Polyps usually occur?
Fundus
What does the histology of an Endometrial Polyp contain?
1. Endometrial glands, cysts, hyperplasia
2. Fibromatous stroma
3. Thick-walled blood vessels
Endometrial Polyps
Benign
Inter-menstrual bleeding
What are these showing?
Are they malignant or benign?
How do they typically present clinically?
Endometrial Polyp

Menorrhagia / Dysfunctional Uterine bleeding
What are these?

What can they result in?
Endometrial Polyp -> thick-walled blood vessel
Biopsy taken from the Endometrium...what is the diagnosis?
What is the treatment for Endometrial Polyps
Curettage = cutting out the polyp with a spoon-like device
Simple Hyperplasia
Endometrium biopsy...what is the diagnosis?
Simple Hyperplasia = increased # of dilated glands
Endometrium biopsy...what is the diagnosis?
Complex Hyperplasia = glands appear crowded and are surrounded by relatively scant stroma
Endometrial biopsy...what is the diagnosis?
Atypical Hyperplasia = glands appear crowded and have an irregular shape, with stratification of cells that often protrude into the lumen
- nuclear atypia
Endometrial biopsy...what is the diagnosis?
Cystic Hyperplasia = Swiss Cheese Hyperplasia
Endometrial biopsy...what is the diagnosis?
Endometrial Polyp with Complex Hyperplasia
What is this picture showing?
What is Endometrial Hyperplasia a precuror of?
Endometrial Carcinoma
What is Endometrial Hyperplasia most often clinically manifested as?
Postmenopausal bleeding
What are some things that can cause Endometrial Hyperplasia?
1. Estrogen secreting tumor
2. Obesity = fat cells store estrogen
3. Polycystic Ovary disease
4. Estrogen therapy
What is the most common cancer of the Female Genital Tract?
Endometrial Adenocarcinoma
What is the cause of Endometrial Adenocarcinoma?
prolonged Estrogen exposure
What are 7 risk factors for Endometrial Adenocarcinoma?
1. Diabetes
2. Nulliparity (no births)
3. Smoking
4. Estrogen secreting tumor
5. HTN
6. Late Menopause = prolonged exposure to estrogen
7. Genetics
What is the gross appearance of Endometrial Adenocarcinomas?
Polypoid, infiltrative, necrosis and hemorrhage
Endometrial Carcinoma
What is this showing?
FIGO I Endometrial Carcinoma
- back to back glands with no stroma
Endometrial biopsy...what is it showing?
FIGO III = poorly differentiated
What is the classification of this Endometrial Carcinoma?
FIGO II
What is the classification of this Endometrial Carcinoma?
Villo-glandular Adenocarcinoma
Endometrial biopsy...what is teh diagnosis?
Papillary Serous Adenocarcinoma
Endometrial biopsy...what is the diagnosis?
Adenocarcinoma with Squamous differentiation
Endometrial biopsy...what is the diagnosis?
Clear cell adenocarcinoma
Endometrial biopsy...what is the diagnosis?
Secretory Adenocarcinoma
- could be confused with Secretory Phase BUT there is NO stroma
Endometrial biopsy...what is the diagnosis?
How does Endometrial Adenocarcinoma usually present clinically?
Abnormal Peri and Post Menopausal bleeding
What is the treatment for Endometrial Adenocarcinoma?
Radical Hysterectomy