JCU MB4 Term 4 Week 6 (Cervix and Uterus)

1

36yo female, abnormal smear report for coloscopy & biopsy. Aceto-white stain and histology shown. Diagnosis?

Aceto-white HSIL

Histology HSIL


  Leukoplakia (cervicitis chronic)

  Candida albicans (thrush)

  HPV 6 - LSIL

  HPV 18 - HSIL

  HPV condylomata acuminata

2

32yo female, routine pap smear cytology shown. Diagnosis?

Cytology Normal


  HSIL (high grade)

  Carcinoma cervix

  Normal smear

  Cervicitis

  LSIL (low grade)


Phase of cycle? Proliferative/Oestrogen Describe microscopic features? Pink, uniform, squamous epithelial cells, small pyknotic nuclei What features suggest dysplasia? Pleomorphism, large irregular hyperchromatic nuclei

3

32yo female, routing pap smear cytology shown. Diagnosis?

Cytology LSIL


  HSIL with koilocytes

  Cervicitis

  HPV infection

  Koilocytes with LSIL

  Carcinoma cervix


Microscopic features? Mild epithelial dysplasia, clear cytoplasm, larger nucleus Diagnosis / smear report? LSIL with koilocytes What is the prognosis? Good, transient, but may become HSIL - follow-up required

4

28yo female, image shows routine smear test. Her previous PAP was reported as normal. What is the recommended management option?

Cytology LSIL


  Repeat PAP in 6 months

  Immediate colposcopy

  Repeat PAP in 12 months

  Targeted biopsy

  Refer to oncology/surgical

5

38yo primigravida, lower abdominal pain worse during menses, dysmenorrhoea for 3yrs. Palpable adnexal mass, enlarged ovary, image shows laparoscopic view of pelvic cavity. Diagnosis?

Endometriosis

Endometriosis


  Adenomyosis

  Endometriosis

  Ectopic pregnancy

  Metastatic carcinoma

  Pelvic Inflammatory Disease (PID)


Etiology/Pathogenesis? Estrogen, metastatic endometrium (benign) Describe microscopic features? Endometrial glands, haemorrhage Complications? Infertility, frozen pelvis, risk of malignancy

6

34yo female, on OCP, vaginal bleeding for 5 weeks. Polypoid mass seen projecting through cervis. Macroscopic and histological images of uterus shown. Diagnosis?

Endometrial polyp macro

Endometrial polyp micro


  Endometrial carcinoma

  Cervical polyp

  Endometrial polyp

  Adenomyosis

  Endometriosis


Etiology: Oestrogen, benign hyperplasia Macroscopic features? Endometrial glands (uniform, cystic), haemorrhage Clinical/complications? Infertility, DUB, +/- malignancy

7

27yo female, vaginal discharge cytology. Vaginal smear shown. Diagnosis?

Bacterial Vaginitis


  Bacterial vaginitis

  Herpes infection

  Chlamydial infection

  LSIL - koilocytes

  Candida thrush


What cells are shown? Clue cells, Gardnerella vaginalis Microscopic features? Epithelial cells covered in bacterial clumps, not many WBC Clinical/Complications? Fishy odour, irritation, itching, STI

8

48yo perimenopausal with 7 month history of irregular vaginal bleeding undergoes hysterectomy. Images shows her opened uterus specimen. Diagnosis?

Endometrial poylps


  Adenomyosis

  Endometriosis

  Endometrial carcinoma

  Endometrial hyperplasia

  Endometrial polyps


Etiology/pathogenesis? Oestrogen, benign hyperplasia Describe microscopic features? Endometrial glands (uniform, cystic), haemorrhage Clinical/complications? Infertility, DUB, +/- malignancy

9

32yo female, biopsy taken after routine pap smear shown. Diagnosis?

Cervix LSIL


  Leukoplakia

  HPV with LSIL

  Chlamydial cervicitis

  HPV with HSIL

  Lichen sclerosis

10

39yo post-coital bleeding after hysterectomy. Macroscopic and histological images shown. Diagnosis?

Cervical carcinoma

Cervical carcinoma


  Erythroplakia

  HSIL + Koilocytes

  LSIL + Koilocytes

  Endometriosis

  Squamous carcinoma

11

42yo female, routine pap smear shown. What is the diagnosis?

Cervix HSIL


  HSIL

  Koilocytes

  Clue cells (cervicitis)

  HPV infection

  LSIL


Microscopic features? Severe dysplasia (high grade) Risk factors? STD, oestrogen, HPV 16-18 Pathogenesis? HPV 16-18 - DNA binding - E6/E7 proteins to oncogenes - carcinoma

12

39yo female, biopsy taken after routine pap smear shown. Diagnosis?

Cervix HSIL


  LSIL

  HSIL

  Cervical carcinoma

  HPV infection

  Chronic cervicitis

13

32yo female, cervical biopsy shown. Diagnosis?

Cervical carcinoma


  LSIL

  HSIL

  Cervical carcinoma

  HSIL with HPV

  LSIL with HPV

14

42yo female, routine pap smear shown. Diagnsosis?

Cervicitis and HSIL


  LSIL

  HSIL

  Cervical carcinoma

  HSIL with HPV

  HSIL and cervicitis

15

49yo female, cervical carcinoma, macroscopic appearance shown. What is the stage?

Cervical carcinoma stage 1


  0

  1

  2

  3

  4

16

30yo female for routine pap smear screening. Diagnosis?

Pap smear LSIL


  Cervicitis

  Koilocytic change

  Severe dysplasia - HSIL

  Mild dysplasia - LSIL

  Candida cervicitis

17

48yo female, reports thick, white vaginal discharge. Examination and smear findings shown. Diagnosis?

Candida albicans macro

Candida albicans smear


  Bacterial vaginitis

  Herpes infection

  Chlamydial infection

  Trichomonas

  Candidal infection

18

35yo female, smelly, frothy yellow discharge. Macroscopic and smear findings shown. Diagnosis?

Trichomonas macro

Trichomonas smear


  Bacterial vaginitis

  Herpes infection

  Chlamydial infection

  Trichomonas vaginalis

  Candida cervicitis

19

30yo female, routine pap smear shown. Diagnsosis?

Cervixs HSIL


  Cervicitis - bacterial

  Koilocytic change

  Severe dysplasia - HSIL

  Mild dysplasia - LSIL

  Candida cervicitis

20

35yo female fishy-smelling vaginal discharge has pap smear report of clue cells and dysplastic cells. Image shows appearance of biopsy on coploscopy and smear. What is the most likely diagnosis?

Cervix HSIL

Pap smear clue cells


  Candida + LSIL

  Trichomonas + HSIL

  Bacterial vaginitis + HSIL

  HSIL with infiltration (cervical carcinoma)

  HPV induced dysplasia

21

31yo female, infertility. Swollen vulva, inguinal lymphadenopathy. Biopsy of enlarged lymph node showed necrotizing granulomas and inclusion bodies. Most likely etiologic agent?

Chlamydia


  Chlamydia trachomatis

  Garderella vaginalis

  Treponema pallidum

  Candida albicans

  HPV serotype 16


What is the diagnosis? Lymphogranuloma venereum (caused by Chlamydia serovars) Clinical features? Flat to raised, soft/hard, warty growth Microscopic features? Acanthosis, koilocytes, para/hyperkeratosis

22

52yo female, 2 year history of vulvar itching, dyspareunia. Examination shows white plaque, shiny thin skin. Image shows clinical and biopsy appearance. What is the most likely diagnosis?

Lichen sclerosis atrophicus macro

Lichen sclerosis atrophicus micro


  HSV-1 infection

  Lichen sclerosis atrophicus

  HPV infection

  Lichen simplex

  Candida albicans (thrush)

23

A 60yo woman presents with a 1-year history of vulval itching, bleeding and inflammation. Physical examination reveals a 1cm exophytic fungatic mass on the labium major. Biopsy of the mass shows poorly differentiated malignant cells. These neoplastic cells would most likely express which of the following tumour markers?


  Alpha-fetoprotein

  Carcinoembryonic antigen

  Cytokeratins

  Oestrogen receptors

  HER2 polypeptides


Etiology? HPV high-risk 16, 18 Gross features? irregular, whitish, ulcerated, haemorrhagic growth Microscopic features? Pleomorphic, hyperchromatic cells, keratin pearls Clinical/complications? Carcinoma - spread, destruction, ?Paget's

24

31yo woman with a 3 month history of warty, non-pruritic, non-haemorrhagic lesions on her perineum and labia majora. Images show two similar history cases and biopsy. What is the most likely diagnosis?

Condyloma accimunata

Condyloma accimunata


  Genital herpes

  Candidiasis

  Condlyomata lata

  CIN3/HSIL

  Condyloma accuminata


Etiology? HPV 6,11 Gross features? Flat to raised, soft/hard, warty growth Microscopic features? Acanthosis, koilocytes, para/hyperkeratosis

25

45yo woman blood tinged vaginal discharge for 1 month, previously had 2 episodes of postcoital bleeding in past 12 months. Images (A & B) show two cases with similar history. What is the most likely diagnosis?

Cervical carcinoma

Cervical carcinoma


  Candida + LSIL

  HPV + HSIL

  Bacterial vaginitis + HSIL

  Carcinoma cervix

  Condyloma accuminata


What is the disease stage? Limited to cervix, >4mm - 1B Gross features? Irregular growth, haemorrhage Microscopic features? Infiltration, keratin pearls, inflammation Risk factors? STD, HPV