1. What tissue is this? What lesion is seen here? What is the cause of this lesion?

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    • Cervix
    • LSIL (CIN I): note focal enlarged hyperchromatic nuclei near the epithelial surface that demonstrate nuclear crowding with irregular nuclear borders; you may also see koilocytic change (clearing of cytoplasm around nucleus due to HPV cytopathic effect)
    • The cause: HPV 6 & 11, low risk types
  2. What is the purple portion of this? What is the pink portion and what lies inside it? What is the lesion? What causes this lesion?

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    • Purple area: epithelial surface of cervix
    • Pink area: endocervical stroma containing endocervical glands
    • Note the lack of squamous cell maturation as they move from the basement membrane to the surface in the middle of the image
    • Also note that the squamous epithelium may extend into the endocervical glands but that this is not invasion and does not alter the prognosis
    • High power: note features of dysplasia, including loss of cell polarity, crowding of cells, numerous mitoses above basal layer, abnormal mitoses, decreased N/C ratio
    • Caused by: High risk HPV types 16 & 18
  3. What is this? What features are unique to some of these types of lesions?

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    • Invasive squamous cell carcinoma of the uterine cervix: note the large irregularly shaped tissue fragement that is deep purple and has spread extensively into the underlying tissue (including the endocervical glands and cervical stroma)
    • Some tumors may show keratinization with keratin or squamous pearls
    • High power: notice that there is chronic inflammatory infiltrate around the projecting tongues of invading tumor that reflects an immune response by the woman to the tumor
  4. What is this? What are the common features of malignancy?

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    • Invasive endocervical adenocarcinoma: also related to HPV infection; is a cancer of the endocervix (which normally contains columnar mucinous epithelium)
    • Features of malignancy (seen in this image): Crowded, dark, hyperchormatic nuclei with irregular nuclear borders and elevated N:C and easily distinguishable mitotic figures
    • Also seen in this image: crowded glands with little intervening stroma and evidence of cribriform architecture; some of the gland lumina contain necrotic debris
  5. What is a leiomyoma? What are the common sx of it? Are they pre-malignant? How do we detect them?
    • Leiomyoma: benign smooth muscle tumorof the uterine corpus; extremely common; range in size from pin-points to basketballs, and may project on a pedicle (risk of infarction)
    • Sx: may be asx or present with abdominal pain, dysfunctional bleeding, and interfere with fertility
    • They are NOT pre-malignant and are the most common benign uterine neoplasm
    • Detection: can be felt on pelvic exam because of enlargement or unusual uterine contour
  6. What are these?
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    Examples of leiomyomas and a leiomyosarcoma
  7. What is this? What is it composed of? What features are notable?

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    • Leiomyoma: composed of spindly smooth msucle cells that are cytologically benign (N/E ratio is nromal, no mitotic figures)
    • Notable features: mitotic rate and nuclear pleomorphism
  8. What is this? Is it malignant or benign? How do most of these arise?
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    • Leiomyosarcoma
    • Malignant
    • Arises de novo (not usually from preexisting leiomyomas)
  9. What is this?
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    • Normal placenta
    • Try to ID the chorionic plate, chorionic villi, syncytiotrophoblast, cytotrophoblast, intervillous space, and decidua
  10. What is this?
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    Normal chorionic villus
  11. How do placenta infections occur?
    • Most frequently through an ascending infection that began in the mother's lower genital tract that ascended up the vagina and cervix before breaching amniotic membranes to infect the amniotic fluid and fetus
    • May also occur hematogenously from a systemically infected mother (rare)
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