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Paper 1
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 49 year old woman has an MRI of her pelvis to assess her uterus. The patient has been having heavy, painful periods. A pelvic ultrasound identified a heterogenous area of uterine wall thickening. This area is evident on the MRI as a focal but ill-defined, thickened area of the posterior uterine wall with T2 hyperintensities. Enhancement is similar to the adjacent uterus. The endometrium measures up to 7 mm. The junctional zone measures 15 mm. There is a right ovarian corpus luteum. The left ovary has normal appearances. There are a couple of cervical Nabothian cysts.
Cervical Ectopic Pregnancy
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
A nabothian cyst is an obstructed mucus-secreting endocervical gland that is believed to be secondary to prior inflammation within the cervix. These cysts generally are asymptomatic and incidentally noted on pelvic ultrasound [15]. They appear as anechoic or have low levels of echogenicity. In addition, there is no surrounding increased vascularity on Doppler evaluation. Finally, there is no known adverse pregnancy outcomes associated with nabothian cysts, and women with these cysts have an excellent prognosis; however, there are reports of possible labor obstruction [15].
Screening
Published in William Bonnez, Guide to Genital HPV Diseases and Prevention, 2019
During the process of normal maturation and puberty, the vaginal pH becomes acidic under the influence of ovarian hormones. What was once a prominent glandular ectropion now becomes a smooth appearing stratified squamous epithelium that lines the exocervix. This process is called metaplasia. Metaplasia originates at the squamo-columnar junction, which progressively migrates towards the endocervix. This area that has once been glandular and is now squamous epithelium is called the transformation zone (Fig. 6.1). This is the area that is at highest risk for developing cervical neoplasia and its sampling for cytology is of paramount importance. Nests of glands retained within the transformation zone often develop inspissated mucous secretions which result in the formation of pinpoint, whitish, pustular lesions called Nabothian cysts. These Nabothian cysts may be raised and with surrounding inflammation, and can often be mistaken for a neoplastic process.
Lobular endocervical glandular hyperplasia mimicking cervical adenocarcinoma
Published in Journal of Obstetrics and Gynaecology, 2021
Felix Boria, Jaime Siegrist, David Hardisson, Nuria Saturio, Ignacio Zapardiel
The Pap smear showed a low-grade squamous intraepithelial lesion (LSIL) confirmed by a biopsy. The cervix was hypertrophic in vaginal US, with an increased vascularisation and multiple cysts in the posterior labia. The MRI revealed multiple grouped cysts versus multilocular cystic lesion located in an enlarged uterine cervix, encircling the cervical canal from the isthmus to the ectocervix and growing into the cervical stroma especially in the posterior labia, with measures of 40 × 50 × 45 mm (height × anteroposterior diameter × transverse diameter) [Figure 1]. The larger cysts partially surrounded the small cysts and this distribution resembled a ‘Cosmos Pattern’. No solid component or restricted diffusion areas were clearly identified within the lesion, however, moderate enhancement and slight irregular thickening of some of the cyst walls or septa could be observed. Radiologic diagnosis suggested LEGH as the best possibility, although minimal deviation adenocarcinoma (adenoma malignum) or, less likely, other benign conditions such as cystic cervicitis or multiple grouped Nabothian cysts could not be ruled out.
Endometriosis resembling endometrial cancer in a postmenopausal patient
Published in Climacteric, 2018
B. Suchońska, M. Gajewska, A. Zyguła, M. Wielgoś
The final histopathological examination report described an intrauterine device in the uterine cavity, fused with the uterine wall. There were intramural fibroids and adenomyosis of the uterine body, simple endometrial hyperplasia without atypia, squamous metaplasia and Nabothian cysts of the cervix. There was chronic inflammation of the adnexa. Both ovaries were atrophic. Both Fallopian tubes were without focal changes. On the surface of the uterine serosa, parametrium, and Fallopian tubes there was material described as bladder area infiltration; among the adhesions of fibrous and adipose tissue, there were foci of cells with light, foamy cytoplasm and slight nuclear atypia (CKAE1/AE3−, CK7−, p63−, S100−, LCA focally +). Additionally, within the foci, there were visible histiocytes, lipophages, siderophages and lymphocytes. The immunohistochemical examinations and the histological picture indicated reactive lesions (inflammatory with the formation of adhesions) which were the endometriosis scar tissue (Figures 1 and 2). No malignant neoplasm was found in the received tissue material.