Female Genital Tract for NEET PG Pathology: Cervical Cancer and CIN, Endometrial Cancer, Fibroids, Endometriosis, Ovarian Tumours, Molar Pregnancy

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🎯 Exam priority: High. Expect: HPV types and the transformation zone, CIN grades and Bethesda terms, type I vs II endometrial cancer, fibroid degeneration, endometriosis sites and chocolate cyst, PCOS criteria, ovarian tumour classes, Meigs syndrome, dermoid cyst, and complete vs partial mole.

CBME mapping: PA 29.1–29.10. Breast is article 25; tumour markers in general are in article 4.

Cervix, uterus, ovary and placenta. Drawn by TrackNation.

Cervix

• Cervicitis: usually sexually transmitted — Chlamydia trachomatis first, then N. gonorrhoeae; also HSV, Trichomonas, Mycoplasma genitalium.

• HPV: types 16 and 18 cause about 70% of precancer and cancer; DNA of a high-risk type is found in 99% of cervical cancers. Smoking and immunodeficiency add risk.

• Nearly all carcinomas start in the transformation zone (squamous metaplasia around the external os). The precursor is CIN: 1 mild, 2 moderate, 3 severe dysplasia/carcinoma in situ. CIN 3 rarely regresses. Bethesda cytology: LSIL = HPV change (koilocytosis) or CIN 1; HSIL = CIN 2–3.

• Cervical cancer: squamous cell carcinoma 80–85%; most of the rest adenocarcinoma.

Uterus

• Endometrial carcinoma presents with postmenopausal bleeding and is usually preceded by endometrial hyperplasia. Risk factors: unopposed oestrogen, age over 45, obesity, tamoxifen over 2 years, Lynch syndrome, pelvic radiation, PCOS.

• Type I (commoner, non-aggressive): oestrogen-responsive, younger obese women, endometrioid (75–80% of all endometrial cancers), mutations in PTEN, PIK3CA, KRAS, CTNNB1. Type II (up to 10%, aggressive): older women, high-grade, serous or clear cell; p53 mutations in 10–30%.

• Leiomyoma (fibroid): benign smooth muscle tumour of the myometrium and the commonest pelvic tumour. Subserosal, intramural or submucosal; grows in the reproductive years and shrinks after menopause (oestrogen). Degeneration: hyaline, myxomatous, calcific, cystic, fatty, red (in pregnancy). Sarcomatous change in < 1%.

• Endometriosis: endometrial tissue implanted outside the uterus — ovaries, broad and uterosacral ligaments, pouch of Douglas, peritoneum. Retrograde menstruation is the leading theory. Triad: dysmenorrhoea, dyspareunia, infertility. Ovarian endometrioma = chocolate cyst.

• PCOS (Rotterdam, 2 of 3): oligo/anovulation, hyperandrogenism, polycystic ovaries; insulin resistance and obesity are common. Unopposed oestrogen raises the risk of endometrial hyperplasia and cancer.

Ovary

• Epithelial tumours dominate; stromal and germ cell tumours are under 10%. High-grade serous carcinoma is the commonest and is treated as one entity with fallopian tube and primary peritoneal cancer. Germline BRCA1/2 in 14–18%. Risk: nulliparity, delayed childbearing, early menarche, late menopause, family history; oral contraceptives lower risk. CA 125 is the marker in older women.

• Germ cell tumours: under 30 years; dysgerminoma, yolk sac (endodermal sinus) tumour, embryonal carcinoma, choriocarcinoma, immature teratoma; XY gonadal dysgenesis predisposes. Mature cystic teratoma (dermoid) is benign and mostly ectodermal.

• Sex cord-stromal: granulosa-theca and Sertoli-Leydig cell tumours. Meigs syndrome = benign ovarian fibroma + ascites + right hydrothorax. Metastases to the ovary come from breast and GI cancers.

• Any adnexal mass over about 4 cm can twist (torsion).

Gestational Trophoblastic Disease

• Hydatidiform moles: grape-like vesicles; commonest under 17 or over 35 years. Most (> 80%) are benign, but β-hCG is followed to detect persistent disease. Theca lutein cysts over 6 cm mark higher risk.

• Choriocarcinoma is the most aggressive form of GTD.

Traps the Examiner Sets

• Complete mole = diploid, all paternal, no fetus; partial = triploid, fetal parts.

• Meigs = fibroma + ascites + RIGHT hydrothorax.

• Type I endometrial = oestrogen + PTEN; type II = serous + p53.

• Red degeneration of a fibroid = pregnancy.

• LSIL = CIN 1; HSIL = CIN 2 and 3.

Memory Hooks & Shortcuts

Shortcuts to lock in this article's numbers and lists. Each one only re-packages facts proven above.

• 🧠 Complete = Copy of dad (46,XX paternal), no baby — complete mole

• 🧠 Partial = Plus one set (triploid), Part of a fetus — partial mole

• 🧠 Meigs: Mass (fibroma) + Moist belly (ascites) + Right lung water — Meigs syndrome

• 🧠 Type I = I'm oestrogen fed; Type II = Too aggressive (p53) — endometrial cancer

• 🧠 Red degeneration = Ready to deliver (pregnancy) — fibroid

• 🧠 LSIL = Little (CIN 1); HSIL = Heavy (CIN 2–3) — Bethesda

Rapid-Revision Cards

• Cervicitis

  Chlamydia > gonococcus.

• HPV in cervical cancer

  16/18 ~70%; high-risk HPV 99%.

• Site of cervical cancer

  Transformation zone.

• Cervical cancer type

  SCC 80–85%; rest adenocarcinoma.

• Bethesda

  LSIL = CIN 1; HSIL = CIN 2–3.

• CIN 3

  Rarely regresses.

• Endometrial type I

  Oestrogen, obesity; endometrioid; PTEN, KRAS.

• Endometrial type II

  Older; serous/clear cell; p53; ≤ 10%.

• Endometrial risks

  Unopposed oestrogen, obesity, tamoxifen, Lynch, PCOS.

• Fibroid

  Commonest pelvic tumour; oestrogen-driven.

• Red degeneration

  Fibroid in pregnancy.

• Fibroid → sarcoma

  < 1%.

• Endometriosis triad

  Dysmenorrhoea, dyspareunia, infertility.

• Chocolate cyst

  Ovarian endometrioma.

• PCOS (Rotterdam)

  2 of 3: anovulation, androgens, cystic ovaries.

• Ovarian cancer type

  High-grade serous (with tube, peritoneum).

• Ovarian BRCA

  Germline 14–18% of HGSC.

• OCP and ovary

  Lowers risk.

• Ovarian germ cell

  < 30 years; dysgerminoma, yolk sac, teratoma.

• Dermoid

  Mature teratoma, mostly ectoderm.

• Meigs

  Fibroma + ascites + right hydrothorax.

• Complete mole

  Diploid 46,XX; no fetus.

• Partial mole

  Triploid; fetal parts.

• GTD marker

  β-hCG.

Sources

Facts in this article were checked against these documents.

• MSD Manual Professional: Cervical Cancer; Endometrial Cancer; Ovarian, Fallopian Tube and Peritoneal Cancer; Gestational Trophoblastic Disease — Merck & Co. (MSD Manuals), reviewed 2023–26 (link)

• MSD Manual Professional: Uterine Fibroids; Endometriosis; Benign Adnexal Masses; Cervicitis; Polycystic Ovary Syndrome — Merck & Co. (MSD Manuals), reviewed 2025–26 (link)

• PDQ Ovarian Epithelial, Ovarian Germ Cell and Gestational Trophoblastic Disease Treatment (Health Professional Version) — US National Cancer Institute, 2025–26 (link)

• Competency Based Undergraduate Curriculum, Pathology (PA 29) — National Medical Commission, 2024

Test Yourself: Practice Questions

Thirty-two questions in NEET PG style, most of them clinical vignettes.

Practice Questions (NEET PG pattern)

Original questions written in the style of the exam: +4 for a correct answer, −1 for a wrong one. Every answer was checked against the sources listed above. NEET PG papers are not published by NBEMS, so these are not past-paper questions.

Q1. A sexually active woman has mucopurulent cervical discharge. The commonest infectious cause is

• (a) Chlamydia trachomatis

• (b) Candida albicans

• (c) Gardnerella

• (d) Neisseria gonorrhoeae

Q2. Most precancerous and invasive cervical lesions are attributable to HPV types

• (a) 6 and 11

• (b) 31 and 33 only

• (c) 16 and 18

• (d) 1 and 2

Q3. Nearly all cervical carcinomas arise in the

• (a) isthmus

• (b) vaginal fornix

• (c) endocervical glands deep in the canal

• (d) transformation zone

Q4. The commonest histological type of cervical cancer is

• (a) sarcoma

• (b) squamous cell carcinoma

• (c) adenocarcinoma

• (d) small cell neuroendocrine carcinoma

Q5. A Pap smear shows changes of HPV infection (koilocytosis) or mild dysplasia. In the Bethesda system this is reported as

• (a) HSIL

• (b) AGC

• (c) ASC-H

• (d) LSIL

Q6. Which cervical lesion is least likely to regress on its own?

• (a) koilocytosis alone

• (b) CIN 1

• (c) squamous metaplasia

• (d) CIN 3

Q7. An obese perimenopausal woman has abnormal uterine bleeding; biopsy shows a low-grade endometrioid adenocarcinoma. The tumour type and a typical mutation are

• (a) type II — BRCA1

• (b) type II — p53 in all

• (c) type I — HER2 amplification

• (d) type I — PTEN

Q8. The usual precursor of endometrioid endometrial carcinoma is

• (a) endometrial hyperplasia

• (b) leiomyoma

• (c) endometrial polyp always

• (d) adenomyosis

Q9. A breast cancer survivor on tamoxifen for 4 years develops abnormal uterine bleeding. Tamoxifen raises the risk of

• (a) ovarian dysgerminoma

• (b) cervical carcinoma

• (c) leiomyoma regression

• (d) endometrial carcinoma

Q10. Which endometrial carcinoma is aggressive, occurs in older women and often carries p53 mutations?

• (a) serous carcinoma (type II)

• (b) grade 1 endometrioid carcinoma

• (c) endometrial hyperplasia

• (d) adenomyosis

Q11. An inherited syndrome raising the risk of endometrial cancer is

• (a) Turner syndrome

• (b) Marfan syndrome

• (c) Lynch syndrome

• (d) Peutz-Jeghers only

Q12. The commonest pelvic tumour in women is

• (a) leiomyoma (fibroid)

• (b) ovarian serous carcinoma

• (c) endometrial carcinoma

• (d) dermoid cyst

Q13. The type of fibroid degeneration seen usually only in pregnancy is

• (a) calcific degeneration

• (b) sarcomatous change

• (c) red degeneration

• (d) hyaline degeneration

Q14. Malignant (sarcomatous) change in a uterine fibroid occurs in

• (a) less than 1%

• (b) about 25%

• (c) most cases after menopause

• (d) about 10%

Q15. Fibroids enlarge during the reproductive years and shrink after menopause because they are

• (a) androgen-driven

• (b) insulin-driven

• (c) independent of hormones

• (d) oestrogen-responsive

Q16. A woman with dysmenorrhoea, dyspareunia and infertility has an ovarian cyst full of old blood. The cyst is

• (a) an endometrioma (chocolate cyst)

• (b) a dermoid cyst

• (c) a serous cystadenoma

• (d) a corpus luteum cyst

Q17. The leading theory of how endometriosis begins is

• (a) adenomyosis spreading through the wall only

• (b) BRCA mutation

• (c) retrograde menstruation through the fallopian tubes

• (d) HPV infection

Q18. A woman has irregular cycles, hirsutism and polycystic ovaries on ultrasound. Long-term she is at increased risk of

• (a) dysgerminoma

• (b) choriocarcinoma

• (c) cervical carcinoma

• (d) endometrial hyperplasia and carcinoma

Q19. The Rotterdam criteria for PCOS require

• (a) a positive pregnancy test

• (b) all 3 plus obesity

• (c) 2 of 3: anovulation, hyperandrogenism, polycystic ovaries

• (d) raised prolactin

Q20. The commonest histological type of ovarian cancer is

• (a) granulosa cell tumour

• (b) Krukenberg tumour

• (c) dysgerminoma

• (d) high-grade serous carcinoma

Q21. A woman with high-grade serous ovarian cancer is tested for germline mutations. The genes found in about 14–18% are

• (a) APC

• (b) VHL

• (c) RB1

• (d) BRCA1 and BRCA2

Q22. Which factor lowers the risk of epithelial ovarian cancer?

• (a) oral contraceptive use

• (b) early menarche

• (c) late menopause

• (d) nulliparity

Q23. A 19-year-old has an aggressive ovarian tumour. The tumour class most likely at her age is

• (a) germ cell tumour

• (b) Brenner tumour

• (c) high-grade serous carcinoma

• (d) metastatic breast cancer

Q24. A benign ovarian cyst contains tissue from all three germ layers, mostly ectoderm. It is

• (a) a mature cystic teratoma (dermoid)

• (b) an endometrioma

• (c) a mucinous cystadenoma

• (d) a dysgerminoma

Q25. A woman with a benign ovarian tumour has ascites and a right pleural effusion. This is

• (a) pseudomyxoma peritonei

• (b) Krukenberg tumour

• (c) Meigs syndrome with an ovarian fibroma

• (d) ovarian hyperstimulation

Q26. Which of these is a sex cord-stromal tumour of the ovary?

• (a) granulosa-theca cell tumour

• (b) dysgerminoma

• (c) serous cystadenocarcinoma

• (d) yolk sac tumour

Q27. A patient with XY gonadal dysgenesis is at increased risk of

• (a) serous carcinoma

• (b) endometriosis

• (c) leiomyoma

• (d) ovarian germ cell tumours

Q28. Evacuated uterine contents show grape-like vesicles with no fetal tissue; the karyotype is 46,XX. This is

• (a) a partial mole

• (b) a complete hydatidiform mole

• (c) choriocarcinoma

• (d) a normal abortion

Q29. A molar pregnancy with some fetal parts and a triploid karyotype is

• (a) a placental site trophoblastic tumour

• (b) a partial mole

• (c) an invasive mole always

• (d) a complete mole

Q30. After evacuation of a molar pregnancy, the test used to detect persistent trophoblastic disease is

• (a) CEA

• (b) serum beta-hCG

• (c) CA 125

• (d) AFP

Q31. The most aggressive form of gestational trophoblastic disease is

• (a) theca lutein cyst

• (b) partial mole

• (c) choriocarcinoma

• (d) complete mole

Q32. Hydatidiform mole is most common in women who are

• (a) nulliparous at 25

• (b) postmenopausal

• (c) aged 20–30

• (d) younger than 17 or older than 35

Active Recall

From memory: name the causes of cervicitis; explain HPV, the transformation zone, CIN grades and Bethesda terms; contrast type I and type II endometrial cancer and list risk factors; describe fibroids, endometriosis and PCOS; classify ovarian tumours and define Meigs syndrome and the dermoid cyst; and compare complete and partial moles.