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

Source: https://tracknation.in/story/female-genital-tract-for-neet-pg-pathology-cervical-cancer-and-cin-endometrial-cancer-fibroids-endometriosis-ovarian-tumours-molar-pregnancy (TrackNation — free UPSC notes with PYQs)

> NEET PG Pathology: HPV and CIN/SIL, cervical carcinoma, type I and II endometrial carcinoma, leiomyoma, endometriosis, PCOS, epithelial, germ cell and stromal ovarian tumours with Meigs syndrome, and complete vs partial hydatidiform mole and choriocarcinoma, with a diagram, hooks, vignette MCQs and cards.

## Start Here

🎯 **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.

| **Feature**

 | **Complete mole**

 | **Partial mole**

 |
| Karyotype

 | Diploid; about 90% 46,XX

 | Triploid

 |
| Origin

 | One sperm duplicates; ovum nucleus absent or inactive

 | Two sperm (or a diploid sperm) + ovum

 |
| Fetal tissue

 | Does not form

 | A fetus may develop but does not survive

 |
| Behaviour

 | Most moles (> 80%) are benign; β-hCG monitors disease

 | As for complete

 |

## 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

- Chlamydia > gonococcus.

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

- Transformation zone.

- SCC 80–85%; rest adenocarcinoma.

- LSIL = CIN 1; HSIL = CIN 2–3.

- Rarely regresses.

- Oestrogen, obesity; endometrioid; PTEN, KRAS.

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

- Unopposed oestrogen, obesity, tamoxifen, Lynch, PCOS.

- Commonest pelvic tumour; oestrogen-driven.

- Fibroid in pregnancy.

- < 1%.

- Dysmenorrhoea, dyspareunia, infertility.

- Ovarian endometrioma.

- 2 of 3: anovulation, androgens, cystic ovaries.

- High-grade serous (with tube, peritoneum).

- Germline 14–18% of HGSC.

- Lowers risk.

- < 30 years; dysgerminoma, yolk sac, teratoma.

- Mature teratoma, mostly ectoderm.

- Fibroma + ascites + right hydrothorax.

- Diploid 46,XX; no fetus.

- Triploid; fetal parts.

- 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

**Answer: (a)** — Gonococcus is second.

**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

**Answer: (c)** — About 70%; high-risk HPV DNA is found in 99% of cancers.

**Q3.** Nearly all cervical carcinomas arise in the

- (a) isthmus

- (b) vaginal fornix

- (c) endocervical glands deep in the canal

- (d) transformation zone

**Answer: (d)** — The zone of squamous metaplasia around the external os.

**Q4.** The commonest histological type of cervical cancer is

- (a) sarcoma

- (b) squamous cell carcinoma

- (c) adenocarcinoma

- (d) small cell neuroendocrine carcinoma

**Answer: (b)** — 80–85%.

**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

**Answer: (d)** — HSIL covers CIN 2 and CIN 3.

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

- (a) koilocytosis alone

- (b) CIN 1

- (c) squamous metaplasia

- (d) CIN 3

**Answer: (d)** — Untreated, it may invade over months or years.

**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

**Answer: (d)** — Type I is oestrogen-responsive and commoner.

**Q8.** The usual precursor of endometrioid endometrial carcinoma is

- (a) endometrial hyperplasia

- (b) leiomyoma

- (c) endometrial polyp always

- (d) adenomyosis

**Answer: (a)** — Driven by unopposed oestrogen.

**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

**Answer: (d)** — Tamoxifen use over 2 years is a listed risk factor.

**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

**Answer: (a)** — Type II is up to 10% of cases.

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

- (a) Turner syndrome

- (b) Marfan syndrome

- (c) Lynch syndrome

- (d) Peutz-Jeghers only

**Answer: (c)** — Also obesity, unopposed oestrogen, tamoxifen.

**Q12.** The commonest pelvic tumour in women is

- (a) leiomyoma (fibroid)

- (b) ovarian serous carcinoma

- (c) endometrial carcinoma

- (d) dermoid cyst

**Answer: (a)** — A benign smooth muscle tumour of the myometrium.

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

- (a) calcific degeneration

- (b) sarcomatous change

- (c) red degeneration

- (d) hyaline degeneration

**Answer: (c)** — Red degeneration occurs usually only during pregnancy.

**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%

**Answer: (a)** — Leiomyosarcoma is rare.

**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

**Answer: (d)** — Hence treatment with GnRH analogues.

**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

**Answer: (a)** — The classic triad of endometriosis.

**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

**Answer: (c)** — Commonest sites: ovaries, ligaments, pouch of Douglas, peritoneum.

**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

**Answer: (d)** — Unopposed oestrogen from anovulation.

**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

**Answer: (c)** — Insulin resistance is common but not a criterion.

**Q20.** The commonest histological type of ovarian cancer is

- (a) granulosa cell tumour

- (b) Krukenberg tumour

- (c) dysgerminoma

- (d) high-grade serous carcinoma

**Answer: (d)** — Treated as one entity with tubal and peritoneal cancer.

**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

**Answer: (d)** — Another 3% have somatic BRCA mutations.

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

- (a) oral contraceptive use

- (b) early menarche

- (c) late menopause

- (d) nulliparity

**Answer: (a)** — Fewer ovulations.

**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

**Answer: (a)** — Germ cell cancers usually occur under 30.

**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

**Answer: (a)** — A germ cell tumour that rarely becomes malignant.

**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

**Answer: (c)** — Fibroma + ascites + right hydrothorax.

**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

**Answer: (a)** — Sertoli-Leydig cell tumour is another.

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

- (a) serous carcinoma

- (b) endometriosis

- (c) leiomyoma

- (d) ovarian germ cell tumours

**Answer: (d)** — Germ cell cancers usually occur under 30.

**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

**Answer: (b)** — One sperm duplicates; the ovum nucleus is absent or inactive.

**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

**Answer: (b)** — Fertilisation by two sperm or a diploid sperm.

**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

**Answer: (b)** — A sensitive marker before, during and after treatment.

**Q31.** The most aggressive form of gestational trophoblastic disease is

- (a) theca lutein cyst

- (b) partial mole

- (c) choriocarcinoma

- (d) complete mole

**Answer: (c)** — Most moles (> 80%) are benign.

**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

**Answer: (d)** — Prior GTD is another risk.

### 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.