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Question Id: 334
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A 28-year-old woman comes to the office due to vaginal spotting. ThePDF
patient normally
Compressor has regular monthly
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menses with 3-4 days of moderate bleeding . However, she has had spotting for the past 2 days, and her last
menstrual period was 6 weeks ago. Vital signs are normal. Serum quantitative 13-hCG level is 800 IU/ml (normal
at 6 weeks gestation : 1,080-56,500), and a repeat level performed 2 days later shows an abnormal rise to 900
IU/ml. Pelvic ultrasound reveals no gestational sac in the uterus. If uterine curettage is performed, which of the
following microscopic findings would most likely be found in this patient?
0 A . Atypical endometrial cells, disorganized glands, and multiple mitoses
0 8 . Dilated, coiled endometrial glands and edematous stroma
0 C. Inflammatory infiltration of endometrial glands
0 D. Straight, short endometrial glands and compact stroma
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Question Id: 334
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A 28-year-old woman comes to the office due to vaginal spotting. ThePDF
patient normally
Compressor has regular monthly
Free Version
menses with 3-4 days of moderate bleeding . However, she has had spotting for the past 2 days, and her last
menstrual period was 6 weeks ago. Vital signs are normal. Serum quantitative 13-hCG level is 800 IU/ml (normal
at 6 weeks gestation : 1,080-56,500), and a repeat level performed 2 days later shows an abnormal rise to 900
IU/ml. Pelvic ultrasound reveals no gestational sac in the uterus. If uterine curettage is performed, which of the
following microscopic findings would most likely be found in this patient?
0 A . Atypical endometrial cells, disorganized glands, and multiple mitoses (35%)
0 C. Inflammatory infiltration of endometrial glands (5%)
O D. Straight, short endometrial glands and compact stroma (8°/o)
Correct I 1,1 50% fl\ 02 mins, 58 secs
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Explanation
Endometrium with pregnancy-related changes
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Endometrium with pregnancy-related changes
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Question Id: 334
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This patient w ith vaginal bleeding , positive 13-hCG, and no visible intrauterine gestational sac has a pregnancy of
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unknown location , which is concerning for an ectopic pregnancy (ie, embryo implantation in an extrauterine
location such as the fallopian tube). Early ectopic pregnancy may not be visible on ultrasound; therefore, patients
require serial 13-hCG measurements for diagnosis.
This patient has an abnormally low J3-hCG level for gestational age (eg , 800 IU/ml at 6 weeks gestation) plus an
inappropriate rise in J3-hCG level . In normal pregnancies, these levels double approximately every 48 hours; in
cases of spontaneous abortion, levels typically decrease. Therefore, the most likely cause of this patient's low 13-
hCG level is ectopic pregnancy. Risk factors include pelvic inflammatory disease and prior pelvic surgery.
Despite its extrauterine location , an ectopic pregnancy changes the uterine endometrium due to the secretion of
13-hCG, which signals the ovarian corpus luteum to continue progesterone production . Progesterone promotes
endometrial remodeling and decidualization , which normally optimizes the intrauterine environment for
pregnancy. Therefore, if uterine curettage is performed on this patient, it would likely show dilated, coiled
endometrial glands and vascularized, edematous stroma (ie, decidualization) but no products of conception (eg,
villi).
(Choice A) Atypical endometrial cells with disorganized glands and multiple mitoses are consistent with
endometrial adenocarcinoma, a uterine malignancy that usually presents with vaginal bleeding. However, it
typically affects postmenopausal women and is not associated with positive 13-hCG levels.
(Choice C) Inflammatory infiltration of endometrial glands suggests endometritis, an infection of the uterine
decidua. Endometritis is not associated with abnormal 13-hCG levels.
(Choice D) Straight, short endometrial glands with compact stroma are found in the early proliferative phase of the
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