Women are susceptible to a variety of gynecologic disorders and malignancies. Gynecology microscopes help gynecologists in assessing and diagnosing these gynecological problems.

Endometrial, cervical, and ovarian malignancies must be ruled out in cases of postmenopausal bleeding thru examination using a gynecology microscope. A Pap test is essential when postmenopausal bleeding is noted, although the Pap test is an insensitive diagnostic test for detecting endometrial cancer. Only about 50% of women with endometrial cancer will have a positive Pap test result. About 5-10% of women with normal endometrial cells on Pap test, as seen under a gynecology microscope, will have endometrial hyperplasia or carcinoma, whereas about one-fourth of those with atypical endometrial cells indicated on Pap test results will have carcinoma. The Pap test results are nega¬tive in some cases of invasive cervical carcinoma because of tumor necrosis.

Cervical malignancy is diagnosed by cervical biopsy of grossly visible lesions and colpo¬scopically directed biopsy for women with abnormal Pap test results using a gynecology microscope. Functional ovarian tumors may produce estrogen and lead to endometrial hyperplasia or carci¬noma, which may present with bleeding.

Pelvic examination using a gynecology microscope to detect local lesions and Pap test to assess cytology are essential first steps in finding the cause of postmenopausal bleeding. Endometrial sampling, through office biopsy, hysteroscopy, or D&C, is usually considered essential. Pelvic ultrasound examination and, in particular, vaginal ultrasonography can suggest the cause of bleeding. Initial office biopsy is more cost-effective than D&C, surgery, or observation alone. The cost-effectiveness of other screening strategies, including transvaginal ultrasound, has not been well studied. It has been suggested that an endometrial thickness of less than 6mm (4-5 mm in some reports) on transvaginal ultrasound is unlikely to indicate endometrial cancer.

The management of atrophic vaginitis includes topical or systemic use of estrogens after other causes of abnormal bleeding have been excluded. Cervical polyps can easily be re¬moved in the office.

Endometrial hyperplasia

The terminology that has been used to describe endometrial hyperplasia is confusing. The gynecologist must examine the patient thru a microscope, such as a gynecology microscope, and consults with the pathologist to ensure an understanding of the diagnosis. The following lesions are considered to be benign: anovulatory, proliferative, cystic glandular hyperplasia, simple cystic hyperplasia, simple hyperplasia, and adenomatous hyperplasia without atypia. These terms re¬flect and describe an exaggerated proliferative response of the endometrium, as seen in a microscope. In most cases, benign endometrial hyperplasia is resolved with D&C or progestin therapy. Repeat surveillance with endometrial biopsy may be warranted.

The presence of atypia with abnormal proliferation when examined under a microscope, including features of “back-to-back” crowding of the glands with epithelial activity demonstrated by papillary projections into the glands, is associated with an increased risk of progression to endometrial carcinoma. These architectural abnormalities may be associated with individual cellular atypia (enlarged, irregular nuclei, chromatin clumping, and prominent nucleoli). The pres¬ence of mitotic activity also can be variable.

The management of endometrial hyperplasia rests on an understanding of the natural history of the lesion involved. In one study, only 2% of 122 patients with hyperplasia without cyto¬logic atypia progressed to carcinoma, whereas 23% of those with atypical hyperplasia subsequently developed carcinoma. Architectural complexity and crowding appears to place patients at greater risk for progression than does the presence of cytologic atypia alone.

These data suggest that most women with endometrial hyperplasia will respond to progestin therapy and are not at increased risk of developing cancer. Gynecologic patients who do not respond are at a significantly increased risk of progressing to invasive cancer and should be advised to have a hysterectomy. Gynecologic patients who are unlikely to respond can be identified on the basis of cytologic atypia.