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Patho > 25. Disease Of The Uterus > Flashcards

25. Disease Of The Uterus Flashcards

1
Q

Disease of the uterus
include
non neoplastic and neoplastic

A

non neo
Abnormal uterine bleeding (AUB)
Dysfunctional uterine bleeding (DUB)
Anovulatory cycle

neoplastic
Endometriosis
Adenomyosis
Endometrial hyperplasia
Endometrial polyps
Endometrial carcinoma
Leiomyoma
Leiomyosarcomas

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2
Q

Abnormal uterine bleeding (AUB)

A

Abnormal uterine bleeding (AUB)
Uterine bleeding which is different from normal menstrual bleeding in amount, duration, etc…

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3
Q

Dysfunctional uterine bleeding (DUB)

A

AUB with out organic (structural) cause
Due to endocrine disturbance
Anovulatory cycle and luteal phase inadequacy are two important cause

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4
Q

Anovulatory cycle

A

Occurs around menarche and menopause
Causes include – PCOS, anxiety, stress, malnutrition, hypothyroidism and hyperprolactinemia

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5
Q

Luteal phase inadequacy

A

= Luteal phase defect
Ovulation occurs but corpus luteum not produce adequate amount of progesterone
Spotting and premature onset of menstrual bleeding are characteristics
Causes include – PCOS, anxiety, stress, malnutrition, hypothyroidism and hyperprolactinemia.

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6
Q

Endometriosis

A

Functional endometrial gland and stroma out side endometrial lining of the uterus
6% - 10% of women
Mostly in the 3rd and 4th decades
3x increase in Endometrioid and Clear cell variant of ovarian cancer

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7
Q

Pathogenesis
of endometriosis 4

A

Retrograde menstruation theory
Metaplasia of coelomic epithelium theory
Benign metastasis theory (lung or lymph nodes)
The extrauterine stem or progenitor theory (arises from stem cells derived from bone marrow)

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8
Q

location of endometrial implant and appearance of nodulesof endometriosis

A

ovary
gun powder

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9
Q

Clinical presentation
of endometriosis

A

Pelvic pain
Infertility (30 - 40% of infertile women has endometriosis)
Dyspareunia
Dysmenorrhea
Pain on defecation and urination
Hemoptysis

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9
Q

Atypical endometriosis

A

1.7 - 4.4% of endometriotic lesions
Precursor lesion for endometriosis associated carcinomas
Cytologic atypia in the epithelial lining of the glands or gland crowding lined by atypical epithelium resembling endometrial atypical hyperplasia

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10
Q

what mutation in atypical endometriosis

A

PTEN and AT-rich interactive domain-containing protein 1A (ARIDA1) mutations

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11
Q

Adenomyosis
aka
define
due to

A

= Endometriosis interna
Island of endometrial gland and stroma deep in the myometrium
15 - 20% of hysterectomy specimen
Probably due to down ward growth of endometrium

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12
Q

The endometrial tissue must be separated from the basalis by at least 2–3 mm

A
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13
Q

Endometrial hyperplasia

A

Proliferation of the endometrial glands resulting in an increased gland to stroma ratio (>1 to 3:1)
Present with post menopausal bleeding
Diffuse thickening of endometrium

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14
Q

causes of endo hyperplasia

A

obesity because aromatase testestrone to estradiol
menopause
pcos
functional granulosa cell tumor
estrogen replacement therapy

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15
Q

Endometrial polyps
define
common in
present with
risk factor

A

Fingerlike masses project into the endometrial cavity
Common in perimenopause women
Presented with spotting or irregular bleeding
Tamoxifen is an important risk factor

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16
Q

Endometrial carcinoma
define
epidemology
present with
types

A

The most common and the 2nd deadly malignant tumor of FGT
Primarily a disease of postmenopausal women, the peak incidence is in 6th to 7th decades of life and is uncommon below the age of 40 years
Present as with irregular or postmenopausal bleeding and leucorrhoea
Broadly divided in to Type I and Type II

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17
Q

Type I (Endometrioid) carcinoma

A

~ 80% of cases
Associated with endometrial hyperplasia
30-80% have PTEN mutation
Associated with Lynch II syndrome (HNPCC) – breast ca + colon ca + endometrial ca

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18
Q

lynch 2 syndrome

A

breast cancer
colon cancer
endometrial cancer

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19
Q

Type II (serous) carcinoma

A

~ 15% of cases
Associated with endometrial atrophy
90% have P53 mutation
Serous carcinoma > clear cell and malignant mixed mullerian tumor
Has poor prognosis due to transtubal metastasis to peritoneal cavity
All are poorly differentiated (grade 3)

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20
Q

Leiomyoma
aka
epidemology
define
often look

A

= fibroid, myoma
The most common neoplasm of FGT
Benign smooth muscle tumor of myometrium
Often they are multiple and are estrogen sensitive
20–30% of women older than 30 yr
More common in black women

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21
Q

types based on location

A

serosal
subserosal
intramural
cervical

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22
Q

clinical intramural –……………..and submucosal - ………………………..

A

menorrhagia
metrorrhagia

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23
Q

Leiomyosarcomas

A

Malignant tumor of smooth muscle
Arises de novo
Often single
Peak incidence at 40 to 60 years of age

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24
Q

Tumors and Cysts of fallopian tube

A
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25
Q
A

Adenomatoid tumor- Benign tumor of mesothelium, which occurs subserosally on the tube or sometimes in the mesosalpinx

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26
Q

Paratubal cysts

A

The most common primary lesions of the fallopian tube. 0.1 to 2-cm translucent cysts filled with clear serous fluid

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27
Q

Ovarian pathology

A

Non neoplastic – cysts (follicular cyst, luteal cyst, chocolate cyst and PCOS)
Neoplastic – ovarian tumor

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28
Q

Follicular cysts

A

Results from failure of ovulation due to hormonal dysfunction
lined by inner granulosa cell layer and outer theca interna layer
Size 3 – 8cm

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29
Q

Corpus luteum cyst

A

Results from filing of corpus luteum by blood
lined by luteinized granulosa cell
Size 3 – 11cm

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30
Q

Poly cystic ovarian syndrome (PCOS)
charachteristic
pathogenesis

A

Characterized by hirsutism, infertility, poly cystic ovaries, oligomenorrhea and/or anovulation.
Associated with obesity, type 2 diabetes
6%-10% reproductive age women
Hyperglycemia, LH/FSH >2 and increase androgen
Etiology and pathogenesis is not completely understood

high lh
high androgen
high estrone in adipose tissue
feeback inhibition of fsh
no estrogen to maintain follicle
degeneratice follicle
cyst

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31
Q

= Ovarian tumor
epidemology
risk factors
types

A

= Ovarian tumor
The most common cause of death from FGT malignancy
Risk factors include nulligravidity, ovarian dysgenesis, family history (BRCA1 and BRCA2 mutation)
Peritoneal seeding (omental caking)
Primary or secondary

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32
Q

primary ovarian tumor types

A

epithelial
germ cell tumor
sex cord tumor

33
Q

Epithelial ovarian carcinoma

A

60 - 70 % of ovarian tumor and 90 % of malignant ovarian cancer
Most of which have cystic component

34
Q

types of epithelial cell tumor
mnemonic

A

serous tumor
mucinous
endometroid
clear cell
transitional
some men eat cervic too

35
Q

Serous tumor

A

35% of ovarian tumor and 40% of malignant ovarian tumor
Usually cystic and field by clear fluid
60% are clearly benign,15% are border line and 25% are clearly malignant.
65 % of borderline and clearly malignant are bilateral

36
Q

Mucinous tumor

A

20% of ovarian tumor and 10 % of ovarian malignant cancer
Comparing to serous it tends to be larger, unilateral and multiloculated
Cystic field by mucinous material and can be benign, borderline and malignant

37
Q

mucinous tumor associated with

A

Associated with pseudomyxoma peritonei (PMP)
jelly belly

38
Q

Endometrioid tumor

A

5% of ovarian tumor and 15%-20% of ovarian malignant cancer
15%-30% has an accompanied endometrial carcinoma of uterus
Malignant transformation of endometriosis
Histologically resemble tumor of endometrium
Borderline are uncommon

39
Q

Clear cell ovarian tumor

A

5% of ovarian tumor
Looks like clear cell adenocarcinoma of the kidney

40
Q

Transitional cell carcinoma
aka

A

= Brenner tumor
2% of ovarian tumor and 90% unilateral

40
Q

Germ cell tumor
list

A

teratoma
choriocarcinoma
endodermal sinus carcinoma
embryonal
dysgerminoma

41
Q

Teratomas
define
type

A

Composed of tissue derived from the three germ layer (endoderm, mesoderm and ectoderm )
Divided in to three mature, immature and monodermal

42
Q

Mature teratomas

A

= Benign teratoma/dermoid cyst
Majority are cystic
Solid area called Rokitansky protuberance
< 1% transform in to malignant cancer most commonly in to squamous cell carcinoma

43
Q

Immature teratomas

A

= Malignant teratoma
Very rare
Predominantly solid tumor composed of immature or embryonal tissue

44
Q

Monodermal teratoma
types

A

= Specialized teratoma
Struma ovarii: only thyroid tissue. May be functional and cause hyperthyroidism
Carcinoid tumor: may produce serotonin (5-HT) and causes carcinoid syndrome

45
Q

Dysgerminoma
epidemo
high what

A

abnormal development of germ cells which give ride to the ova

2% of ovarian cancer and ~ 50% of malignant germ cell tumor
75% occurs in 2nd and 3rd decades
Some occurs in gonadal dysgenesis
All are malignant and radiosensitive
LDH and ?PLAP may be elevated and 3-5% has elevated HCG

46
Q

Choriocarcinoma
elevated what
different from normal by

A

Gestational or non gestational (gonadal)
Non gestational is more malignant and less responsive for chemotherapy than gestational one
Metastases hematogenously
Produce HCG
Composed of cytotrophoblast and syncytiotrophoblast with no villi

46
Q

Yolk sac tumor
what is elevated
epidemology
histologic features

A

= Endodermal sinus tumor.
2nd most common malignat tumor of germ cell origin
Most commonly occurs in children
Highly aggressive and grows rapidly
Produce α- fetoprotein (AFP)
The characteristic histologic feature is glomerulus like structure called Schiller-Duval body

47
Q

Embryonal carcinoma

A

Produce HCG and α-fetoprotein.

48
Q

Sex cord stromal tumor

A

granulosacell tumor
theca cell tumor
sertoli leydig

49
Q

Granulosa cell tumor
causes
histology

A

Most produce estrogen which causes precocious puberty in children and endometrial polyp/hyperplasia/carcinoma or cystic breast change in older adult
Some produce androgen and cause virilization effect
Histologically granulosa cell arrange them self as rosette called Call-Exner bodies

50
Q

Thecoma

A

Pure thecoma is almost always is benign
Frequently in postmenopausal women.
Produce estrogen and occasionally androgen

51
Q

Fibroma

A

Fibroma- benign tumor of fibroblast
Hormonally inactive

52
Q

Meig’s syndrome;

A

Meig’s syndrome; ovarian fibroma
+ ascites + right side pleural effusion

53
Q

Sertoli - leydig cell tumor

A

Produce androgen and cause virilization
Peak incidence in 2nd and 3rd decade

54
Q

Secondary ovarian tumor
special name

A

Metastases to the ovaries
10% of ovarian tumor
Usually both ovary are involved
Primary sites include carcinomas of breast, genital tract, stomach, colon and appendix
krukenberg

55
Q

Abdominal pregnancy

A

1ᵒ initial gestational sac implantation directly in the abdominal peritoneum.
2ᵒ after a tubal abortion or rupture.
Placenta will not be removed at the time of baby delivery

56
Q

Lithopedion

A

(Greek lithos (stone) and paedion (child)), is an abdominal ectopic pregnancy in which the fetus dies but cannot be reabsorbed by the mother’s body
The dead fetus is retained in the abdominal cavity, forming a calcium shell around it

57
Q

vascular anastamose complications in monozygote twins

A

trap
ttts

58
Q

TTTS

A

Twin-to-twin transfusion syndrome (TTTS)
Unbalanced flow of blood from one twin (the donor) to its co-twin (the recipient) through one or more arteriovenous shunts
If severe, it may result in the death of one or both fetuses
polyhydramnios-oligohydramnios–syndrome—“poly-oli.”

59
Q

TRAP

A

This “used” arterial blood reaches the recipient twin through its umbilical arteries and preferentially goes to its iliac vessels. Thus, only the lower body is perfused, and disrupted growth and development of the upper body results. Failure of head growth is called acardius acephalus; a partially developed head with identifiable limbs is called acardius myelacephalus; and failure of any recognizable structure to form is acardius amorphous

60
Q

Placental Infections

A

Ascending infection - Commonest, always bacterial, Chorionamnionitis and “vasculitis” of the umbilical and fetal chorionic plate vessels. Results in PROM (vice versa) and preterm delivery.
Hematogenous (transplacental) infection- TORCH group (toxoplasmosis and others [syphilis, tuberculosis, listeriosis], rubella, cytomegalovirus, herpes simplex. Chronic villitis

61
Q

Placenta Previa

define
risk
contraindication in

A

Implantation of placenta in lower uterine segment
Present as third trimester bleeding (APH)
Risk factors include high order pregnancy, smoking, high altitude
Don’t do vaginal (PV) exam unless you exclude placenta Previa in women with antepartum hemorrhage (APH)

62
Q

Placenta accreta spectrum
define
risk factors

A

Adhesion of placenta to myometrium due to partial or complete absence of decidua
Risk factors include placenta Previa, uterine surgery and aggressive curettage
Some time it can invade even penetrate the myometrium and known as placenta increta and placenta percreta respectively.
Cause of retained placenta and PPH

63
Q

Placental Abruption

A

Separation of placenta before the birth of last fetus
Related with hypertension and trauma

64
Q

Preeclampsia

A

=Toxemia
3% - 5% of pregnant women mainly in nulliparous
Usually occurs in 3rd trimester
Characterized by hypertension after 20wk of gestation, proteinuria and/or edema

65
Q

Eclampsia

A

Eclampsia = Preeclampsia + convulsions(seizer), due to cerebral artery by thrombus and delivery is mode of treatment

66
Q

what syndrome associated with preeclampsia

A

HELLP syndrome

67
Q

HELLP syndorme

A

Severe form of preeclampsia with hemolytic anemia , elevated liver enzyme and low platelets
Delivery is the mode of treatment

68
Q

gestational trophoblastic diseases
define
include

A

a group of rare diseases in which abnormal trophoblast cells grow inside the uterus after conception
molar pregnancy, invasive mole, choriocarcinoma, ETT and PSTT

69
Q

Molar pregnancy
define
type

A

= Hydatidiform mole
Result of faulty fertilization
Classified in to complete and partial hydatidiform mole

70
Q

partial and complete mole difference

A

P57+ partial mole
P57-complete

genetic makeup
partial
1 egg with 2 sperm
complete
0 egg 2 sperm

fetal tissue
present partial
absent complete

villious edema
some in partial
most in complete

trophoblastic proliferation
focal proli. around hydropic villi in partial
diffuse in complete

risk

71
Q

Clinical presentation
of molar pregnancy

A

Passage of grapes like vesicle
Preeclampsia before 20 weeks of gestation
Hyperthyroidism
Big for date uterus

72
Q

why hyperthyroidism

A

high levels of hcg can stimulate thyroid gland
hCG-α is identical to the α-subunit of LH, FSH, and TSH.

73
Q

Invasive mole

A

Mole which invade even penetrate the uterine wall
Locally destructive and some time embolize to other site

74
Q

Invasive mole , choriocarcinoma and PSTT are collectively known as

A

GTN
neoplasia

75
Q

Choriocarcinoma

A

Malignant proliferation of cytotrophoblast and syncytiotrophoblast
50% follow molar pregnancy, 25% follow abortion and 25% follow normal pregnancy
Histologically lacks villi
The most common sites of metastasis are the lungs (50%) and vagina (30% to 40%)

76
Q

Placental site trophoblastic tumor (PSTT)
define
hormone ?
risk

A

Arises from implantation site intermediate trophoblasts
Monitored by human placental lactogen (HPL)
> 50% follow normal pregnancy
Resistance for chemotherapy and hysterectomy is the mode of treatment

77
Q

HPL induces

A

HPL induce peripheral insulin resistance

78
Q

Epithelioid trophoblastic tumor(ETT)

A

Derived from chorionic intermediate trophoblasts

Patho (33 decks)

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