ASF - Uterus (Richardson)

Question 1

In order to be diagnosed with endometriosis, what 3 histologic diagnostic criteria must be met?

Answer 1

1. Endometrial glands
2. Endometrial stroma
3. Hemosiderin pigment

Question 2

What are some ways that the endometrial cells spread to places outside of the uterus?

Answer 2

Through the fallopian tubes, lymph, and vasculature

Question 3

What is a leiomyosarcoma?

Answer 3

Malignant smooth muscle tumor of the myometrium

Question 4

What are 3 histological characteristics of the endometrium of a patient with chronic endometritis?

Answer 4

1. Atrophy of stroma (with edema)
2. Presence of multiple types of endometrial glands
3. Intense lymphocytic/plasma cell invasion

If acute, plasma cells would not be present in the endometrium

Question 5

How does serous endometrial carcinoma typically metastasize?

Answer 5

It travels up the fallopian tubes and out into the peritoneum

Question 6

Which patient populations are at highest risk for getting a leiomyoma?

Answer 6

African American Women

Question 7

What is menometorrhagia?

Answer 7

Irregular, prolonged bleeding during menstruation

Question 8

Which days of the menstrual cycle occur during the proliferative phase? What hormone is responsible for this phase?

Answer 8

Days 6-13

Estrogen

Question 9

What is a leiomyoma?

Answer 9

Smooth muscle tumor

Question 10

What are some predisposing factors for patients that will lead to endometrial hyperplasia?

Answer 10

1. PCOS
2. Obesity - increased sex hormone production
3. Diabetes
4. Estrogen replacement therapy

Question 11

When leiomyosarcoma recurs, where does it commonly metastasize to?

Answer 11

Lungs

Question 12

Which gene(s) are inactive in patients with endometrioid carcinoma?

Answer 12

PTEN and DNA-repair genes

Question 13

Assuming that your patient has endometriosis, what treatment options does she have?

Answer 13

1. Oral contraceptives
2. Estrogen inhibitors
3. Surfical removal

Question 14

What is the primary cause of disordered uterine bleeding?

Answer 14

High estrogen levels with low progesterone levels

Causes prolfierative phase of endometrium, but cannot undergo secretory phase. Excess endometrial stroma and glands get degraded, forming endometrial crumbles and bleeding (anovulatory bleeding)

Question 15

What type of epithelial cells make up the endometrial glands in the proliferative phase?

Answer 15

Pseudostratified columnar

Question 16

What is the most site of implantation of ectopic endometrial cells in patients with endometriosis?

Answer 16

Ovaries

Question 17

Which type of uterine carcinoma is most commonly associated with peri-menopausal women?

Answer 17

Endometroid carcinoma

Caused by excess estrogen

Question 18

What is the driving factor that causes hyperplasia of the endometrium?

Answer 18

Estrogen

Question 19

What is the clinical term for painful menstruation?

Answer 19

Dysmenorrhea

Question 20

What are some common predisposing factors that contribute to disordered uterine bleeding?

Answer 20

• Obesity
• Hypopituitarism
• Oral contraceptives
• Stress
• Excessive physical activity

Question 21

A 25-year-old female presents to her general practitioner complaining of painful and heavy periods, dyspareunia (painful intercourse), and pain with urination. She says that the pain during her periods have never been this bad. Ultrasound of the uterus and pelvic exam all appear normal. What is one possible condition this patient could be suffering from?

Answer 21

Endometriosis

Heavy, painful periods, pain with urination and intercourse, and a seemingly normal physical exam tend to indicate endometriosis.

Question 22

A 42-year-old woman visits her gynecologist complaining of abdominal pain, fever, and some vaginal bleeding. She states that she has had this problem for almost a year now, and figures that she should check it out. Urine cultures and vaginal swab tested positive for Chlamydia, and you see some mild reddness of the ectocervix during the pelvic exam. If you were to biopsy a piece of this patient’s uterus, what specific cell type would you find that should not be there?

Answer 22

Plasma Cells

The patient has intermittent abdominal pain, fever, vaginal bleeding, and an active Chlamydia infection. All of these point to chronic endometritis. This can also be seen in patients with IUDs or after giving birth.

Plasma cells in the stroma indicate that this has been going on for a while.

Question 23

A 32-year-old female visits your clinic complaining of irregular “periods”, pelvic pain, and weight loss of 20 pounds in a month without trying. You examine the vagina and cervix and see some mild discharge, but everything appears normal. When asked about her menstrual history, she tells you that it happens at random, and does not follow the typical pattern. Based on these symptoms, how would you treat this patient?

Answer 23

Tamoxifen

This patient has endometrial hyperplasia, a condition in which excess estrogen causes hyperplasia of the endometrial layer of the uterus. Tamoxifen blocks estrogen’s effects.

The “periods” are not actual menstruation, but are anovulatory bleeding between regular menses caused by death of excess endometrial stroma and glands.

Question 24

Why are patients with polycystic ovarian syndrome (PCOS) more at risk of developing endometrial hyperplasia?

Answer 24

PCOS causes an excess production of estrogen. Estrogen is the driving factor for endometrial hyperplasia.

Question 25

What type of epithelial cells make up the endometrial glands in a uterus in the secretory phase?

Answer 25

Simple cuboidal

Question 26

True or False: Ectopic endometrial tissue (from endometriosis) is responsive to hormones, especially estrogen.

Answer 26

True

This causes ectopic endometrial cells to follow normal menstrual cycle –> bleeding, mucus secretion, etc.

Question 27

How does endometrioid cancer typically spread?

Answer 27

Through lymphatics

Question 28

A 67-year-old female has an apointment with an oncologist after her gynecolegist palpated a uterine mass at her last visit. During the ultrasound, a small, dense mass is present in the myometrium. Biopsy of this structure showed many smooth muscle cells. When discussing the results with your patient, you tell her that more than likely, this tumor has shrunken over time. Why does this occur?

Answer 28

Menopause –> lack of estrogen –> shrinks the tumor

This patient has a leiomyoma, a smooth muscle tumor, of the myometrium. This type of tumor is estrogen dependent. When menopause occurs, estrogen decreases, which shrinks the tumor.

Question 29

What is menorrhagia?

Answer 29

Prolonged or profuse bleeding during menses.

Question 30

What are the 3 diagnostic criteria for leiomyosarcoma?

Answer 30

• Tumor necrosis
• Cytologic atypia
• Increased mitotic activity (> 10 mitoses)

Question 31

What is the normal stroma to gland ratio of the endometrium?

Answer 31

2:1

Differences in this ratio can indicate cancer or inflammatory processes

Question 32

What is endometriosis?

Answer 32

Abnormal growth of endometrial tissue outside of the endometrium

Question 33

A 26-year-old female who is 2 weeks post-partum comes to her gynecologist conplaining of abdominal pain and vaginal bleeding for the past few days. Her temperature is 99F. On inspection of the vagina, you notice no abnormalities of the cervix, but do see some bleeding from the cervical os. What is the most likely cause of this condition?

Answer 33

Remnants of products of conception (placenta, membranes, etc.)

This patient has acute endometritis, inflammation of the endometrium that caused by remnants of pregnancy that leads to abdominal pain, fever, and vaginal bleeding. Acute because it has recently started.

Question 34

Which gene(s) are inactive in patients with serous endometrial carcinoma?

Answer 34

p53 and TP53 genes

Question 35

A 35-year-old G3P3 female presents to the gynecologist complaining about heavy periods that last much longer than usual and dyspareunia (painful intercourse). Physical exam revealed no abnormalities. During an ultrasound, you notice that the patient’s myometrium is much thicker than it should be. What is making the myometrium thicker than normal?

Answer 35

Growth of endometrial tissue into the myometrial layer

This patient has adenosis, a condition typical in women who have given birth (usually age 30). Endometrial tissue invades the endomyometrial junction and enters the myometrium. On histologic section, the myometrium would have endometrial glands and stroma between layers of smooth muscle.

Question 36

What is a characteristic finding on a histological section of endometrium in a patient with Actinomyces endometritis?

Answer 36

Sulfur Granules

Sulfur granules are structures that contain progeny bacteria so that more of the host organism can be infected.

Question 37

What is a common cause of Actinomyces endometritis?

Answer 37

IUD placement

IUDs facilitate the growth of Actinomyces bacteria, which colonize the area and cause abdominal pain and vaginal secretions/bleeding