AUB PP Flashcards
avg age for menarche
Menses cycle/duration can be measured objectively w
Volume measurement is
Objective sign for volume loss indicated by
12
mestrual calendar
subjective
hb/hct
Polyp AUB more common in
Clincal presentation-
can have __ on pap smear
can be ___ on imaging/Hysterectomy
may see ___ on exam
Dx
TX
___ can prevent recurrence
repro age/ postmen women
light intermenstrual bleeding, heavy possible
endometrial cells
incidental finding
prolapsing through cervix
biopsy/D&C
D&C/polypectomy
levonorgestrel IUD
Adenomysosis has endometrial glands/stroma outside
More likely in
hallmark sx
Uterus is often ___ mildly
Rarely exceeds size of ___
Dx by ___ from specimen
Definitive tx
for females who desire fertility preservation, __ may be helpful
uterus
repro yrs
heavy menstrual bleeding, dysmenorhea
globally enlarged
12 wk gestation
patho from hysterectomy
hysterectomy
hormonal meds
Leiomyomas are ___
may have ___ and ___
Higher risk w
Lower risk w
Sx include
can cause ___ w submucosal/intramural due to ___
Dx suspect w ___ on exam
__ can help pinpoint
Ultimate Dx ___ w ___ confirm
incredibly common
large fibroids, anemia
early menarche, hormonal meds, FH
parity, smoking
Heavy menses, anemia, pelvic pain/pressure
infertility, cavity distortion
enlarged uterus
MRI/US
direct visualization and histologic confirmatino
Leiomyomas hormal meds ___
Most effect med therapy is ____, but ___ on discontinuation common
___ is removal of fibroid tumor
Can be done ___ for submucosal or ____
If intracavitary breach during procedure, can inc risk of
Definitive tx
Less invasive option
Can develop ___ leiomyomas, ending in ___
Leiomyomatosis benign but ___
can spread to __ or to __
regulate sx
GnRH ag, recur
myomectomy
hysteroscopically, abdominally
uterine rupture
hysterectomy
uterine artery embolization
benign metastazing leiomyomas, organs/lungs
disseminated nodules
peritoneal cavity, vasc/heart
Leiomyosarcoma
Difficult to distinguis from
On pathology, cells are ___ with mitotic index >, showing areas of ___
Spread is ____ w possible
Tx is ___
Prognosis
benign leiomyomas
nuclear atypia, 10, zonal necrosis
hematologic, mets
surgery and/or chemo
poor
Gyne cancers that do not typically present w bleeding
Endometrial cancer typically occurs in women > ___, usually not below ____
most common in ___ women, but ___ women more likely to die
Endometrial adenocarcinoma type 2 more likely to occur in ___ women w no signs of
often tx aggressively w
ovarian, fallopian tube, peritoneal carcinomas
60, 30
caucasian, AA
thin women, hyperestrogenism
chemo
Type 1 age
Clinical pic
Morphology
Precursor lesion
Molecular genetics
Behavior
Spreads via
55-65yr
hyperestrogen, DM, HTN, obese
endometrioid
hyperplasia
PTEN/PIK3CA/KRAS/Beta catenin/P53
indolent
lymphatics
Type 2 age
Clinical pic
Morph
Precursor
Genes
Behavior
Spread
65-75
atrophy, thin
serous, clear cell, mixed mullerian
intraepithelial carc
p53 (MC), PIK3CA
aggressive
intraep, lmyph
major risk for endometrial cancer
___ is protective
common genes mutated in HNPCC
causes
other ca possible
obesity >50 lbs
progesterone
MLH1, MSH2, MSH6, PMS2
microsatelite instab
colon, ovary, renal, brain, upper GI
Type 1 endometrial cancer hyperestrogenism usually from
Can come from ___
inc adipose correlates to __
___ causes proliferation of ___
prolonged ___ exposure leads to endometrial carcinoma
Precursor to Endo ca Type 1
without atypia
simple- gland is ___, w occasional __ surrounded by
complex has proliferation of ___, crowded ___ w little __
W atypia, cells are __ and show loss of __ w __ nuclear/cytoplasmic ratio
nuclei appear ____, with course ___ and prominent ___
HRT, or granulosa cell tumor
adipose tissue
estrone
estrone
endometrial cells
estrone
cystically dilated, outpouchings, stroma
highly complex. glands, stroma
stratified, polarity, inc
enlarged, irregular, chromatin clumping, nucleoli
Endometrial cancer typical sx
AUB can present in ___ pts
w obesity, pts can be ___
P
P esp in elderly w stenotic __ and hematometra
also Asx w ___ or incidental __
DX w
Vagial ultrasound indicates no cancer if
Postmen bleeding
perimenopausal, anovulatory
younger
Purulent discharge
Pain, os
abnormal pap, hysterectomy
endometrial biopsy, D/C
ET<5mm
Tx endometrial cancer
surgery w H___, Bilateral ___, pelvic/paraaortic ____
possible
Radiation for women w
Hormonal therapy w (for women who want to preserve fertility)
hysterectomy, salpingo-oophorectomy, washings/LNectomy
adjuvant tx
contraindication
progestin
Adenosarcoma is ___ w ___
Tend to grow __, and are ___
Carcinosarcoms known as ___ (MMMT)
contain both __ and __ components
sarcoma can be native __ or
__ component dominates
benign glands, malignant stroma
locally, hormone responsive
malig mixed mullerian tumors
carcinoma/sarcoma
uterine elements, non native
carcinoma
Majority of women w cervical cancer have not had __ in 5yrs
women usually >
Cervical cancer other rf
NOT a rf
RF for HPV
pap test
65
early first sex contact, STDs, IC, low SES
FH
AA/hispanic, inc alcohol, mult partners & partners w multiple partners
HPV viral DNA ___ and __ thoght to be crucial in stimulatng __
E6 inhibits __ which is involved in
E7 binds____
Once bound, Rb releases ___ to cause cellular prolif
Together, this inhibits ___ and __ cell
E6 and E7, cell proliferation
p53
Rb
E2F TF
regulatory mech, stims proliferation
Cervical dysplasia low grade lesions can
CIN 2/3 tx w to avoid cancer
can take __ for tissue to be malignant
Early stage sx
Late stage sx
sx attributed to
regress
excision
10yrs
vaginal bleeding, post coital spotting, foul smelling yellow discharge
back pain, lethargy, NV
RF from ureteral obs
Dx cervical cancer
Early cancer can be dx by
staging is ___, utilizes __, __, __, ___
majority of cases occur in
Cell types
S
can be L or L
A
A
S result of
biopsy after visualization
excision to treat dysplasia
clinical, CXR, cytoscopy, proctoscopy, IVP
squamous
large cell keratinizing/non keratinizing
adenocarcinoma
adenosquamous
small cell, neuroendocrine tumor
Cervical ca tx
stage 1a1
Stage 1a2-1b1
stage 1b2-3b
Stage 4
primary prevention
secondary prevention
cervical cone/hysterectomy
hysterectomy, removing parametrial tissue
chemoradio
radio w adjuvant chemo
HPV vaccine
Pap/HPV
Women w coagulation do may present w
many women w __ have bleeding diathesis
potentials
most present at/near
suspect w __ or ___
heavy menstrual bleeding
menorrhagia
VW dz, ITP, platelet dysfxn
menarche
hx of easy bleeding, FH
potential causes of ovulatory dysfxn
Endo/myometrium relatively ___ bc __ forms barrier to ascending infection
Acute endometritis typically due to ___ after ___
Chronic endometritis occurs in pt w
P
I esp w
T via
sx
biopsy shows
Excess stress, wl, hyperprolactinemia/thyroid dz, PCOS
bacterial infection, delivery/miscarriage
chronic PID
postpartum/abortion w retained placenta
IUD, actinomyces
Tb, miliary spread, Tb salpingitis
abnormal bleeding, pain, discharge, infertility
stromal plasma cells
Endometrial atrophy often visible on
anticoags seen w
can cause AUB in women by ___
consider in pt on
may need
hysteroscopy
Arrhythmias, DVT, thrombophilias, stroke, CAD
making bleeding worse
Coumadib, Lovenox, Plavix
endo ablation, hysterectomy
