Disorders of the Uterus

Question 1

Length of normal menstrual cycle?

Answer 1

21-35 days

Question 2

Phases of Normal Menstrual cycle

Answer 2

Proliferative/follicular

Ovulation

Secretory/Luteal (early, mid, late)

Menstruation

Question 3

Description of Proliferative phase

Answer 3

Small glands and stroma

Mitoses within the glands and stroma

Question 4

Description of early secretory phase

Answer 4

Vacuolation of glandular epithelium

Ovulation–>subnuclear vacuoles

Question 5

Description of mid-secretory phase

Answer 5

luminal secretions

stromal edema

Question 6

description of late secretory phase

Answer 6

spiral arteries

decidual cells in stroma

saw-tooth glandular pattern

Question 7

LOOK AT SLIDES FOR PHASE HISTOLOGY

Answer 7

LOOK AT SLIDES FOR PHASE HISTOLOGY

Question 8

Describe the endometrium during pregnancy

Answer 8

Hypersecretory with dilated glands

decidual transformation of stromal cells

infolding and vacuolation of the glandular epithelium (arias stella phenomenon)

Question 9

Cause of abnormal bleeding in post menopausal women

Answer 9

Neoplasm

Question 10

Cause for abnormal uterine bleeding in perimenopausal women

Answer 10

irregular shedding

Question 11

Causes of abnormal bleeding in reproductive age group

Answer 11

Organic DIs

DUB

Question 12

Common general causes of abnormal uterine bleeding

Answer 12

Anovulatory endometrium

Endometrial polyp

chronic endometriosis

submucosal leiomyoma

Question 13

Types of Dysfunctional Uterine Bleeding

Answer 13

Anovulatory Cycle

Inadequate Luteal Phase

Oral Contraceptives induced changes

Menopausal and Postmenopausal

Question 14

Inadequate Luteal phase dysfxn

Answer 14

inadequate corpus luteum fxn

Question 15

Oral contraceptive induced changes

Answer 15

discordant gland and stroma

Question 16

Menopausal and Postmenopausal dysfxn

Answer 16

endometrial hyperplasia, cystic changes

Question 17

pathogensis of anovulatory bleeding

Answer 17

failure of ovulation–>persistent and unopposed endometrial exposure to estrogens–>persisten proliferation of endometrium–> ischemic necrosis and bleeding

Question 18

Causes of anovulatory bleeding

Answer 18

unknown etiology (majority of causes)

Menarche and peri-menopausal stage

endocrine disorder

estrogen secreting tumors

polcystic ovary syndrome

marked obesity

severe malnutrition

chronic systemic diseases

Question 19

Clnical features of chronic endometriosis

Answer 19

Abnormal bleeding

pain

discharge

infertility

Question 20

Histology of chronic endometriosis

Answer 20

plasma cells, lymphocytes, histiocytes

Question 21

What is Adenomyosis

Answer 21

Endrometrial tissue within myometrium

Question 22

What can be visualized histologically in Adenomyosis

Answer 22

Endometrial glands within myometrium

Question 23

What is a chocolate cyst

Answer 23

Endometrial glands and hemosiderin

D/2 profund activation of the inflammatory cascase in endometriosis with high levels of PGE2, IL-1B, TNF, and IL-6

Question 24

Benign proliferative lesions of the endometrium?

Answer 24

Endometrial Polyp

Question 25

History of endometrial polyp

Answer 25

possible tamoxifen administration

Question 26

histology of endometrial polyp

Answer 26

dilated or atrophic glands

Question 27

Ulceration of endrometrial polyp?

Answer 27

uterine bleeding

Question 28

What causes endometrial hyperplasia

Answer 28

unopposed estrogen stimulation

Question 29

Endometrial hyperplasia increases risk of…?

Answer 29

Endometrioid Endometrial Carcinoma

Question 30

Simple Hyperplasia

Answer 30

Minimal Gland crowding

small cysts

Question 31

complex hyperplasia

Answer 31

crowded back to back glands

>30% tissue in glands

Question 32

Atypical complex hyperplasia

Answer 32

nuclear pleomorphism

mitoses

Question 33

Endometrioid Endrometrial Carcinoma risk factors?

Answer 33

Happens in Post menopausal women

Risk factors: Unopposed estrogen, Immunosuppression

Precursor Lesion: Endometrioid Hyperplasia and gene mutations

Good Px

Question 34

Causes of prolonged estrogen exposure?

Answer 34

• obesity
• early menarche
• late menopause
• polycystic ovary syndrome
• nulliparity
• tamoxifen administration
• diabetes
• HTN

Question 35

Non Endometrioid Endometrial Carcinoma

Answer 35

Happens in older women

Risk Factor: Estrogen Deficiency

Prognosis is poor

All non endometrioid carcinomas are graded as poorly differentiated

Question 36

Natual history of non-endometrioid endometrial CA

Answer 36

Atrophic endometrium–> endometrial intraepithelial CA–>serous CA

Question 37

Hallmark of Serous Endometrial Carcinoma

Answer 37

TP53 mutation

Question 38

Types of non endometrioid endometrial CA

Answer 38

Serous Carcinoma

Clear Cell CA

Malignant Mixed Mullerian Tumor (MMMT)

Question 39

Origin of serous CA

Answer 39

from endometrial surface epithelium

Question 40

Clear Cell carcinoma resembles…?

Answer 40

gestational endometrium

Question 41

Mixed Malignant Mullerian tumor

Answer 41

both glandular and stromal compartments are malignant

Question 42

Neoplastic Lesions of Myometrium

Answer 42

Leiomyoma

Question 43

Leiomyoma

Location?

Complications?

Answer 43

Most common gynecologic tumor

Located: submucosal, intramural, subserosal

Complcations: bleeding, spontaneous abortions, infertility

NO MALIGNANT TRANSFORMATION

Question 44

Leiomyoma description

Answer 44

Discrete, firm, well-circumscribed, and grey-white nodules

Cut surface: bulges and whorls

Question 45

Do leiomyomas have high or low mitotic activity?

Answer 45

LOW (usually, subtypes vary)

< 4 mitoses per 10 HPFs

Question 46

Leiomyosarcoma

Answer 46

Classic sarcoma

Rapid growth, hematogenous metastases, bulky and fleshy appearance, areas of necrosis

cellular and nuclear atypia, mitotic activity: > 10 HPFs

Question 47

Where does leiomyosarcoma metastasize to?

Answer 47

BRAIN

LUNG

BONES