Disorders of the Uterus Flashcards
Length of normal menstrual cycle?
21-35 days
Phases of Normal Menstrual cycle
Proliferative/follicular
Ovulation
Secretory/Luteal (early, mid, late)
Menstruation
Description of Proliferative phase
Small glands and stroma
Mitoses within the glands and stroma
Description of early secretory phase
Vacuolation of glandular epithelium
Ovulation–>subnuclear vacuoles
Description of mid-secretory phase
luminal secretions
stromal edema
description of late secretory phase
spiral arteries
decidual cells in stroma
saw-tooth glandular pattern
LOOK AT SLIDES FOR PHASE HISTOLOGY
LOOK AT SLIDES FOR PHASE HISTOLOGY
Describe the endometrium during pregnancy
Hypersecretory with dilated glands
decidual transformation of stromal cells
infolding and vacuolation of the glandular epithelium (arias stella phenomenon)
Cause of abnormal bleeding in post menopausal women
Neoplasm
Cause for abnormal uterine bleeding in perimenopausal women
irregular shedding
Causes of abnormal bleeding in reproductive age group
Organic DIs
DUB
Common general causes of abnormal uterine bleeding
Anovulatory endometrium
Endometrial polyp
chronic endometriosis
submucosal leiomyoma
Types of Dysfunctional Uterine Bleeding
Anovulatory Cycle
Inadequate Luteal Phase
Oral Contraceptives induced changes
Menopausal and Postmenopausal
Inadequate Luteal phase dysfxn
inadequate corpus luteum fxn
Oral contraceptive induced changes
discordant gland and stroma
Menopausal and Postmenopausal dysfxn
endometrial hyperplasia, cystic changes
pathogensis of anovulatory bleeding
failure of ovulation–>persistent and unopposed endometrial exposure to estrogens–>persisten proliferation of endometrium–> ischemic necrosis and bleeding
Causes of anovulatory bleeding
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
Clnical features of chronic endometriosis
Abnormal bleeding
pain
discharge
infertility
Histology of chronic endometriosis
plasma cells, lymphocytes, histiocytes
What is Adenomyosis
Endrometrial tissue within myometrium
What can be visualized histologically in Adenomyosis
Endometrial glands within myometrium
What is a chocolate cyst
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
Benign proliferative lesions of the endometrium?
Endometrial Polyp
History of endometrial polyp
possible tamoxifen administration
histology of endometrial polyp
dilated or atrophic glands
Ulceration of endrometrial polyp?
uterine bleeding
What causes endometrial hyperplasia
unopposed estrogen stimulation
Endometrial hyperplasia increases risk of…?
Endometrioid Endometrial Carcinoma
Simple Hyperplasia
Minimal Gland crowding
small cysts
complex hyperplasia
crowded back to back glands
>30% tissue in glands
Atypical complex hyperplasia
nuclear pleomorphism
mitoses
Endometrioid Endrometrial Carcinoma risk factors?
Happens in Post menopausal women
Risk factors: Unopposed estrogen, Immunosuppression
Precursor Lesion: Endometrioid Hyperplasia and gene mutations
Good Px
Causes of prolonged estrogen exposure?
- obesity
- early menarche
- late menopause
- polycystic ovary syndrome
- nulliparity
- tamoxifen administration
- diabetes
- HTN
Non Endometrioid Endometrial Carcinoma
Happens in older women
Risk Factor: Estrogen Deficiency
Prognosis is poor
All non endometrioid carcinomas are graded as poorly differentiated
Natual history of non-endometrioid endometrial CA
Atrophic endometrium–> endometrial intraepithelial CA–>serous CA
Hallmark of Serous Endometrial Carcinoma
TP53 mutation
Types of non endometrioid endometrial CA
Serous Carcinoma
Clear Cell CA
Malignant Mixed Mullerian Tumor (MMMT)
Origin of serous CA
from endometrial surface epithelium
Clear Cell carcinoma resembles…?
gestational endometrium
Mixed Malignant Mullerian tumor
both glandular and stromal compartments are malignant
Neoplastic Lesions of Myometrium
Leiomyoma
Leiomyoma
Location?
Complications?
Most common gynecologic tumor
Located: submucosal, intramural, subserosal
Complcations: bleeding, spontaneous abortions, infertility
NO MALIGNANT TRANSFORMATION
Leiomyoma description
Discrete, firm, well-circumscribed, and grey-white nodules
Cut surface: bulges and whorls
Do leiomyomas have high or low mitotic activity?
LOW (usually, subtypes vary)
< 4 mitoses per 10 HPFs
Leiomyosarcoma
Classic sarcoma
Rapid growth, hematogenous metastases, bulky and fleshy appearance, areas of necrosis
cellular and nuclear atypia, mitotic activity: > 10 HPFs
Where does leiomyosarcoma metastasize to?
BRAIN
LUNG
BONES
