Disorders of the Uterus Flashcards
what are the Disorders of Uterus and endometrium?
- Adenomyosis*
- Endometriosis*
- Endometrial hyperplasia*
- Endometrial carcinoma*
- Leiomyoma*
- Leiomyosarcoma*
what is adenomyosis?
what are the clinical findings here?
presence of endometrial glands and stroma within the myometrium**.
- Menorrhagia, dysmenorrhea and Pelvic pain
how do you diagnose adenomyosis?
myometrial biopsy
what is endometriosis?
what will patients note?
- Presence of benign ,functional endometrial glands and stroma OUTSIDE** of the uterus
- excess bleeding because cells outside of uterus will bleed as well in menses
what are the areas most involved in endometriosis?
where does it spread?
most common ovaries
rectal pouch, fallopian tubes, intestines
to ectopic sites (metaplasia of multipotential celomic peritoneum)
what are the gross findings in endometriosis?
- red brown serosal nodules
- fibrosis in ectopic sites
-
powder burns (surface of affected area is scarred and becomes gross brown discoloration)
- scarring can cause intestinal obstruction
- ovaries will have cysts due to repeated hemorrhages
- look for chocolate cysts (cysts have chocolate looking material)
how do you diagnose endometriosis?
what are the clinical findings of endometriosis?
laproscopy
- Dysmenorrhea
- implants are on uterosacral ligament
- Painful stooling during menses
- implants on rectal pouch
- Intestinal obstruction and bleeding during menses
- implants on serosal surface of intestine
- Enlargement of ovaries (chocolate cysts)
- Infertility and ectopic pregnancy
- implants are on fallopian tube
what is endometrial hyperplasia?
what causes endometrial hyperplasia?
what are the risk factors for endometrial hyperplasia?
abnormal proliferation of endometrial glands.
excess and unopposed estrogenic stimulation.
- taking estrogen with w/o progesterone
- obesity
- polycystic ovary syndrome (you have a lot of estrogen)
- estrogen-producing tumor (granulosa cell tumor)
what are the 3 classifications of endometrial hyperplasia?
- simple
- complex
- atypical
what are the characteristics for simple endometrial hyperplasia?
- Increased number of cystically dialted glands
- No gladular crowding
- No cytologic atypia
what are the characteristics for complex endometrial hyperplasia?
- Increased number of dilated glands
- Glandular crowding
- No cytologic atypia
what are the characteristics for atypical endometrial hyperplasia?
what risk can atypical endometrial hyperplasia present?
- Glandular crowding and dysplastic epithelium
- Increased risk for endometrial cancer
what are clinical findings in endometrial hyperplasia?
there is a risk for endometrial hyperplasia to progress to what?
- Abnormal uterine bleeding
- Menorrhagia or irregular menses
- Increased risk of progression to endometrial adenocarcinoma
there is Increased risk of progression to endometrial adenocarcinoma, but which type of endometrial hyperplasia has the most probable progression and which has the least?
- Least with simple
- Max with atypical.
endometrial hyperplasia affects most commonly what part of the population?
what is the most common clinical presentation?
what risk factor can increase the chance of endometrial carcinoma?
post-menopausal women
post-menopausal vaginal bleeding
prolonged estrogen stimulation
what are the different endometrial cancers?
which is the most common?
- adenocarcinoma
- adenosquamous carcinoma
- papillary adenocarcinoma
adenocarcinoma, adenosquamous carcinoma
what is an adenocarcinoma?
what is a adenosquamous carcinoma?
what is a papillary adenocarcinoma?
tumor that contains benign squamous tissue along with malignant glands
tumor that contains malignant squamous cancer along with malignant cells
Highly aggressive cancer
where does endometrial cancer spread?
where does it spread most commonly?
spreads into the cervix and uterine wall
most common site of spread are lungs
how do you treat endometrial cancer?
hysterectomy and radiation
what is a leiomyoma?
what is its other name?
its the most common tumor of what?
a benign tumor of smooth muscle cells.
myoma or fibroid
of the female genital tract
leiomyomas are sensitive to what?
and what will that cause?
estrogen
Estrogen promotes:
- its growth
- Increase in size during pregnancy.
- Decrease in size following menopause
how does a leiomyoma look grossly?
what are the liomyoma types?
firm, pale-gray, with no encapsulation
(looks like a potato)
- intramural (within myometrium)
- subserosal (below the serosa)
- submucosal (below the mucosa of uterus)
how does a leiomyoma look under the microscope?
interlascing fascicles of uniform spindle cells
Leiomyomas commonly undergo what in dead or dying tissue?
dystrophic calcification and do not transform into leiomyosarcomas
what are the clinical findings in a leiomyoma of the uterus? (fibroids)
usually asymptomatic but can manifest with:
- menorrhagia
- If large:
- intestinal bladder problems
- obstructive deliver
what is a leiomyosarcoma?
is it caused by malignant transformation of leiomyoma?
a malignant tumor of smooth muscle cells of the uterus that arises de novo.
never
leiomyosarcomas will show what features?
gross: poor, features of invasion
histo: pleomorphism and abnormal mitosis
mestastasis: yes
describe in a leiomyoma these: gross, histo, metastasis
gross: well circumscribed
histo: uniform size and uniform nuclei
metastasis: no
