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Repro 2 Midterm > Dobson: Vulvar, Vaginal, Cervical, Uterine, and Endometrial pathology > Flashcards

Dobson: Vulvar, Vaginal, Cervical, Uterine, and Endometrial pathology Flashcards

1
Q

What is Mayer-Rokitansky-Kuster-Hauser syndrome?

A
  • causes vagina and uterus to be underdeveloped or absent
  • no periods
  • first sign is no menstruation by 16
  • kidneys may be screwed up too
  • may have hearing loss or heart defects
  • normal 46, XX karyotype
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2
Q

What hormone drops to cause shedding of the functionalis layer?

A

-progesterone

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3
Q

in proliferative phase, what do the glands look like?

A
  • straight, tubular

- no mucus secretion or vacuolization

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4
Q

in the secretory pphase, what is it marked by?

A
  • subnuclear vaculoles

- tortuous and serated or saw toothed

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5
Q

What are the causes of abnormal uterine bleeding in prepubertal group?

A

-precocious puberty

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6
Q

Causes of AUB in adolescence?

A
  • anovulatory cycle

- coag disorders

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7
Q

causes of AUB in reproductive age?

A
  • complications of preggo
  • anatomic lesions
  • dysfunctional uterine bleeding
  • anovulatory cycle
  • ovulatory dysfunctional bleeding
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8
Q

causes of AUB in perimenopausal women?

A

-dyfunctional uterin bleeding
-anovulatory cycle
-anatomic lesions
-

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9
Q

Causes of AUB in postmenopausal women?

A
  • endometrial atrophy

- anatomic lesions

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10
Q

bolded thing as a presentation of chronic endometritis?

A

-abnormal bleeding

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11
Q

if there is plasma cells in biopsy of endometrium, what is it until proven otherwise?

A

-chronic endometritis

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12
Q

What is endometriosis?

A

-endometrial tissues outside of the uterus

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13
Q

What is adenomyosis

A

-presence of endometrial tissue withing the myometrium 2-3 mm below the basalis layer

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14
Q

most common sites of endometriosis?

A
  • ovaries!
  • uterine ligaments
  • rectovaginal septum
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15
Q

what is the enzyme that makes a lot of estrogen and makes stromal cells in ectopic endometrial tissue go nuts?

A

-aromatase

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16
Q

When extensive, what can endometriosis cause?

A

-fibrous adhesions!

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17
Q

What color are the nodules in endometriosis?

A
  • brown material

- hemosiderin… breakdown of blood

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18
Q

can endometrial polyps be malignant?

A

hell yes!

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19
Q

what will endometrial hyperplasia and malignancy lead to?

A

-endometrial carcinoma

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20
Q

What is the first gene thing to be weird with endometrial hyperplasia?

A

-PTEN

21
Q

What can give us increased estrogen?

A
  • anovulation
  • obesity
  • prolonged administration of estrogenic substances
22
Q

What is Cowden syndrome?

A

-germline PREN mutation and high incidence of endometrial and breast cancer

23
Q

What does the loss of PTEN lead to?

A

-overactivation of the PI3K/AKT pathway

24
Q

What is the cardinal feature of Non atypical hyperplasia?

A
  • increased gland to stroma ratio

- rarely progresses to cancer

25
Q

Atypical hyperplasia in uterus… what does it look like?

A
  • complex patterns of proliferating glands displaying nuclear atypia
  • glands back to back and branching
  • overlap with well differentiated cancer
26
Q

What is the treatment for the hyperplasia?

A
  • if reproductive age, place on progesterone and follow up

- otherwise hysterectomy

27
Q

What are the two malignant endometrial tumors?

A
  • Carcinoma of the endometrium

- malignant mixed mullerian tumors

28
Q

What is the most common invasive cancer of the female genital tract?

A

-Endometrial carcinoma

29
Q

What age is EC at?

A
  • -55-65

- uncommon under 40

30
Q

What is the early sign for EC

A

-bleeding

31
Q

Type 1 endometrial carcinoma

A
  • 55-65
  • unopposed estrogen, obesity, htn, diabetes
  • endometrioid morphology
  • hyperplasia precursor
  • PTEN mutation at first, ends with TP53
  • indolent behavior
  • spreads via lymphatics
32
Q

Type 2 endometrial carcinoma

A
  • 65-75 yo
  • endometrial Atrophy, thin physique
  • serous, clear cell, mixed mullerian tumor morphology
  • seour endometrial intraepithelial carcinoma precursor
  • TP53 is first gene mutated
  • AGGRESSIVE
  • intraperitoneal and lymphatic spread
33
Q

What are the risk factors for endometrial carcinoma?

A
  • obesity
  • diabetes
  • htn
  • infertility
  • unopposed estrogen
  • high estrogen seems to be the common demoninator**
34
Q

which type of endometrial cancer was more common in african americans?

A
  • type 2
  • that serous kind
  • arises in endometrial atrophy
35
Q

What staining do we use for type 2 endometrial carcinoma?

A

-p53!

36
Q

How is the staging done form both type 1 and 2 endometrial adenocarcinoma and malignant mixed mullerian tumors?

A
  • 1: carcinoma is confined to the corpus uteri itself
  • 2: involves the corpus and the cervix
  • 3: extends outside the uterus but not outside the true pelvis
  • 4: extends outside the true pelvis or involves the mucosa of the bladder or the rectum
37
Q

What are malignant mixed mullerian tumors (MMMT’s)?

A
  • carcinosarcoma= malignant glandular and mesenchymal elements
  • mutations similar to endometrial carcinomas in the epithelial component (TP53, PTEN, PIK3CA)
38
Q

how does MMMT’s present?

A

-postmenopausal with bleeding

39
Q

Are stromal tumors rare or common in the uterus?

A

-rare

40
Q

Adenosarcoma

A

-benign glands and malignant appearing stroma

41
Q

Leiomyoma basic facts

A
  • Leiomyoma: most common tumor in women
  • HMGIC and HMGIY genes
  • MED12 gene encodes component of mediator which allows cells to divide in an uncontrolled way
42
Q

What are the gross features of leiomyoma

A
  • sharply circumscribed
  • single or multiple
  • small or large
  • firm grey-white masses
  • subserosal, myometrial, submucosal
  • rarely uterine ligaments, LUS, or cervix
43
Q

Microscopic features of leiomyoma

A
  • bundles of smooth muscle cells (whorled)
  • uniform in size and shape, oval nucleus, long bipolar processes
  • RARE mitosis
  • can degenerate
44
Q

Clinical presentation of leiomyomas?

A
  • abnormal bleeding
  • urinary frequency due to compression of bladder
  • impaired fertility
  • problems with preggo
  • malignant transformation is very rare
45
Q

Leiomyosarcoma (be able to tell this apart from leiomyoma)

A
  • uncommon (peak age 40-60)
  • arise from a stromal precursor cell
  • complex karyotypes that include deletions
  • recurrence common
  • MORE THAN HALF METASTASIZE
46
Q

Gross features of leiomyosarcoma?

A
  • 2 patterns
  • Bulky fleshy invasive masses
  • Polypoid intraluminal masses
47
Q

Microscopic features of leiomyosarcoma

A
  • Nuclear atypia
  • mitotic index 10 or >10= MALIGNANT
  • zonal necrosis
48
Q

What does STUMP stand for?

A

-smooth muscle tumor of uncertain malignant potential

49
Q

Where does a metastatic leiomyosarcoma spread most often?

A
  • lung
  • peritoneum
  • bones
  • liver
  • muscles

Repro 2 Midterm (9 decks)

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