Endometrial Dx Flashcards
What is acute endometritis
Presence of polymorphonuclear leukocytes in endometrium
Main causes of acute endometritis
Ascending infections from cervix caused by abortion, delivery, or medical instrumentation
What procedure helps with diagnosis and cure of acute endometritis
Curettage by removing necrotic tissues
What is chronic Endometritis
Rare condition following complicate acute Endometritis
What do you see in the stroma of Chronic a Endometritis
Infiltrated stroma by plasma cells
Chronic Endometritis is associated with
Intrauterine contraceptive devices
Pelvic inflammatory disease
Product retention of conception after abortion or delivery
Main clinical manifestation of chronic endometritis
Bleeding
pelvic pain or both
Is Chronic Endometritis self-limiting or not
Self-lim
What is tuberculosis Endometritis
Endometritis due to tuberculosis
What are the main characteristics of tuberculous Endometritis
Extension from fallopian tubes
amenorrhea
Caseated necrosis
granulomatous inflammation with langhans giant cells
What is pyometra
Pus in the endometrial cavity
What gross anatomy defects are associated with pyometra
Fistulous Tracts between bowel and uterine cavity
bulky or perforating malignancies
cervical stenosis
What are the two forms of endometrial hyperplasia
Simple
complex
What are the two forms of complex endometrial hyperplasia
Atypia
Without atypia
What is complex hyperplasia
High Glandular crowding
increased gland to stromal ratio
What are atypical glands in complex hyperplasia
increased mitotic figures
dysplastic cells line glands
Between typic and atypic complex hyperplasia k which is considered a premalignant condition
Atypic
Two types of endometrial carcinoma
Endometrioid cancers
non endometrioid types
What are Endometrioid cancer
 Associated with endometrial intraepithelial neoplasia Precursors
Slow clinical course
prior estrogen exposure
Non Endometrioid types characteristics
No warning
Seen in older woman
higher fatality rates
3/4 of women with endometrial cancer or in which phase of their life
Postmenopausal
Median age of diagnosis of endometrial cancer
63 years old
Major form of endometrial cancer
Endometrioid adenocarcinoma
What is the main associated factor in endometrioid Adenocarcinoma
Prolonged estrogenic stimulation
Defect in the PTEN tumor suppressor pathway
Common risk factors of endometrioid adenocarcinoma
Obesity diabetes nulliparity early Menarche Late menopause All have in common hyperestrinism
Can woman with ovarian agenesis develop endometrial cancer
No unless treated with exogenous estrogens
What factor is cooperated with the fact that there is high frequency of endometrial cancer in women with Œstrogen secreting granulosa cell tumors
Body weight - 10x more if above 23kg overweight
Why is there a reduced risk of endometrial cancer with cigarette smoking
interference with hepatic conversion of estrone to active metabolites estriol
Which drug used for treatment of breast cancer increases risk of endometrial cancer because of synthesis of anti-estrogen which also has agonist activity
Tamoxifen
Most common histologic variant in endometrioid carcinoma
60% have glandular cells and are endometrioid adénocarcinoma
What are the three grades of endometrioid endometrial carcinoma based on
The ratio of glandular to solid elements solid elements signifying poorer differentiation
Grade 1 endometrioid ca Characteristics
Well differentiated cells
mostly neoplastic glands
minimal solid areas - less than 5%
Grade 2 Endometrioid carcinoma characteristics
Moderately differentiated cells
More than 50% glandular elements
Less than 50% solid tumor
Grade 3 and me triode carcinoma characteristics
Poorly differentiated cells
large areas of solid tumor more than 50%
Characteristics of non-endometrioid ca
Unrelated to estrogen exposure
women in their 60s and 70s
Adjacent endometrium usually atrophic - estrogen deficiency
p53 gene mutations
sometimes can be serous Endometrial intraepithelial carcinoma
What is the most common extra colony cancer in women Other than non-polyposis colon cancer syndrome
Non endometrioid cancer
Can you see areas of squamous metaplasia in well differentiated adenocarcinoma of endometrium
Yes
Gross morphology of endometrial ca
Diffuse or focal
May extend to myometrium cervix and vagina
Extend to parametrium and pelvic lymphatics
Pattern of growth of endometrial carcinoma
Exophytic Growth
May involve multiple areas
What are characteristics of a large tumors of endometrial carcinoma
Hemorrhagic
Necrotic
What are endometrial sarcomas
Where tumors arising from stem cells with ability to differentiate into homologous and heterologous tissues
Two types of endometrial sarcomas
Mixed homologous carcinosarcomas
Mixed mesodermal sarcomas
What are trophoblatic disease of endometrium
Tumor is derived from chorionic tissue or germinal cells
How do you call a trophoblastic disease coming from placenta
Gestational trophoblastic disease
How do you call the disease coming from the gonads
None gestational trophoblastic disease
Three forms of gestational trophoblastic disease
Hydatidiform mole
invasive mole
choriocarcinoma
high level of this hormone can cause multicystic ovaries
Hcg
Clinical features of hydatidiform moek
Bleeding Abortion of mole Excess vomiting in early pregnancy Doughy consistency uterus No fetal in complete mole Hypertension in 2nd trimester Bilateral enlarged cystic ovaries
2 forms of hydatidiform mole
Complete mole
Partial mole
Characteristics complete mole
No fetus
No fetal component
46XX from father empty ovum fertilized by sperm
Tolerance of women to husband tissues
Partial mole characteristics
Malformed fetus Partial maternal Partial paternal Placenta affected 69xxx or xxy 2 sperms fertilize one ovum
Invasive mole characteristics
Myometrium penetration
Blood vessels and lungs by hydatidiform mole
What is choriocarcinoma
Malignant tumor of trophoblast
Hormone secreted abundantly in choriocarcinoma
HCG
Characteristics of choriocarcinoma
Pleomorphic cytotrophoblast Syncytiotrophoblast Highly vascular Blood vessels invasion Early metastasis to lungs Suburethral metastatic nodule
Would you see a large bulky mass in uterine choriocarcinoma
No
Men manifestation of choriocarcinoma
Irregular spotting of bloody brown sometimes foul smelling fluid
Which means widespread metastases are characteristic of choriocarcinoma
Lungs vagina brain liver kidneys
Treatment of choriocarcinoma
Evacuation of uterus contents
surgery
chemotherapy
Result of chemotherapy in choriocarcinoma
Hundred percent success
Which type of Korea carcinoma is more resistant to therapy
Non gestational
Common tumors in the myometrium
Leiomyoma
Leiomyosarcoma
Commonest tumor of uterus
Fibroids known as leiomyoma
 main age affected by fibroids
Reproductive age
Different classification of fibroids
Submucosal
intramural
subserosal
Factors contributing in fibroids
Nulliparity
Delivery interval
Prolonged infertility
Who is the most affected by fibroids
Young African woman in reproductive age
Symptoms or presentation of fibroids
Heavy menstrual bleeding
intermenstrual bleeding
lower abdominal mass
lower abdominal pain
Complications of fibroids
Hyaline degeneration red degeneration fatty change necrosis cystic degeneration calcification torsion infertility Subfertility abortion polycythemia Sarcomatous change
Which is more common fibroids orLeiomyosarcoma
Fibroids
Incidence of Lieiomyosarcoma
1/1000
Women affected by Leiomyosarcomas
Woman over 50 years old
Gross and micro examination of Leiomyosarcoma
Necrosis soft irregular borders invasion into neighboring myometrium no bulging above surface when cuts Mitotic activity cellular atypia geographical necrosis sharp transitioned from viable tumor to large zones of necrosis
Diagnostic criteria of leiomyosarcoma
Mitotic activity
cellular atypia
geographical necrosis
Why are most leiomyosarcoma fatal
Because they are discovered very late so too late for therapy
Five-year survival of leiomyosarcoma
20
What is endometriosis
Endometrial tissue outside the uterus which is common in pelvis and genital tract
What are the sites where you can find endometrial tissue in endometriosis
Cæcum genital tract system rectum naval laparotomy scar
Causes of endometriosis
Deposits implanted at surgery
retrograde spill of menstrual debris
metaplasia of tissues into mullerian duct elements
lymphatic and hematogenous spread
Main site involved in endometriosis
Ovaries at 60% Uterine adnexae- Uterine ligament, rectal vagina septum, patch of Douglas, pelvic peritoneum Fallopian tube Rectosigmoid colon bladder
What is adenomyosis
Ectopic endometrial tissue in the myometrium. Which can be diffuse or localized
Which one is commoner adenomyosis that is diffused or localized
Diffused
What accompanies adenomyosis
Overgrowth of muscle and connective tissue
What is salpingitis
Inflammation of the fallopian tubes generally due to infection ascending from the lower genital tract
What are the most common causes of organisms in salpingitis
N gonorrhea
E. coli
chlamydia
mycoplasma
Is salpingitis do mostly monomicrobial or polymicrobial
Poly microbial
Clinical presentation of salpingitis
Infiltration by polymorphonuclear leukocytes (. Lymphocytes and plasma cells)
pronounced edema
congestion of mucosal folds
What is Pyosalpinx
When pus distend Fallopian tube In the late stage of salpingitis
What is hydrosalpinx
When there’s transfer dates in fallopian tube that are distended due to late stage salpingitis
Can you have peritonitis and pelvic inflammatory disease in salpingitis due to ascension of microorganism
Yes
Do you have fibrinous adhesion between Fallopian tube seRosa and surrounding peritoneal surfaces in salpingitis
Yes
Can you have a tubal ovarian abscess. In salpingitis
Yes
Why are there complications in salpingitis
Damage of Fallopian tube
How are adhesions in severe chronic salpingitis
Dense and form a blunted clubbed end of the tube
What is the general consequence of damage of Fallopian tubes after clinics up in Gytis
Tubal motility and passage of sperm impairment so infertility
Most common cause of ectopic pregnancy
Chronic salpingitis
Where do most of the tuberculosis of female genital tract starts
In the tubes
Why there may be infertility in tuberculosis salpingitis
Because of healing adhesions
What’s benign tumors do you see in the fallopian tubes
Fibromas
Leiomyoma’s
Are carcinomas of the fallopian tube common
No rare
Main presentation of carcinoma a Fallopian tubes
Profuse vagina discharge
Where is the most common sites of ectopic pregnancy
Ampulla of the tube
In which woman do we see an increased incidence of ectopic pregnancy
In women using intraintrauterine contraceptive devices
