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Pathology II Exam II > Female Genital II > Flashcards

Female Genital II Flashcards

1
Q

Day 1-4 in female cycle is what? 4-14? 15-27? 28?

A
  1. Menses
  2. Proliferative Phase
  3. Secretory Phase
  4. Collapse
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2
Q

What hormone is being produced in the proliferative phase?

A

Only estrogen

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3
Q

What type of endometrium has small regular glands that are evenly spaced and gland stroma ratio is 1:1?

A

proliferative endometrium

[the glands are not very squiggly yet]

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4
Q

What event does the secretory phase follow? what happens to the stroma during this phase?

A
  1. Ovulation and subsequent progesterone secretions

2. decidualizes in preparation of implantation

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5
Q

What happens if there is no implantation?

A

endometrium sheds (menses) and the cycle repeats

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6
Q

T-F– significant pathologic disease in the uterus will cause obvious abnormality on clinical exam?

A

False0 often does not

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7
Q

T-F– the uterine lining changes daily in a reproductive age woman

A

True

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8
Q

What are 3 common systemic causes of abnormal vaginal bleeding?

A
  1. von Hillebrand
  2. thrombocytopenia
  3. Thyroid disorders
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9
Q

What is anovulatory dysfunctional uterine bleeding?

A

disturbed hypothalamic pituitary ovarian axis

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10
Q

What is ovulatory dysfunctional uterine bleeding referring to?

A

Normal HPO axis but increased menstrual flow

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11
Q

What are the 4 common clinical management techniques of abnormal bleeding?

A
  1. History and exam
  2. labs- HCG, thyroid
  3. Transvaginal US
  4. Endometrial Biopsy
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12
Q

What are endometrial polyps thought to be related to? where are they most common? what are the three key features?

A
  1. hyperestrogenism
  2. Fundus
  3. Fibrous stroma, dilated endometrial glands, thick walled vessels
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13
Q

What are the 2 types of endometrial hyperplasia?

A

simple and complex

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14
Q

What is the low power architecture of simple endometrial hyperplasia?

A

1:1 glands:stroma and some irregular/branched glands

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15
Q

What is the low power architecture of complex endometrial hyperplasia?

A

> 1:1 glands:stroma, more irregularly shaped glands with many branches and offshoots

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16
Q

What is the number 1 parameter in determining whether hyperplasia might progress to adenocarcinoma?

A

Atypia

  • Fewer than 3% without progress to adenocarcinoma
  • 29% with progress to cancer
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17
Q

What is the 2nd step in evaluation of hyperplasia?

A

describe cytomorphology of cells

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18
Q

When there is no atypia what do the glandular cells look like? what is the only thing that is altered?

A
  1. similar of normal proliferative endometrium

2. Only the architecture of the glands is altered

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19
Q

Atypia in hyperplasia has what 2 major things can be visualized?

A
  1. loss of polarity of the glandular cells

2. rounding up of nuclei, vesicular chromatin, nucleoli

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20
Q

T-F– hyperplasia differs from carcinoma because invasion of the endometrial stroma occurs without invasion of the myometrium?

A

False- invasion does NOT occur in either

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21
Q

The spectrum of changes in the endometrium hyperplasia are due to what? what are they treated with?

A
  1. unopposed estrogen stimulation

2. progesterone

22
Q

Where are endogenous hormones converted to estrone?

A

in peripheral fat

more fat= more estrogens

23
Q

Why do PCOS have increased risk of adenocarcinoma?

A

do not ovulate regularly and thus have prolonged estrogen stimulus

24
Q

In estrogen therapy for osteoporosis, what else needs to be administered?

A

progesterone in women who still have a uterus

25
Q

What is the potential risk of Lynch Syndrome (HNPCC) and adenocarcinoma of the endometrium?

A

45%

26
Q

What are the 2 types of endometrial carcinoma?

A

endometrioid and serous carcinoma

27
Q

What is endometrioid carcinoma associated with? What is the precursor lesion?

A
  1. estrogenic stimulation

2. atypical hyperplasia

28
Q

What is serous carcinoma associated with? what is the precursor lesion?

A
  1. atrophic endometrium in older patients

2. intraepithelial carcinoma

29
Q

What are the percentages of solid growth pattern in endometrioid type adenocarcinoma FIGO grade I? Grade II? GRADE III

A
  1. 5% solid 95% glandular
  2. 5-50%
  3. > 50% solid <50% glandular
30
Q

Does serous carcinoma or endometrioid carcinoma have a worse prognosis?

A

serous

31
Q

In serous carcinoma, the growth pattern may ne solid, papillary, or glandular, but the cells are highly atypical with what?

A
  1. tufting or hobnailing

[always FIGO III]

32
Q

Involvement of outer myometrium allows access to what?

A

Different lymphatics as does involvement of the cervix

33
Q

Endometrial carcinoma with involvement of the cervix is considered what stage?

A

Stage II

34
Q

Endometrial carcinoma with involvement beyond the uterus is considered what stage?

A

Stage III

35
Q

Endometrial carcinoma with involvement of the bladder or rectal muscosa is considered what stage

A

stage IV

36
Q

What is the difference between endometrial carcinoma stage I A and IB?

A

IA half the myometrium

37
Q

Are leiomyomas benign?

A

Yes

38
Q

T-F– leiomyomas decrease the surface area of the endometrium?

A

False- increases

39
Q

What does a leiomyoma look like grossly?

A

well circumscribed, bulging, whitish, trabeculated and whorled

40
Q

What does a leiomyoma look like microscopically?

A

smooth muscle bundles in fascicles at right angles to each other, bland nuclei with few mitoses.

41
Q

Review some of the common secondary changes of leiomyomata-

A
  1. Hyalinization
  2. Cystic Degeneration
  3. Calcification
    4 Infection
  4. Infarction
  5. Fatty Change
42
Q

T-F– uterine sarcomas are common?

A

False- 3% of malignancies

  • leiomyosarcoma
  • endometrial stromal sarcoma
43
Q

Describe the gross features of a leiomyosarcoma?

A

soft, fleshy appearance, no clear demarcation from the myometrium, areas of hemorrhage

44
Q

What do leiomyosarcoma look like microscopically?

A
  1. growth in bundles but there is cell atypic and an excess of mitoses
45
Q

What does an endometrial stromal sarcoma look like grossly?

A

soft, fleshy pale tumor that resembles endometrium in texture grossly. appears in nodules in the myometrium due to vessel invasion and has a VERMIFORM appearance

46
Q

What does endometrial stromal sarcoma look like microscopically?

A

normal endometrial stroma but has no intervening glands and invades the myometrium and blood vessels.

47
Q

Review the staging of uterine sarcomas–REMEMBER THEY ARE DIFF THAN CARCINOMAS

A

Stage I- tumor limited to uterus
Stage II- tumor extends beyond the uterus but stays within pelvis
Stage III- tumor infiltrates ab tissues
StageIV- tumor invades bladder or rectum

48
Q

How is leiomyosarcoma treated? how does it spread?

A

resect
chemo/XRT

spreads hematogenously- poor survival

49
Q

How is ESS treated?

A

resection

progestin (considered low grade)

50
Q

What is a hybrid neoplasm that has both epithelial and mesenchymal components?

A
  1. malignant mixed mullerian tumor

- or Triple MT, carcnosarcoma, sarcomatoid carcinoma

51
Q

T-F–Triple MMTs can either be homologous or heterologous

A

True- can resemble uterine sarcoma or sarcoma from somewhere else

Pathology II Exam II (16 decks)

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