Female Genital II Flashcards
Day 1-4 in female cycle is what? 4-14? 15-27? 28?
- Menses
- Proliferative Phase
- Secretory Phase
- Collapse
What hormone is being produced in the proliferative phase?
Only estrogen
What type of endometrium has small regular glands that are evenly spaced and gland stroma ratio is 1:1?
proliferative endometrium
[the glands are not very squiggly yet]
What event does the secretory phase follow? what happens to the stroma during this phase?
- Ovulation and subsequent progesterone secretions
2. decidualizes in preparation of implantation
What happens if there is no implantation?
endometrium sheds (menses) and the cycle repeats
T-F– significant pathologic disease in the uterus will cause obvious abnormality on clinical exam?
False0 often does not
T-F– the uterine lining changes daily in a reproductive age woman
True
What are 3 common systemic causes of abnormal vaginal bleeding?
- von Hillebrand
- thrombocytopenia
- Thyroid disorders
What is anovulatory dysfunctional uterine bleeding?
disturbed hypothalamic pituitary ovarian axis
What is ovulatory dysfunctional uterine bleeding referring to?
Normal HPO axis but increased menstrual flow
What are the 4 common clinical management techniques of abnormal bleeding?
- History and exam
- labs- HCG, thyroid
- Transvaginal US
- Endometrial Biopsy
What are endometrial polyps thought to be related to? where are they most common? what are the three key features?
- hyperestrogenism
- Fundus
- Fibrous stroma, dilated endometrial glands, thick walled vessels
What are the 2 types of endometrial hyperplasia?
simple and complex
What is the low power architecture of simple endometrial hyperplasia?
1:1 glands:stroma and some irregular/branched glands
What is the low power architecture of complex endometrial hyperplasia?
> 1:1 glands:stroma, more irregularly shaped glands with many branches and offshoots
What is the number 1 parameter in determining whether hyperplasia might progress to adenocarcinoma?
Atypia
- Fewer than 3% without progress to adenocarcinoma
- 29% with progress to cancer
What is the 2nd step in evaluation of hyperplasia?
describe cytomorphology of cells
When there is no atypia what do the glandular cells look like? what is the only thing that is altered?
- similar of normal proliferative endometrium
2. Only the architecture of the glands is altered
Atypia in hyperplasia has what 2 major things can be visualized?
- loss of polarity of the glandular cells
2. rounding up of nuclei, vesicular chromatin, nucleoli
T-F– hyperplasia differs from carcinoma because invasion of the endometrial stroma occurs without invasion of the myometrium?
False- invasion does NOT occur in either
The spectrum of changes in the endometrium hyperplasia are due to what? what are they treated with?
- unopposed estrogen stimulation
2. progesterone
Where are endogenous hormones converted to estrone?
in peripheral fat
more fat= more estrogens
Why do PCOS have increased risk of adenocarcinoma?
do not ovulate regularly and thus have prolonged estrogen stimulus
In estrogen therapy for osteoporosis, what else needs to be administered?
progesterone in women who still have a uterus
What is the potential risk of Lynch Syndrome (HNPCC) and adenocarcinoma of the endometrium?
45%
What are the 2 types of endometrial carcinoma?
endometrioid and serous carcinoma
What is endometrioid carcinoma associated with? What is the precursor lesion?
- estrogenic stimulation
2. atypical hyperplasia
What is serous carcinoma associated with? what is the precursor lesion?
- atrophic endometrium in older patients
2. intraepithelial carcinoma
What are the percentages of solid growth pattern in endometrioid type adenocarcinoma FIGO grade I? Grade II? GRADE III
- 5% solid 95% glandular
- 5-50%
- > 50% solid <50% glandular
Does serous carcinoma or endometrioid carcinoma have a worse prognosis?
serous
In serous carcinoma, the growth pattern may ne solid, papillary, or glandular, but the cells are highly atypical with what?
- tufting or hobnailing
[always FIGO III]
Involvement of outer myometrium allows access to what?
Different lymphatics as does involvement of the cervix
Endometrial carcinoma with involvement of the cervix is considered what stage?
Stage II
Endometrial carcinoma with involvement beyond the uterus is considered what stage?
Stage III
Endometrial carcinoma with involvement of the bladder or rectal muscosa is considered what stage
stage IV
What is the difference between endometrial carcinoma stage I A and IB?
IA half the myometrium
Are leiomyomas benign?
Yes
T-F– leiomyomas decrease the surface area of the endometrium?
False- increases
What does a leiomyoma look like grossly?
well circumscribed, bulging, whitish, trabeculated and whorled
What does a leiomyoma look like microscopically?
smooth muscle bundles in fascicles at right angles to each other, bland nuclei with few mitoses.
Review some of the common secondary changes of leiomyomata-
- Hyalinization
- Cystic Degeneration
- Calcification
4 Infection - Infarction
- Fatty Change
T-F– uterine sarcomas are common?
False- 3% of malignancies
- leiomyosarcoma
- endometrial stromal sarcoma
Describe the gross features of a leiomyosarcoma?
soft, fleshy appearance, no clear demarcation from the myometrium, areas of hemorrhage
What do leiomyosarcoma look like microscopically?
- growth in bundles but there is cell atypic and an excess of mitoses
What does an endometrial stromal sarcoma look like grossly?
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
What does endometrial stromal sarcoma look like microscopically?
normal endometrial stroma but has no intervening glands and invades the myometrium and blood vessels.
Review the staging of uterine sarcomas–REMEMBER THEY ARE DIFF THAN CARCINOMAS
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
How is leiomyosarcoma treated? how does it spread?
resect
chemo/XRT
spreads hematogenously- poor survival
How is ESS treated?
resection
progestin (considered low grade)
What is a hybrid neoplasm that has both epithelial and mesenchymal components?
- malignant mixed mullerian tumor
- or Triple MT, carcnosarcoma, sarcomatoid carcinoma
T-F–Triple MMTs can either be homologous or heterologous
True- can resemble uterine sarcoma or sarcoma from somewhere else
