Female Genital Tract 2 Flashcards
What are the two layers of the uterus?
- endometrium
-lined by columnar epithelium and deep to that endometrial glands (glads change depending phase) and stroma
-normally some lymphocytes
A. functionalis-near the lumen, hormonally responsive
B. basalis-produces new cells to replace endometrium that was shed during menstruation - myometrium
- smooth muscle layer
What does normal postmenopausal endometrium look like?
atrophic endometrium
- glands diminished in number, thin epithelium
- stroma abundant collagen
Endometritis
Acute vs Chronic
Acute
-abnormal presence of neutrophils
-neutrophils normally present during menstruation
Chronic
-plasma cells diagnostic
-lymphocytes present in normal endometrium
What are causes of endometritis? What is the presentation? What are the long term complications?
Causes
1. Ascending infection from cervix
-std, pelvic inflammatory disease
-abortion, delivery, medical instrumentation
2. IUDs
3. Retained products of conception post delivery
Presentation
-fever, abdominal pain, menstrual abnormalities
Long term complications
-infertility
-ectopic pregnancy-if ascending to fallopian tube-scarring
What can cause PID? How does it present and look? What can it lead to?
STD
- chlamydia trachomatis
- neisseria gonorrhoea
- polymicrobial
Ascending infection
Cervicitis–Endometritis—Salpingitis–Tubo Ovarian abscess
present
-purulent cervical discharge, cervical motion tenderness
Fallopian tubes distorted
Fimbriated ends adherent
Serosa hyperemic
Exudate
–infertility and ectopic pregnancy
Endometriosis?
Presence of endometrial glands and stroma outside the endometrium
- ovaries, uterine ligaments, fallopian tubes, pouch of douglas, rectovaginal septum
- less frequently peritoneal cavity, periumbilical tissues
- uncommonly lungs, heart, lymph nodes
What are the three theories of endometriosis?
- Regurgitation (favored)
- menstrual flow back through fallopian tubes leads to implantation - Metaplastic
- endometrial differentiation of multipotential coelomic epithelium - Vascular or Lymphatic dissemination
- explains extrapelvic intranodal implants
What is the pathogenesis of endometriosis?
- Increased inflammatory mediators
- High aromatase activity of stromal cells, increasing estrogen production
- Activated macrophages contribute to establishment, maintenance
- Decreased immune clearance
What must be present histologically for endometriosis?
- Endometrial glands
- Endometrial stroma
- Hemosiderin pigment
Chocolate cyst ovary
What are the symptoms of endometriosis, which affects 10% of women?
- infertility ~50%
Depends on site of implants - severe dysmenorrhea–intrapelvic bleeding
- pelvic pain, increased risk of ectopic pregnancy, infertility–result of scarring
- pain with defecation
- pain with urination
Adenomyosis
Presence of endometrial glands and stroma within the myometrium
- cause unknown
- uterus may enlarge-result of myometrial hypertrophy
- clinically asymptomatic to irregular bleeding to pelvic pain
What is endometrial hyperplasia and what causes it? HOw does it present?
Exaggerated endometrial proliferation
glands>stromal hyperplasia
Result of ESTROGEN EXCESS -exogenous estrogen -estrogen producing ovarian lesions PCOS Granulosa theca cell tumor -obesity -failure of ovulation Perimenopause
Presents
-postmenopausal uterine bleeding
How does non atypical vs atypical hyperplasia affect the risk of endometrial cancer?
Non atypical
-short term risk of endometrial cancer is LOW
Atypical
-marked increased risk of endometrial cancer
Atypical Hyperplasia Histology
Low power: glandular crowding
High power: cytologically atypical rounded, vesicular nuclei with prominent nucleoli
What causes atypical endometrial hyperplasia?
PTEN tumor suppressor gene mutation
- phosphatase protein product involved in the regulation of the cell cycle
- hyperplastic glands may ultimately proliferate autonomously
Endometrial Intraepithelial Neoplasm= neoplastic growth genetically altered cells with greatly increased risk o becoming endometrioid type of endometrial carcinoma