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Repro 2 AH > Female Genital Tract 2 - Dobson > Flashcards

Female Genital Tract 2 - Dobson Flashcards

1
Q

Chocolate cyst is what?

Risk for what?

A

Ovarian endometriosis (macrophages filled w/hemosiderin)

Cancer

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2
Q

What mutations in MMMTs?

A

TP53
PTEN
PIK3CA

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5
Q

What stage is carcinoma which involves the corpus and the cervix?

A

2

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6
Q

Leiomyosarcoma local spread to where?

Distant?

A

Abdominal cavity

Lung

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7
Q

MRKH karyotype?

A

46 XX

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8
Q

What is the recurrence rate in Type II endometrial carcinoma?

Mortality higher in whom?

5yr survival when confined to uterus?

A

80%

2x higher in African Americans

18-27%

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9
Q

What stage is carcinoma that extends outside the true pelvis or involves the mucosa of the bladder or rectum?

A

4

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12
Q

What has the morphology of bulky and polypoid, protrude through the cervical os and may contain 2 distinct and seprate epithelial and mesenchymal components?

Which component metastases from LN?

A

MMMT

Epithelial only

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15
Q

Leiomyoma (fibroids) have what abnormality?

Mutation in what gene?

A 
Karyotype abnormality
(HMGIC and HMGIY genes)

MED12

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16
Q

Type 1 endometrial carcinoma survival stage 1 (grade 1 and 2)?

Stage 1 grade 3?

Stage 2 or 3?

A

90%

75

50

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17
Q

What inflammatory disorders of the uterus cause acute endometritis?

A

Bacterial
Retained POC
Group A strep or steph

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18
Q

Type II (serous) carcinoma is defined how?

More frequent in whom?

A

Poorly diff

African-Americans
Pts 10 years older than type 1

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21
Q

What stage is carcinoma that extends outside the uterus but not outside the true pelvis?

A

3

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23
Q

What are the common signs of leiomyomas?

A

AUB
Sudden pain from infarction of a pedunculated tumor
Impaired fertility

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24
Q

Main theory of Pathogenesis of endometriosis?

A

Regurgitation theory - retrograde flow of menstrual endometrium thru the Fallopian tubes

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26
Q

What is defined by the presence of endometrial tissue within the myometrium 2-3 mm below the basalis layer?

A

Adenomyosis

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27
Q

In the regurgitation theory, what pro-inflammatory cytokines are elevated?

A

PGE2
IL-1B
TNF-a

INC estrogen and aromatase

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29
Q

Treatment for endometrial hyperplasia?

A

If reproductive age –> progesterone

Otherwise hysterectomy

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31
Q

Atypical hyperplasia (EIN = endometrial intraepithelial neoplasia) has what major morphologic features?

23-48% of biopsies will show what?

A

Complex patterns of proliferating glands w/nuclear atypia
Glands BACK to BACK and branching
Nuclear chromatin open (vesicular)

Carcinoma on hysterectomy

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32
Q

Presentation of MMMT?

What portends a worse outcome?

A

Postmenopausal women w/bleeding

Heterologous elements (fat, bone, muscle)

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33
Q

Type 1 endometrial carcinoma is described how?

A

Well-differentiated, aka endometrioid carcinoma, most common (80%)

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34
Q

Morphology of leiomyosarcoma?

A

Bulky fleshy invasive mass

Polypoid intraluminal mass

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37
Q

Type 1 endometrial carcinoma is associated w/what?

A 
Obesity
DM
HTN
Infertility
Unopposed estrogen
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38
Q

What may prolapse through the cervical os, present in the 4th/5th decade w/low grade malignancy and is estrogen sensitive?

Tx?

A

Adenosarcoma

Oophorectomy

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39
Q

What is composed of bundles of smooth muscle cells (whorled appearance) that are uniform in size and shape, oval nucleus, long bipolar process w/rare mitosis and can degenerate?

A

Leiomyoma

40
Q

What pigment may be found in endometriosis bleeding?

A

Hemosiderin

42
Q

What phase is characterized by straight glands w/tubular structures that has no mucus secretion or vacuolization and has numerous mitotic figures in glands and stromal cells?

A

Proliferative phase (estrogenic)

This phase stops at ovulation (day 14)

44
Q

Leiomyomas in pregnant women increases the frequency of what?

A

Spontaneous abortion
Fetal malpresentation
Uterine inertia
Postpartum hemorrhage

46
Q

Endometrial polyps may be common in what age groups?

Can they be malignant?

A

Reproductive, perimenopausal, postmenopausal

YES

48
Q

What are the key features of leiomyosarcoma in terms of microscopy?

A

Nuclear atypia
Mitotic index (10 or >/ 10 hpf = malignant)
Zonal necrosis

50
Q

5 yr survival for leiomyosarcoma?

High grade tumors?

A

40%

10-15%

52
Q

What are the symptoms of endometriosis?

A 
Pelvic pain
Dysmenorrhea "colicky"
Infertility (30-40% of presenting complaint)
Dyspareunia
Painful shitting
Dysuria
53
Q

What pathology indicates chronic endometritis?

A

Plasma cell in biopsy (only need 1)

54
Q

Germline PTEN mutation and high incidence of endometrial and breast cancer is what?

A

Cowden syndrome (Multiple hamartoma syndrome)

55
Q

What is described by the morphology of a localized polypoid tumor or diffuse infiltration of the endometrial lining w/spread by invasion of myometrium and direct extension to surrounding organs?

A

Type 1 endometrial carcinoma

57
Q

What has high N:C ratio, atypical mitoses, hyperchromasia and prominent nucleoli?

A

Type II Serous endometrial carcinoma

58
Q

Leiomyosarcoma peak age when?

Arise from what?

Deletion in what gene?

Metastases?

A

40-60

Stromal precursor cell (de novo)

MED12

More than half metastasize

60
Q

Type II endometrial carcinoma arises in what setting?

Mutation in what?

Precursor lesion is what?

A

Endometrial atrophy, thin patient

TP53

Serous endometrial intraepithelial carcinoma (SEIC)

61
Q

Endometriosis bleeding produces what?

Causes what?

A

Red/blue to yellow/brown nodules beneath the mucosa/serosa
aka power burn marks

Fibrous adhesions –> SBO

63
Q

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

Peak age?

Early sign?

A

Endometrial carcinoma

55-65 (postmenopausal)

Bleeding

64
Q

A leiomyosarcoma w/nuclear atypia or large (epithelioid cells) and 5 mitoses/10 hpf) indicates what?

A

Malignancy

66
Q

Endometrial hyperplasia is a precursor to what?

Caused by what?

A

Endometrial carcinoma

Prolonged estrogenic stimulation of the endometrium

67
Q

What is the most frequent cause of AUB?

Due to what?

A

Anovulation

Hormonal distrurbance –> unopposed estrogen

68
Q

Women w/MRKH may have what other abnormalities?

A

kidneys
Vertebrae
Hearing loss
Heart defects

69
Q

Type 1 endometrial carcinoma has LOF mutations in what?

What other mutations?

A

PTEN, ARID1A

PIK3CA, KRAS, CTNNB1, DNA MMR

71
Q

What conditions cause increased estrogen?

A

Anovulation
Obesity
Prolonged admin of estrogenic stimulation
PCOS
Functioning ovarian tumors (granulosa cell)
Menopause

73
Q

MMMTs are what?

A

Carcinosarcoma - malignant glandular and mesenchymal elements

75
Q

Mnemonic for causes of AUB?

A

PALM - structural
COEIN - nonstructural

Polyps
Adenomatous is
Leiomyoma
Malignancy and hyperplasia

Coagulopathy 
Ovulatory dysfunction
Endometrial 
Iatrogenic 
Not classified
77
Q

What is a large bulky tumor that deeply infiltrates the myometrium and has a propensity for extrauterine spread?

A

Type II (serous) endometrial carcinoma

79
Q

What stage is carcinoma confined to the corpus uteri itself?

A

1

83
Q

Type 2 endometrial carcinoma arises in the setting of what?

What mutation?

A

Endometrial atrophy

TP53

84
Q

Cardinal feature of non-atypical hyperplasia?

What other important features?

A

Increase in G:S ratio

Intervening stroma remains and RARELY progresses to cancer

Think of 35 y/o obese pt w/AUB and lots of glands

87
Q

Loss of PTEN leads to what?

A

Overactivation of PI3K/AKT

88
Q

Mutation in what genes is associated with endometriosis?

A

PTEN

ARID1A

89
Q

Females that present w/primary amenorrhea due to a lack of uterine development but have fully developed secondary sexual characteristics w/functional ovaries have what?

A

Mayer-Rokitansky-Kuster-Hauser syndrome

91
Q

Most common cause of dysfunctional/abnormal uterine bleeding?

A

Hormonal disturbance (HPO axis)

93
Q

Inactivation of what gene is common in endometrial hyperplasia and cancer?

A

PTEN

102
Q

Most common sites of endometriosis?

A

Ovary
Uterine l.
Rectovaginal septum
Pouch of Douglas

103
Q

What phase is characterized by the degeneration of the functionalis layer and bleeding into the stroma with stromal breakdown?

A

Menstrual phase (days 1-5)

104
Q

What phase is marked by secretory subnuclear vacuoles which become supranuclear with an appearance of tortuous and serrated (saw-toothed) endometrium?

A

Secretory phase (progesterone and luteal phase)

106
Q

What phase is manifested by stromal changes, prominent spiral arteries, and a stromal predecidual change?

A

Late secretory phase

110
Q

What inflammatory disorders of the uterus causes chronic endometritis?

A

PID
Retained gestational tissue
IUD
Tb

Repro 2 AH (6 decks)

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