Female Genital Tract 2 - Dobson Flashcards by Alex Hamidi

Chocolate cyst is what?

Risk for what?

Ovarian endometriosis (macrophages filled w/hemosiderin)

Cancer

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What mutations in MMMTs?

TP53
PTEN
PIK3CA

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

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Leiomyosarcoma local spread to where?

Distant?

Abdominal cavity

Lung

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MRKH karyotype?

46 XX

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What is the recurrence rate in Type II endometrial carcinoma?

Mortality higher in whom?

5yr survival when confined to uterus?

80%

2x higher in African Americans

18-27%

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

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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?

MMMT

Epithelial only

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Leiomyoma (fibroids) have what abnormality?

Mutation in what gene?

Karyotype abnormality
(HMGIC and HMGIY genes)

MED12

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

Stage 1 grade 3?

Stage 2 or 3?

90%

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What inflammatory disorders of the uterus cause acute endometritis?

Bacterial
Retained POC
Group A strep or steph

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Type II (serous) carcinoma is defined how?

More frequent in whom?

Poorly diff

African-Americans
Pts 10 years older than type 1

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

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What are the common signs of leiomyomas?

AUB
Sudden pain from infarction of a pedunculated tumor
Impaired fertility

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Main theory of Pathogenesis of endometriosis?

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

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

Adenomyosis

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

PGE2
IL-1B
TNF-a

INC estrogen and aromatase

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Treatment for endometrial hyperplasia?

If reproductive age –> progesterone

Otherwise hysterectomy

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

23-48% of biopsies will show what?

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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Presentation of MMMT?

What portends a worse outcome?

Postmenopausal women w/bleeding

Heterologous elements (fat, bone, muscle)

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Type 1 endometrial carcinoma is described how?

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

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Morphology of leiomyosarcoma?

Bulky fleshy invasive mass

Polypoid intraluminal mass

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Type 1 endometrial carcinoma is associated w/what?

Obesity
DM
HTN
Infertility
Unopposed estrogen

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

Tx?

Adenosarcoma

Oophorectomy

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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?

Leiomyoma

What pigment may be found in endometriosis bleeding?

Hemosiderin

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?

Proliferative phase (estrogenic) This phase stops at ovulation (day 14)

Leiomyomas in pregnant women increases the frequency of what?

Spontaneous abortion Fetal malpresentation Uterine inertia Postpartum hemorrhage

Endometrial polyps may be common in what age groups? Can they be malignant?

Reproductive, perimenopausal, postmenopausal YES

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

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

5 yr survival for leiomyosarcoma? High grade tumors?

40% 10-15%

What are the symptoms of endometriosis?

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

What pathology indicates chronic endometritis?

Plasma cell in biopsy (only need 1)

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

Cowden syndrome (Multiple hamartoma syndrome)

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?

Type 1 endometrial carcinoma

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

Type II Serous endometrial carcinoma

Leiomyosarcoma peak age when? Arise from what? Deletion in what gene? Metastases?

40-60 Stromal precursor cell (de novo) MED12 More than half metastasize

Type II endometrial carcinoma arises in what setting? Mutation in what? Precursor lesion is what?

Endometrial atrophy, thin patient TP53 Serous endometrial intraepithelial carcinoma (SEIC)

Endometriosis bleeding produces what? Causes what?

Red/blue to yellow/brown nodules beneath the mucosa/serosa aka power burn marks Fibrous adhesions --> SBO

What is the most common invasive cancer of the female genital tract? Peak age? Early sign?

Endometrial carcinoma 55-65 (postmenopausal) Bleeding

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

Malignancy

Endometrial hyperplasia is a precursor to what? Caused by what?

Endometrial carcinoma Prolonged estrogenic stimulation of the endometrium

What is the most frequent cause of AUB? Due to what?

Anovulation Hormonal distrurbance --> unopposed estrogen

Women w/MRKH may have what other abnormalities?

kidneys Vertebrae Hearing loss Heart defects

Type 1 endometrial carcinoma has LOF mutations in what? What other mutations?

PTEN, ARID1A PIK3CA, KRAS, CTNNB1, DNA MMR

What conditions cause increased estrogen?

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

MMMTs are what?

Carcinosarcoma - malignant glandular and mesenchymal elements

Mnemonic for causes of AUB?

PALM - structural COEIN - nonstructural Polyps Adenomatous is Leiomyoma Malignancy and hyperplasia ``` Coagulopathy Ovulatory dysfunction Endometrial Iatrogenic Not classified ```

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

Type II (serous) endometrial carcinoma

What stage is carcinoma confined to the corpus uteri itself?

Type 2 endometrial carcinoma arises in the setting of what? What mutation?

Endometrial atrophy TP53

Cardinal feature of non-atypical hyperplasia? What other important features?

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

Loss of PTEN leads to what?

Overactivation of PI3K/AKT

Mutation in what genes is associated with endometriosis?

PTEN | ARID1A

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?

Mayer-Rokitansky-Kuster-Hauser syndrome

Most common cause of dysfunctional/abnormal uterine bleeding?

Hormonal disturbance (HPO axis)

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

PTEN

Most common sites of endometriosis?

Ovary Uterine l. Rectovaginal septum Pouch of Douglas

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

Menstrual phase (days 1-5)

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

Secretory phase (progesterone and luteal phase)

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

Late secretory phase

What inflammatory disorders of the uterus causes chronic endometritis?

PID Retained gestational tissue IUD Tb