Female GU Pathology II: Uterus

Question 1

Consists of bundles of smooth muscle

Answer 1

Myometrium

Question 2

Composed of endometrial glands and surrounding stroma, responsive to hormone stimulation, and undergoes monthly shedding

Answer 2

Endometrium

Question 3

Endometritis

Answer 3

Inflammation of the endometrium

Question 4

What is characteristic of acute endometritis?

Answer 4

Abnormal presence of neutrophils

Question 5

What is characteristic of chronic endometritis?

Answer 5

Plasma cells are diagnostic

Question 6

What are some possible causes of endometritis?

Answer 6

• Infection
• Abortion
• Delivery
• IUDs
• STDs

Question 7

What are some complications of endometritis?

Answer 7

– Infertility

– Ectopic pregnancy

Question 8

What are common causes of pelvic inflammatory disease?

Answer 8

• Chlamydia trachomatis

* Neisseria gonorrhoeae

Question 9

What is the clinical presentation of PID?

Answer 9

Purulent cervical discharge, cervical motion tenderness

Question 10

Endometriosis

Answer 10

Endometrium glands or stroma presents in abnormal locations outside the uterus

Question 11

What is the pathogenesis of endometriosis?

Answer 11

Multiple theories but regurgitation is favored - Menstrual backflow though fallopian tubes leads to implantation with decreased immune clearance.

Question 12

Adenomyosis

Answer 12

The presence of endometrial glands and surrounding stroma deep WITHIN the myometrium.

Question 13

With what can “chocolate” cysts be seen in?

Answer 13

Endometriosis

Question 14

What can be seen in the uterus with adenomyosis?

Answer 14

Uterus can enlarge due to myometrial hypertrophy

Question 15

What is the main cause of endometrial hyperplasia?

Answer 15

Excess estrogen

Question 16

What is the risk of endometrial cancer in nontypical endometrial hyperplasia?

Answer 16

Low risk

Question 17

What is the risk of endometrial cancer in atypical endometrial hyperplasia?

Answer 17

High risk - this is AKA Endometrial Intraepithelial Hyperplasia

Question 18

What is the clinical presentation of endometrial hyperplasia?

Answer 18

Abnormal uterine bleeding or postmenopausal bleeding

Question 19

What is the most frequently altered gene in endometrial carcinoma?

Answer 19

PTEN

Question 20

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

Answer 20

Endometrial Carcinoma

Question 21

What is the most common type of endometrial carcinoma?

Answer 21

Endometrioid

Question 22

What is the main risk factor for endometriod endometrial carcinoma?

Answer 22

Unopposed estrogen - many sources (obesity, early menarche, late menopause, DM, HTN)

Question 23

What does serous endometrial carcinoma arise from?

Answer 23

Usually arises from atrophic endometrium

Question 24

What is seen on histology of serous endometrial carcinoma?

Answer 24

Papillary Structures

Question 25

What drug are endometrial polyps associated with?

Answer 25

Tamoxifen

Question 26

A 37‐year‐old woman has had dysmenorrhea for 8 months. On pelvic examination the uterus appears symmetrically enlarged. This microscopic appearance is representative of her myometrium. Which of the following is the most likely diagnosis? ``` A. Adenomyosis B. Endometriosis C. Endometritis D. Invasive endometrioid carcinoma E. Invasive secretory carcinoma ```

Answer 26

A. Adenomyosis

Question 27

Leiomyoma

Answer 27

Most common BENIGN tumor in females that arises from myometrial smooth muscle cells

Question 28

What is the histological appearance of leiyomyomas?

Answer 28

Well-delineated, whorled bundles of smooth muscle cells, resembling the surrounding normal myometrium

Question 29

Leiomyosarcoma

Answer 29

Uncommon tumors, arise de novo from either myometrial layer or endometrial stroma - do NOT arise from benign leiomyomas

Question 30

What is the prognosis of leiomyosarcoma?

Answer 30

Poor

Question 31

A 14‐year‐old girl has had irregular menstrual cycles for 6 months. She had menarche at age 12. There are no abnormal physical examination findings. An endometrial biopsy is taken on calculated post‐ ovulatory day 9 and shows proliferative phase endometrium. Which of the following is the most likely diagnosis? ``` A. Adenomyosis B. Anovulatory cycles C. Acute endometritis D. Endometrial adenocarcinoma E. Leiomyomata ```

Answer 31

B. Anovulatory cycles

Question 32

What is the most common cause of abnormal uterine bleeding in adolescents?

Answer 32

Anovulatory Cycles