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2nd Repro > Female Pathology > Flashcards

Female Pathology Flashcards

1
Q

The body of the uterus is made of up 3 layers:

A

the outer Serosa, the middle Myometrium and the inner Endometrium

–he serosa is covered by peritoneum and is continuous with the broad ligament laterally.

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2
Q

The myometrium is made up of ______oriented in different directions.

A

3 layers of smooth muscle

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3
Q

The endometrium is covered by _____ that is supported by a very cellular lamina propria consisting of spindle-shaped stromal or interstitial cells.

A

simple columnar epithelium

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4
Q

The mucosa of the endometrium has 2 zones:

the Basal zone and the Functional zone.

A

Basal zone comprises 1/3rd of the endometrium and does not undergo cyclic changes. The remaining 2/3rd of the endometrium is the outer layer and undergoes cyclic change – it is sloughed at the end of the cycle.

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5
Q

______comprises 1/3rd of the endometrium and does not undergo cyclic changes.

A

Basal zone

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6
Q

2/3rd of the endometrium is the outer layer and undergoes cyclic change – it is sloughed at the end of the cycle.

A

Functional Endometrium

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7
Q

(day 5-15) the thickness of the endometrium changes from 1 mm to 3-4 mm. growth occurs in all epithelial and stromal components. The glands are relatively straight to somewhat wavy in appearance.

A

During the proliferative phase

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8
Q

, under the influence of progesterone from the corpus luteum the endometrial glands become coiled and sacculated because they secrete glycogen and other carbohydrates. Stromal cells in the outer functional zone become epitheloid

***tortuous secraetory glands and pseudodecidulaized stroma

A

During the secretory phase (day 15-26)

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9
Q

the spiral arteries undergo spasms and constrict, blanching the endometrium and rendering it ischemic, resulting in shedding.

A

During the menstrual phase (day 1-5),

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10
Q

– Retained tissue
– Acute endometritis (Neisseria gonorrheae, Chlamydia trachomatis)

can cause:

A

Inflammation/endometritis/pelvic inflammatory disease

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11
Q

– Glandular

– Mesenchymal/soft tissue
– Malignant Mixed Mullerian Tumor (MMMT)

all examples of:

A

Malignant

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12
Q

Inflammationof Endometrium can be d/t PID, retained POC, IUD

See plasma cells in endometrial stroma

A

Endometritis

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13
Q

Benignbiphasic neoplastic growth (glands and stroma) causes dysfuntional bleeding d/t rearragnement of 6p21

see dilated glands and sessile or peducnulated growth

A

Endometiral Polyps

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14
Q

Presence of endometrial glands and stroma outside of uterus, see cyclic bleeding and can become blood filled cysts (chocolate cyst)

A

Endometriosis

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15
Q

What are some consequences of endometriosis histologically

A

Discharge of blood leads to reactive changes, fibrosis and adhesions

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16
Q

Histology:
Endometrial glands + stroma ± hemosiderin

**Cox-2 and aromatase inhibitors **

A

Endometriosis

17
Q

• Growth of endometrium in the myometrium, see enlarged, nodular myometrium and have abnormal Uterine bleeding

looks very cystic!!

A

Adenomyosis

18
Q

Enlarged, nodular myometrium with cysts, Hemorrhagic cysts in functional endometrium

Abnormal Uterine bleeding; infertility

A

also adenomyosis

19
Q

– Exageratedendometrial proliferation

– Glands/stroma: >50% thus more GLANDULAR

– Abnormal glandular architecture

A

Hyperplasia of endometrium

20
Q

What can cause endometrial hyperplasia?

A

obesity, anovulation, estrogen prodcution tumors

21
Q

Increase gland/stroma ratio > 1/1

Glandular irregularity

Nuclear atypia

A

Hyperplasia or endometrium (can lead to adenocarcinoma so be sure to reule it out)

22
Q

Back to back glands, Cellular atypia, Abundant mitosis, including abnormal forms, Necrosis seen in ENDOmetrium

A

Adenocarcinoma

23
Q

Correlation of severity of hyperplasia & duration of :

– Endometrial Hyperplasia

A

excess estrogen

24
Q

____ risk of progression to carcinoma in hyperplasia without atypia

_____ risk of carcinoma in hyperplasia _with atypia _

A

5%

20%-50%

25
Q

Risk factors for endormetrial carcinomas

A

Risk factors: Obesity, diabetes, hypertension, infertility, exposure to unopposed estrogen

– Endometrial carcinoma occurs predominantly in developed countries

26
Q

Type I Endometrial adenocarcinoma

– In a background of _________

– Low grade endometrioid and mucinous adenocarcinoma

– ______ dependent

A

endometrial hyperplasia

Estrogen

27
Q

HOw do we devo Type I adenocarcinoma of endometrium?

A

Hyperplasia-carcinoma sequence

‒ Mutation in Mismatch repair (HNPCC) ; tumor suppressor gene PTEN (Cowden syndrome) are early event in stepwise development

28
Q

– Usually in a atrophic background
– Independent of endometrial hyperplasia

– Older women; more aggressive

A

Type II Endometrial carcinoma

29
Q

• High grade endometrial carcinoma

  • Serous carcinoma
  • Clear cell carcinoma
  • Carcinosarcoma
  • Undifferentiated
A

example of Type II endometrial carcinoma

30
Q

Endometrial intraepithelial carcinoma (EIC) the precursor to

A

serous carcinoma.

31
Q

Strong, diffuse expression of ____as detected by immunohistochemistry in EIC with accumulation of _____ protein in the nucleus

A

p53

p53

32
Q

o Most common benign tumors in females (35%‐50%)
o Blacks> whites
o Usually asymptomatic but can cause abnormal uterine bleeding

A

Leiomyomas (Uterine fibroids) originates in myometrium!

33
Q

Presentation of leimyoma

A

abnormal bleeding or asymptomatic

34
Q

Usually multiple

Sharply demarcated tumors

Submucosal, intramural and subserosal

In the Myometrium

A

Leiomyoma

35
Q

Monoclonal proliferation of smooth muscle cells (bundles of benign smooth muscle)

A

Leiomyoma

36
Q

De novo from myometrial mesenchymal cell , devo after menopause, solitary lesion

A

Leiomyosarcoma

37
Q

Soft, hemorrhagic, necrotic mass

Pathological Diagnostic Features

– Tumor necrosis, cytological atypia and mitosis (abnormal forms)

A

Leiomyosarcoma

38
Q

Recurrence and mets are common in leimyosarcoma: will go to:

A

pelvis and lungs and bones

2nd Repro (16 decks)

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