Female Pathology Flashcards
The body of the uterus is made of up 3 layers:
the outer Serosa, the middle Myometrium and the inner Endometrium
–he serosa is covered by peritoneum and is continuous with the broad ligament laterally.
The myometrium is made up of ______oriented in different directions.
3 layers of smooth muscle
The endometrium is covered by _____ that is supported by a very cellular lamina propria consisting of spindle-shaped stromal or interstitial cells.
simple columnar epithelium
The mucosa of the endometrium has 2 zones:
the Basal zone and the Functional zone.
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.
______comprises 1/3rd of the endometrium and does not undergo cyclic changes.
Basal zone
2/3rd of the endometrium is the outer layer and undergoes cyclic change – it is sloughed at the end of the cycle.
Functional Endometrium
(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.
During the proliferative phase
, 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
During the secretory phase (day 15-26)
the spiral arteries undergo spasms and constrict, blanching the endometrium and rendering it ischemic, resulting in shedding.
During the menstrual phase (day 1-5),
– Retained tissue
– Acute endometritis (Neisseria gonorrheae, Chlamydia trachomatis)
can cause:
Inflammation/endometritis/pelvic inflammatory disease
– Glandular
– Mesenchymal/soft tissue
– Malignant Mixed Mullerian Tumor (MMMT)
all examples of:
Malignant
Inflammationof Endometrium can be d/t PID, retained POC, IUD
See plasma cells in endometrial stroma
Endometritis
Benignbiphasic neoplastic growth (glands and stroma) causes dysfuntional bleeding d/t rearragnement of 6p21
see dilated glands and sessile or peducnulated growth
Endometiral Polyps
Presence of endometrial glands and stroma outside of uterus, see cyclic bleeding and can become blood filled cysts (chocolate cyst)
Endometriosis
What are some consequences of endometriosis histologically
Discharge of blood leads to reactive changes, fibrosis and adhesions
Histology:
Endometrial glands + stroma ± hemosiderin
**Cox-2 and aromatase inhibitors **
Endometriosis
• Growth of endometrium in the myometrium, see enlarged, nodular myometrium and have abnormal Uterine bleeding
looks very cystic!!
Adenomyosis
Enlarged, nodular myometrium with cysts, Hemorrhagic cysts in functional endometrium
Abnormal Uterine bleeding; infertility
also adenomyosis
– Exageratedendometrial proliferation
– Glands/stroma: >50% thus more GLANDULAR
– Abnormal glandular architecture
Hyperplasia of endometrium
What can cause endometrial hyperplasia?
obesity, anovulation, estrogen prodcution tumors
Increase gland/stroma ratio > 1/1
Glandular irregularity
Nuclear atypia
Hyperplasia or endometrium (can lead to adenocarcinoma so be sure to reule it out)
Back to back glands, Cellular atypia, Abundant mitosis, including abnormal forms, Necrosis seen in ENDOmetrium
Adenocarcinoma
Correlation of severity of hyperplasia & duration of :
– Endometrial Hyperplasia
excess estrogen
____ risk of progression to carcinoma in hyperplasia without atypia
_____ risk of carcinoma in hyperplasia _with atypia _
5%
20%-50%
Risk factors for endormetrial carcinomas
Risk factors: Obesity, diabetes, hypertension, infertility, exposure to unopposed estrogen
– Endometrial carcinoma occurs predominantly in developed countries
Type I Endometrial adenocarcinoma
– In a background of _________
– Low grade endometrioid and mucinous adenocarcinoma
– ______ dependent
endometrial hyperplasia
Estrogen
HOw do we devo Type I adenocarcinoma of endometrium?
Hyperplasia-carcinoma sequence
‒ Mutation in Mismatch repair (HNPCC) ; tumor suppressor gene PTEN (Cowden syndrome) are early event in stepwise development
– Usually in a atrophic background
– Independent of endometrial hyperplasia
– Older women; more aggressive
Type II Endometrial carcinoma
• High grade endometrial carcinoma
- Serous carcinoma
- Clear cell carcinoma
- Carcinosarcoma
- Undifferentiated
example of Type II endometrial carcinoma
Endometrial intraepithelial carcinoma (EIC) the precursor to
serous carcinoma.
Strong, diffuse expression of ____as detected by immunohistochemistry in EIC with accumulation of _____ protein in the nucleus
p53
p53
o Most common benign tumors in females (35%‐50%)
o Blacks> whites
o Usually asymptomatic but can cause abnormal uterine bleeding
Leiomyomas (Uterine fibroids) originates in myometrium!
Presentation of leimyoma
abnormal bleeding or asymptomatic
Usually multiple
Sharply demarcated tumors
Submucosal, intramural and subserosal
In the Myometrium
Leiomyoma
Monoclonal proliferation of smooth muscle cells (bundles of benign smooth muscle)
Leiomyoma
De novo from myometrial mesenchymal cell , devo after menopause, solitary lesion
Leiomyosarcoma
Soft, hemorrhagic, necrotic mass
Pathological Diagnostic Features
– Tumor necrosis, cytological atypia and mitosis (abnormal forms)
Leiomyosarcoma
Recurrence and mets are common in leimyosarcoma: will go to:
pelvis and lungs and bones
