Female Pathology - Uterus

Question 1

How can the functional endometrium be subdivided?

Answer 1

• Secretory endometrium
  
  • Tortuous secretory glands + pseudodecidualized stroma
• Proliferative endometrium

Question 2

What conditions can affect the uterine body?

Answer 2

1. Inflammation/endometritis/pelvic inflammatory disease
2. Polyps
3. Adenomyosis
4. Leiomyomas
5. Premalignant (hyperplasia)
6. Malignancies

Question 3

What is common between the conditions that affect the uterine body?

Answer 3

All uterine body conditions may lead to dysfunctional and/or abnormal bleeding

Question 4

1. What is endometritis?
2. What can cause it?
3. What can be seen in the stroma?

Answer 4

1. Inflammation of Endometrium
   
   • Acute/Chronic
2. Due to:
   
   • PID
   • Retained POC
   • IUD
3. Plasma cells in the endometrial stroma

Question 5

Endometrial Polyps

• Definition:
• Clinical Signs:
• Prevalence:
• Immunohistochemistry:
• Polyp Type:
• Appearance of glands:

Answer 5

• Benign biphasic neoplastic growth (glands and stroma)
• Dysfuntional bleeding
• Most common ± menopause
• Rearrangement of 6p21
• Intrauterine sessile or pedunculated growth
• Dilated glands

Question 6

Endometriosis:

• Definition:
• Clinical Signs:
• Characteristic Finding:
• Discharge of blood leads to ….
• Histology:

Answer 6

• Presence of endometrial glands and stroma outside of uterus
• Cyclic bleeding
• Can become blood filled cysts (chocolate cyst)
• Discharge of blood leads to reactive changes, fibrosis and adhesions
• Histology:
  
  • Endometrial glands + stroma
  • ± hemosiderin

Question 7

• What is adenomyosis?
• What are the histological changes?
• What is the clinical sign?

Answer 7

• Growth of endometrium in the myometrium
• Histology:
  
  • Enlarged, nodular myometrium with cysts
  • Hemorrhagic cysts in functional endometrium
• Clinical Signs:
  
  • Abnormal uterine bleeding
  • Infertility

Question 8

What can cause endometrial disorders?

Answer 8

1. hyperplasia
2. prolonged/excess estrogen

Question 9

What defines endometrial hyperplasia (4)?

Answer 9

1. Exagerated endometrial proliferation
2. Abnormal glandular architecture
3. Increase gland/stroma ratio ( > 1:1)
4. Nuclear atypia

Question 10

What can lead to prolonged/excess estrogen (3)?

Answer 10

1. Obesity
2. Anovulation
3. Estrogen producing tumors

Question 11

What changes are seen in endometrial adenocarcinoma?

Answer 11

1. Back to back glands
2. Cellular atypia
3. Abundant mitosis, including abnormal forms
4. Necrosis

Question 12

What are the risk factors for endometrial disorders?

Answer 12

• Obesity
• Diabetes
• Hypertension
• Infertility
• Exposure to unopposed estrogen

Question 13

Is there a risk for adenocarcinoma if endometrial hyperplasia is present?

Answer 13

Yes

• 5% risk of progression to carcinoma in hyperplasia without atypia
• 20%-50% risk of carcinoma in hyperplasia with atypia

Question 14

Type I Endometrial Adenocarcinoma:

• Endometrial hyperplasia association?
• Grade:
• Estrogen dependence?
• Progression:
• Mutation:

Answer 14

• In a background of endometrial hyperplasia
• Low grade endometrioid and mucinous adenocarcinoma
• Estrogen dependent
• Progression:
  
  • Hyperplasia-carcinoma sequence
• Mutation in Mismatch repair (HNPCC) ;
  
  • tumor suppressor gene PTEN (Cowden syndrome)

Question 15

Type II Endometrial Adenocarcinoma

• Association with endometrial hyperplasia?
• Mutation:
• Demographics:

Answer 15

• Usually in a atrophic background
  
  • Independent of endometrial hyperplasia
• p53 mutation
• Older women; more aggressive
  
  • High grade endometrioidcarcinoma
  • Serous carcinoma
  • Clear cell carcinoma
  • Carcinosarcoma
  • Undifferentiated

Question 16

What is also known as fibroids?

Answer 16

Leiomyoma

Question 17

Leiomyoma

• Prevalence:
• Symptoms:
• Apperance:
• Pathogenesis:

Answer 17

• Most common benign tumors in females (35%-50%)
  
  • Blacks > whites
• Asymptomatic, usually
  
  • Abnormal bleeding
• Sharply demarcated tumors
  
  • Usually multiple
  • Submucosal, intramural and subserosal
• Monoclonal proliferation of smooth muscle cells (bundles of benign smooth muscle)

Question 18

What is the relation between leiomyoma and leiomyosarcoma?

Answer 18

**No relation**

Question 19

Leiomyosarcoma

• Pathogenesis:
• Demographics:
• Appearance:
• Pathological Diagnostic Features:
• Recurrence and Metastasis?

Answer 19

• De novo from myometrialmesenchymal cells
• Post menopausal
• Solitary
  
  • Soft, hemorrhagic, necrotic mass
• Pathological Diagnostic Features
  
  • Tumor necrosis, cytological atypiaand mitosis (abnormal forms)
• Recurrence and metastasis are common
  
  • Pelvis, lungs, bones