Female Reproductive Tract Pathology Part 2 Flashcards
What is the overall appearance of the proliferative endometrium?
cellular blue stroma with many round to tubular glands
glands are relatively straight in cross section and show pseudostratification of nuclei with readily identifiable mitotic figures
What is the overall histologic appearance of the secretory phase endometrium?
the glands of secretory endometrium are much more tortuous and serrated
in early secretory endometrium: subnuclear vacuoles are present which mimic an appearance of piano keys
what is the overall histologic appearance of the menstrual phase endometrium?
the endometrial stroma breaks down into tight blue clusters
what is the most common subtype of abnormal uterine bleeding?
dysfunctional uterine bleeding, which is uterine bleeding that lacks an underlying structural basis
of the causes of dysfunctional uterine bleeding, what is the most common?
hormonal disturbances which result in lack of ovulation (termed an anovulatory cycle)
what is acute endometritis?
What are the histological findings?
What is it caused by?
an acute infection of the endometrium
neutrophils infiltrating and destroying endometrial epithelium +/- microabscesses
caused by: bacterial infection (group A strep, staphylococci) after delivery
What is chronic endometritis?
What is it caused by?
What is the histologic hallmark?
What is the clinical presentation?
Caused by: retained products of conception
chronic PID
IUD (actinomyces)
the histologic hallmark is plasma cells within the stroma
clinical presentation: often asymptomatic but can see abnormal bleeding, crampy lower abdominal pain
what is endometriosis?
“ectopic” endometrial tissue outside of the uterus
commonly affects the ovaries and pelvic tissue
What are the clinical findings associated with endometriosis?
severe dysmenorrhea, ovarian mass, dyspareunia, also infertility
What are the morphologic gross features of endometriosis?
gross findings: endometriosis appears as red-brown to blue-black lesions termed “powder-burn” lesions which often are seen involving a serosal or peritoneal surface
what is it called when endometriosis involves the ovary?
it can create a large blood filled cyst called a chocolate cyst
what are the histologic findings associated with endometriosis?
endometrial glands
endometrial stroma
hemosiderin laden macrophages (evidence of hemorrhage)
*need 2 of 3 for diagnosis
what is adenomyosis?
what are the clinical findings?
endometriotic tissue in the muscle of the uterus (myometrium)
can be identical to those seen in endometriosis
what are endometrial polyps?
benign exophytic hyperplastic polypoid neoplastic-like masses
The growth and formation of endometrial polyps is promoted by?
certain proestrogenic factors, the most important being tamoxifen
What is endometrial hyperplasia?
increase in the number of endometrial glands relative to the stroma, premalignant condition
what are the two types of endometrial hyperplasia?
typical hyperplasia and atypical hyperplasia
what do the nuclei look like in atypical hyperplasia?
they show enlargement with rounding and identifiable nucleoli
what are some risk factors for endometrial hyperplasia and carcinoma?
chronic, unopposed estrogen
obesity
PCOS
There are estrogen producing tumors, which can increase risk for endometrial hyperplasia and carcinoma. Which are they?
granulosa cell tumor and thecoma of the ovary
what is the most common type of endometrial carcinoma?
endometroid carcinoma of the uterus
what are the histologic characteristics of endometrioid carcinoma of the uterus?
it histologically mimics normal endometrium
which endometrial cancer typically has a papillary growth pattern with marked cytologic atypia?
serous carcinoma of the uterus
what is serous carcinoma of the uterus strongly associated with?
TP53
what is malignant mixed mullerian tumor?
MMMT
rare, aggressive, same demographic group as serous carcinoma
comprised of both malignant glands and malignant stroma
What is lynch syndrome?
an autosomal dominant disorder which runs in families in which there is a mutation in a mismatch repair gene
which mismatch repair gene is the most important in lynch syndrome and why?
MLH1 and MSH2
they give the highest risk for colorectal carcinoma
mutation in mismatch repair gene (including MLH1 and MSH2) leads to what?
microsatellite instability (MSI)
what are the major molecular abnormalities associated with type I endometrial carcinoma?
PTEN
P13K/AKT
MSI
what is adenosarcoma of the uterus?
rare, low grade malignancy
consists of benign glands and malignant stroma (sarcoma)
what is low grade endometrial stromal sarcoma?
relatively rare malignant tumor of endometrial stroma
invades myometrium and/or has lymph/vascular invasion
what is low grade endometrial stromal sarcoma associated with?
JAZF1 gene translocation
unlike leiomyoma, leiomyosarcoma presents with what 3 histological findings?
- atypia
- increased mitoses
- tumor necrosis
the two benign cysts of the ovary are?
the follicular cyst
the luteal cyst
what is the follicular cyst derived from?
What lines it?
derived from ovarian follicle
lined by inner layer of granulosa cells, outer layer of follicular cells
what is the luteal cyst derived from?
what is it lined by?
occurs when corpus luteum fails to regress
lined by: luteinized inner granulosa cells, outer theca cells
what is an adenomatoid tumor?
rare, benign tumor of mesothelial origin
most common tumor of the fallopian tube
PCOS is a complex syndrome characterized by what 4 things?
hyperandrogenism
hormonal imbalance (increased LH, decreased FSH)
insulin resistance
polycystic ovaries
