Female Reproductive Tract Pathology Part 3 (endometrium) Flashcards

1
Q

the mentrual cycle is driven through complex interactions of endocrine signals released from the _, _, and _

A

hypothalamus, pituitary, and ovaries

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2
Q

menstrual cycle abnormalities are caused by both _ lesions that affect secretion of estradiol and progesterone and _ disorders that affect the pituitary. or hypothalamic axis

A

ovarian

endocrine

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3
Q

the average menstrual cycle lasts _ days

A

28

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4
Q

during menses the superficial portion of _ is shed

A

endometrium

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5
Q

menses is followed by the / phase which is when there is a risk in estrogen levels that are released in response follicular stimulating hormone causing rapid growth of glands and stroma

A

follicular/proliferative phase

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6
Q

at the midpoint of the cycle _ and _ both surge causing a release of the egg from the ovary. After which the ovarian corpus luteum forms.

A

lutenizing hormone and follicule stimulating hormone

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7
Q

the corpus luteum releases a lot of _ driving the secretory ot luteal phase which prepares the endometrium to carry pregnancy

A

progesterone

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8
Q

if the egg is fertilized the corpus luteum will persists and form adequate amounts of progesterone to until the _ takes over

A

placenta

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9
Q

if fertilization does not occur the corpus luteum will degenerate and _ and _ levels will drop and menses will occur again

A

estrogen and progesterone

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10
Q

on histology what does the proliferative/follicular stage look like?

stroma
glands

A

cellular blue stroma with many round tubular glands

psuedostratification in glands with mitotic figures

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11
Q

unlike proliferative endometroim the glands of secretory endometrium are much more _

A

tortuous/serrated

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12
Q

in early secretory endometrium _ are present which mimics the apperance of piano keys

A

subliminal/subnuclear vacuoles

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13
Q

as the menstural cycle progresses in secretory endometrium the subnuclear vacules more adjacent to he lumen and evnetially give rise to _ secretions

A

luminal

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14
Q

the endometrial stroma in secretory endometrium starts out similar in apperance to strome of proliferative endometrium but by the end the stromal cells have abundant pink cytoplasm termed?

what else is present

A

predecidualized stroma

spiral arteries

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15
Q

during menses with a lack of progesterone the spiral arteries _ and the endometrial tissue becomes _

A

constict

ischemic

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16
Q

mestrual phase endometrium histology

A

tight blue clusters of stromal cells

sloughing off with hemorrhage

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17
Q

what is abnormal uterine bleeding?

A

bleeding that is longer, heavier or occurs outside of the time of menstruration

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18
Q

the most common subtype of abnormal uterine bleeding is?

A

dyfunctional uterine bleeding

  • hormone distubances that lead to anovulation

lacks a structural basis

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19
Q

in early adolescents anovulatory cyles are related to the immaturitry and lack of a fiunctioning _

A

hypothalamic-pituitary axis

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20
Q

in the perimenopasal period anovulatory cycles are caused by _ imbalances culminating in menopause

21
Q

anatomic lesions can cause abnormal uterine bleeding as you increase in age these lesions are more suggextive of?

A

a malignant lesion/process

22
Q

anvoulatory cycles leading to AUB are most commonly caused by hormone imbalances during menarch and the perimenopausal period. What other disorders can lead to an anovulatory cycle and AUB?

A

ovarian lesions like PCOS

Obesity

endocrine disorders: thyroid, adrenal, pituitary disease)

23
Q

how does obesity increase estrogen levels

A

these is peripheral conversion to estrogen in adipose tissue

24
Q

acute endometritis is an acute infection of the _ and is a relatively common cause of _, _ , and _

A

post partum fever

uterine tenderness

abdominal pain

25
often times acute endometritis occurs after _ and is precipiated by reatin products of _
pregnancy conception
26
acute endometritis is caused by _ infection
bacterial
27
acute endometritis on histology
acute inflammation with neutrophils and microabcess formation
28
the hitologic hallmark of chronic endometritis is ?
plasma cells in the stroma
29
how do plasma cells look?
eccentrically placed nucleus with cleared halo (perinuclear hoff) clearing is representative of where immunoglobulines are made
30
what causes chronic endometritis?
retained products of conception, PID (especially the chlaymdia type) **IUD**
31
intrauterine devices are associated with infections like fungus-like bacteria _
actinomyces
32
_ is a rare cause of endometritis
tuberculosis
33
symptoms of chronic endometritis
abnormal bleeding (postcoital, intermenstural), crampy lower abdominal pain
34
endometriosis is _ ?
ectopic endometrial tissue outside of the uterus
35
endometriosis commonly affects what sites?
ovaries and pelvic tissue (ligaments, serosal surfaces) however it can be found in different locations like the fallopian tubes, colon, small intestine, bladder etc.
36
ectopic deometrium reacts to the _ (same/different) hormonal signals that the normal endometrium reacts to, causing it to buildup and breakdown during menses
same
37
symptoms of endometriosis
severe menstrual cramps (dysmenorrhea) , dyspareuinia (pain with intercourse) and issues with infertility sometimes if the ectopic tissue is on the ovary it can present with an ovarian mass
38
what are some theories about the pathogenesis of endometriosis
regurgitation theory- retrograde flow of normal endometrial tissue benign metastases- spread through lymphatics of bloodstream metaplastic theory- embryologic reminants extrauterine stem cell theory - from bone marrow
39
persistance and survivial of ectopic endometrial tissue in endometriosis is achieved through?
proinflammatory and inflammatory factors like IL-1, TNFa, etc. metalloproteases aromatase enzyme production from endometrial stromal cells that increase estrogen and lead to more robust implants/response mutations in the ectopic endometrial tissue that allows them to survive outside of their normal environment the endometrium
40
gross findings of endometriosis
red-brown to blue-black lesion termed powder burn lesions on the surface
41
when endometriosis involves the ovary it can create?
a large blood filled cysts termed a chocolate cyst
42
on histology of endometriosis 2/3 of the following need to be seen?
1. endometrial glands 2. endometrial stroma 3. hemosiderin laden macrophages: shows hemorrage
43
what is hemosiderin?
a brown granular pigment that is a byproduct of breakdown of red blood cells
44
what is adenomyosis
endometrial tissue in the myometrium (muscle of the uterus)
45
clinical findings of adenomyosis?
same as endometriosis: painful menses, pain with intercourse, infertility
46
endometrial polyps are _ (endophytic/exophiitic) and are _ (benign/malignant)
exophytic meaning they protrufe from the surface of the endometrium benign ## Footnote cystically dilated glands and stroma : polypoid apperance
47
the formation and growth of a endometrial polyp is through?
estrogenic factors the most important is tamoxifen use can be obesity, hormone replacement etc.
48
what is one of the most common causes of vaginal bleeding
endometrial polyps
49
what is tamoxifen?
a selective estrogen modulator that inhibits estrogen effect in the breast but increases estrogen in the endometrium