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ENRP II > Female Reproductive Tract Pathology Part 3 (endometrium) > Flashcards

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

A

hormone

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
Q

often times acute endometritis occurs after _ and is precipiated by reatin products of _

A

pregnancy

conception

26
Q

acute endometritis is caused by _ infection

A

bacterial

27
Q

acute endometritis on histology

A

acute inflammation with neutrophils and microabcess formation

28
Q

the hitologic hallmark of chronic endometritis is ?

A

plasma cells in the stroma

29
Q

how do plasma cells look?

A

eccentrically placed nucleus with cleared halo (perinuclear hoff)

clearing is representative of where immunoglobulines are made

30
Q

what causes chronic endometritis?

A

retained products of conception, PID (especially the chlaymdia type)

IUD

31
Q

intrauterine devices are associated with infections like fungus-like bacteria _

A

actinomyces

32
Q

_ is a rare cause of endometritis

A

tuberculosis

33
Q

symptoms of chronic endometritis

A

abnormal bleeding (postcoital, intermenstural), crampy lower abdominal pain

34
Q

endometriosis is _ ?

A

ectopic endometrial tissue outside of the uterus

35
Q

endometriosis commonly affects what sites?

A

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
Q

ectopic deometrium reacts to the _ (same/different) hormonal signals that the normal endometrium reacts to, causing it to buildup and breakdown during menses

A

same

37
Q

symptoms of endometriosis

A

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
Q

what are some theories about the pathogenesis of endometriosis

A

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
Q

persistance and survivial of ectopic endometrial tissue in endometriosis is achieved through?

A

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
Q

gross findings of endometriosis

A

red-brown to blue-black lesion termed powder burn lesions on the surface

41
Q

when endometriosis involves the ovary it can create?

A

a large blood filled cysts termed a chocolate cyst

42
Q

on histology of endometriosis 2/3 of the following need to be seen?

A
  1. endometrial glands
  2. endometrial stroma
  3. hemosiderin laden macrophages: shows hemorrage
43
Q

what is hemosiderin?

A

a brown granular pigment that is a byproduct of breakdown of red blood cells

44
Q

what is adenomyosis

A

endometrial tissue in the myometrium (muscle of the uterus)

45
Q

clinical findings of adenomyosis?

A

same as endometriosis: painful menses, pain with intercourse, infertility

46
Q

endometrial polyps are _ (endophytic/exophiitic) and are _ (benign/malignant)

A

exophytic meaning they protrufe from the surface of the endometrium

benign

cystically dilated glands and stroma : polypoid apperance

47
Q

the formation and growth of a endometrial polyp is through?

A

estrogenic factors the most important is tamoxifen use

can be obesity, hormone replacement etc.

48
Q

what is one of the most common causes of vaginal bleeding

A

endometrial polyps

49
Q

what is tamoxifen?

A

a selective estrogen modulator that inhibits estrogen effect in the breast but increases estrogen in the endometrium

ENRP II (25 decks)

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