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Repro > Gyn Path 1 & Bleeding CPC > Flashcards

Gyn Path 1 & Bleeding CPC Flashcards

1
Q

What are signs of proliferative endometrium? (3)

A

Round/regular Glands
Stratified nuclei
Mitoses

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2
Q

What does secretory endothelium look like on day 17? (2)

A

Observe single row of nuclei in glands

Glandular epithelial cells contain uniform subnuclear vacuoles

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3
Q

What is first sign of ovulation?

A

Uniform subnuclear vacuoles

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4
Q

What signs are visible of normal endometrium on day 20-21? (2)

A

“Naked nuclei” Marked stromal edema

Intraluminal secretions

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5
Q

What is present in normal secretory endometrium on day 23/24? (2)

A 
Spiral arteries
Predicidual change (pinkening)
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6
Q

What is visible in secretory endometrium of day 27? (2)

A

Predecidua– confluent sheets of very eosinophilic cells

Lymphocytes

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7
Q

What are causes of abnormal uterine bleeding?

A

PALM-ON-ICE
Polyps, adenomyosis, leiomyoma, malignancy (related to uterus)
Ovulatory dysfunction; Not defined; Iatrogenic; Coagulapathy; endometrial

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8
Q

Dysfunctional Uterine Bleeding: What does it indicate?

A

Ovulatory dysfunction due to alteration of normal hormonal stimulation of endometrium

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9
Q

Why is there bleeding in dysfunction uterine bleeding?

A

Stromal and glandular breakdown

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10
Q

What is course of glandular/stromal breakdown?

A

Estrogen stimulates proliferation; lack of ovulation means no progesterone and continued proliferation
Glands become enlarged, irregular and outgrow vascular support leading to breakdown and bleeding

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11
Q

What are histological signs of dysfunctional uterine bleeding?

A

Aggregation of stromal cells into condensed “blue balls”

Gland proliferation, irregularity

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12
Q

In which demographic is endometrial atrophy most common?

A

Endometrial atrophy is cause of 25-50% of uterine bleeding in postmenopausal women

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13
Q

What is main cause of endometrial atrophy?

A

Lack of estrogen stimulation

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14
Q

Describe histological appearance of endometrial atrophy (3)

A

Cystic enlargement of glands with thinning of epithelium
Storm is fibrotic and less cellular
Thickening of endometrial stripe

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15
Q

Endometrial polyps originate from ____

A

localized endometrial hyperplasia

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16
Q

How do endometrial polyps present? When do they typically present

A

Abnormal bleeding in 4th/5th decades

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17
Q

Describe gross appearance of endometrial polyp

A

Big white fixed mass in endometrial cavity

18
Q

Describe histological appearance of polyp…how do glands appear?

A

Large tissue fragments with dense-walled arteries
Glands are crowded, irregular and dilated
Separate fragments of normal endometrium

19
Q

What is a leiomyoma? Where do they typically appear? (4)

A

Benign smooth muscle tumor that can present in corpus, cervix uterine ligaments, ovaries

20
Q

Describe epidemiology of leiomyomas: When do they typically present? Is everyone equally susceptible?

A

Leiomyomas present in 20-30% women over 30 and in more than 40% of women over 40.

They are more common in African American women– appear younger; are larger; are more often symptomatic

21
Q

What is the etiology of leiomyomas? Under what conditions do they enlarge? (2)

A

They exhibit abnormal gene expression to maintain high sensitivity to estrogen– enlarge during pregnancy and under tamoxifen

22
Q

How might a leiomyoma present? (6)

A 
Uterine enlargement
Pelvic mass
Pelvic/abdominal pain
Abnormal bleeding
Spontaneous abortion
Infertility
23
Q

What are some complications of a leiomyoma? (3)

A

Torsion
Infarct
Separation from uterus– “parasitic leiomyoma”

24
Q

Describe the gross appearance of leiomyomas?

A

Well circumscribed, solid, whorled, bulging from myometrium
Uterine enlargement
No necrosis/hemorrhage

25
Q

Describe the histological appearance of a leiomyoma:

Cells–cytoplasm and nuclei
Endometrial lining

A

Walled mass of uniform spindled cells
Cells have abundant pink cytoplasm and cigar-shaped nuclei with only rare mitoses
Thinning of endometrial lining above tumor

26
Q

Which groups are more susceptible to leiomyosarcomas? (2)

A

African American women and patients on tamoxifen

27
Q

What are gross features of leiomyosarcoma? (5)

Pattern, margin, color, etc.

A 
Loss of whorled pattern
Poorly defined margin
Yellow color
Necrosis/hemorrhage
Softer, no longer bulging
28
Q

Describe the histological features of a leiomyosarcoma: (5)

A 
Invasion of tissue/vasculature
Increased cellularity
Nuclear atypia--bizarre giant cells
Mitotic activity
Coagulative necrosis
29
Q

What is endometriosis? What are most frequent sites? (2)

A

Endometrial tissue outside uterine cavity– most frequently occurs in pelvic peritoneum and ovaries

30
Q

Which group is most affected by endometriosis? What is rate of endometriosis?

A

Rate is 4-10% of women in reproductive years. Also affects 25-50% infertile women and 5-25% women with pelvic pain

31
Q

What are risk factors for endometriosis? (2)

What are protective factors? (2)

A

Risk factors: genetics and increased exposure to menstrual products (duration of flow, volume of retrograde flow, cervical stenosis)

Protective factors: Multiparity, OCP

32
Q

What are the three theories of the pathogenesis of endometriosis?

A

Transplantation of endometrial fragments
Metaplasia of peritoneum
Induction of undifferentiated mesenchyme in ectopic tissues

33
Q

Describe the gross appearance of endometriosis: peritoneum vs. ovary

A

Peritoneum: Nodules– can be vesicles, red/blue, black (resolving)

Ovaries: cystic deposits…chocolate cyst

34
Q

What are classic symptoms of endometriosis? (4) Name some others due to unusual locations

A

Classic: dysmenorrhea, dyspareunia, pelvic pain, infertility

Others: ascites, hemoptysis, rectal bleeding, bowel obstruction, uterinal obstruction

35
Q

Describe histological appearance of endometriosis:

A

Presence of endometrial glands and stroma in the wrong place

36
Q

What is adenomyosis?

A

Presence of endometrial tissue within myometrium…it is continuity with endometrium

37
Q

How common is adenomyosis?

A

Occurs in 20% uteri

38
Q

What are symptoms of adenomyosis? (4)

A

Menometrorrhagia
Dysmenorrhea
Dyspareunia
Pelvic pain

39
Q

What is gross appearance of adenomyosis? (2)

A

Functional endometrial nests within myometrium

Foci of hemorrhagic cysts in uterine wall

40
Q

Describe the histological appearance of adenomyosis:

A

Nests of endometrial stroma and glands in myometrium near base of endometrium

Repro (29 decks)

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