Gyn Path 1 & Bleeding CPC Flashcards
What are signs of proliferative endometrium? (3)
Round/regular Glands
Stratified nuclei
Mitoses
What does secretory endothelium look like on day 17? (2)
Observe single row of nuclei in glands
Glandular epithelial cells contain uniform subnuclear vacuoles
What is first sign of ovulation?
Uniform subnuclear vacuoles
What signs are visible of normal endometrium on day 20-21? (2)
“Naked nuclei” Marked stromal edema
Intraluminal secretions
What is present in normal secretory endometrium on day 23/24? (2)
Spiral arteries Predicidual change (pinkening)
What is visible in secretory endometrium of day 27? (2)
Predecidua– confluent sheets of very eosinophilic cells
Lymphocytes
What are causes of abnormal uterine bleeding?
PALM-ON-ICE
Polyps, adenomyosis, leiomyoma, malignancy (related to uterus)
Ovulatory dysfunction; Not defined; Iatrogenic; Coagulapathy; endometrial
Dysfunctional Uterine Bleeding: What does it indicate?
Ovulatory dysfunction due to alteration of normal hormonal stimulation of endometrium
Why is there bleeding in dysfunction uterine bleeding?
Stromal and glandular breakdown
What is course of glandular/stromal breakdown?
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
What are histological signs of dysfunctional uterine bleeding?
Aggregation of stromal cells into condensed “blue balls”
Gland proliferation, irregularity
In which demographic is endometrial atrophy most common?
Endometrial atrophy is cause of 25-50% of uterine bleeding in postmenopausal women
What is main cause of endometrial atrophy?
Lack of estrogen stimulation
Describe histological appearance of endometrial atrophy (3)
Cystic enlargement of glands with thinning of epithelium
Storm is fibrotic and less cellular
Thickening of endometrial stripe
Endometrial polyps originate from ____
localized endometrial hyperplasia
How do endometrial polyps present? When do they typically present
Abnormal bleeding in 4th/5th decades
Describe gross appearance of endometrial polyp
Big white fixed mass in endometrial cavity
Describe histological appearance of polyp…how do glands appear?
Large tissue fragments with dense-walled arteries
Glands are crowded, irregular and dilated
Separate fragments of normal endometrium
What is a leiomyoma? Where do they typically appear? (4)
Benign smooth muscle tumor that can present in corpus, cervix uterine ligaments, ovaries
Describe epidemiology of leiomyomas: When do they typically present? Is everyone equally susceptible?
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
What is the etiology of leiomyomas? Under what conditions do they enlarge? (2)
They exhibit abnormal gene expression to maintain high sensitivity to estrogen– enlarge during pregnancy and under tamoxifen
How might a leiomyoma present? (6)
Uterine enlargement Pelvic mass Pelvic/abdominal pain Abnormal bleeding Spontaneous abortion Infertility
What are some complications of a leiomyoma? (3)
Torsion
Infarct
Separation from uterus– “parasitic leiomyoma”
Describe the gross appearance of leiomyomas?
Well circumscribed, solid, whorled, bulging from myometrium
Uterine enlargement
No necrosis/hemorrhage
