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GYN path 2 Flashcards

1
Q

What is endometrial hyperplasia?

A

Non-physiologic, non-invasive proliferation of endometrium

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2
Q

What is the cause of endometrial hyperplasia?

A

Increased, unopposed estrogen effect

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3
Q

What is the clinical presentation of endometrial hyperplasia?

A

Abnormal bleeding

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4
Q

What age group is more affected with endometrial hyperplasia?

A

Perimenopausal years (anovulatory cycles leads to relative dec in progesterone, things are unbalanced)

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5
Q

What are the risk factors for endometrial hyperplasia?

A

Exogenous: estrogens

Endogenous:
-Ovarian lesions, obesity, hypertension, diabetes, reproductive factors (late menopause, early menarche, nulliparity=no births), smoking

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6
Q

What are some protective factors for endometrial hyperplasia?

A
  • Large # births
  • Old age at first birth
  • Long birth pd
  • Short premenopausal delivery-free pd
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7
Q

What are the histologic features of endometrial hyperplasia?

A
  • Abundant material with curettage
  • Diffuse abnormality
  • Inc gland-to-stroma ratio
  • Irregular gland shape/size
  • Mitotic activity
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8
Q

What are the classifications of endometrial hyperplasia?

A

Hyperplasia without atypia (simple or complex=based on glandular complexity and amt of stroma)

Hyperplasia with atypia (simple or complex)

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9
Q

What classification type is most at risk for cancer?

A

Hyperplasia with atypia

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10
Q

What is the difference between hyperplasia and carcinoma?

A

Carcinoma has…

  • Myometrial invasion
  • Invasion of endometrial stroma–any of the 3
    1. Irregular infiltration of glands associated with altered fibroblastic stroma (desmoplastic response=growth of fibrous or connective tissue)
    2. Confluent glandular pattern uninterrupted by stroma (cribriform glands=like honeycomb cereal)
    3. Extensive papillary pattern (fibrovascular cores lined by epithelial cells)
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11
Q

What is endometrial carcinoma?

A

Most common malignant tumor of female genital tract

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12
Q

What are the two types of endometrial carcinoma?

A

Type I: estrogen dependent (endometrioid type, related to hyperplasia)

Type II: estrogen independent (serous/clear cell type, not related to hyperplasia)

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13
Q

What is the difference between type I and type II with regards to unopposed estrogen?

A

I: present

II: absent

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14
Q

What is the difference between type I and type II with regards to menopausal status?

A

I: pre and peri

II: post

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15
Q

What is the difference between type I and type II with regards to precursor lesion?

A

I: Atypical hyperplasia

II: Intraepithelial carcinoma

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16
Q

What is the difference between type I and type II with regards to tumor grade?

A

I: Low

II: High

17
Q

What is the difference between type I and type II with regards to myometrial invasion?

A

I: minimal

II: deep

(both are variable)

18
Q

What is the difference between type I and type II with regards to histologic subtypes?

A

I: Endometrioid

II: Serous, clear cell

19
Q

What is the difference between type I and type II with regards to behavior?

A

I: Indolent

II: Aggressive

20
Q

What is the difference between type I and type II with regards to genetic alterations?

A

I: PTEN mut, K-ras mut, Microsatellite instability (proliferation)

II: P53 mut (no proliferation with abnormal nuclei)

21
Q

What is stage I endometrial carcinoma?

A

Confined to uterus
IA: confined to endomet
IB: invades 50% myomet

22
Q

What is stage II endometrial carcinoma?

A

Cervical involvement
IIA: Glandular involvement only
IIB: cervical and stromal involvement

23
Q

What is stage III endometrial carcinoma?

A

Uterine serosa, adnexa, pos cytology, vaginal or pelvic LN metastases

24
Q

What is stage IV endometrial carcinoma?

A

Invasion of bladder or bowel mucosa or distant metastases

25
Q

What is the prognosis for endometrial carcinoma?

A

Survival rate of 75-80%
African Americans=poorer prognosis
Survival for localized disease is 90%

26
Q

What are the symptoms/signs of cervical cancer?

A

Abnormal vaginal bleeding, post-coital bleeding

27
Q

What are the risk factors for cervical cancer?

A

HPV 16, 18

Less evidence: >6 sexual partners, smoking, early age 1st interocourse, immunosuppresion

28
Q

What are the precursor lesions to cervical cancer?

A

Dysplasia of inc severity (CIN1-3), detection by pap and histology

29
Q

Where do precursor lesions to cervical cancer occur?

A

Squamocolumnar jxn (transformation zone)

30
Q

What viral genes of high risk HPV cause the cellular transformation?

A

E6 and E7 genes

31
Q

What is necessary for dev of cancer?

A

HPV persistence since immune system can often reverse low grade lesions

Reproduction (23 decks)

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