GYN path 2 Flashcards
What is endometrial hyperplasia?
Non-physiologic, non-invasive proliferation of endometrium
What is the cause of endometrial hyperplasia?
Increased, unopposed estrogen effect
What is the clinical presentation of endometrial hyperplasia?
Abnormal bleeding
What age group is more affected with endometrial hyperplasia?
Perimenopausal years (anovulatory cycles leads to relative dec in progesterone, things are unbalanced)
What are the risk factors for endometrial hyperplasia?
Exogenous: estrogens
Endogenous:
-Ovarian lesions, obesity, hypertension, diabetes, reproductive factors (late menopause, early menarche, nulliparity=no births), smoking
What are some protective factors for endometrial hyperplasia?
- Large # births
- Old age at first birth
- Long birth pd
- Short premenopausal delivery-free pd
What are the histologic features of endometrial hyperplasia?
- Abundant material with curettage
- Diffuse abnormality
- Inc gland-to-stroma ratio
- Irregular gland shape/size
- Mitotic activity
What are the classifications of endometrial hyperplasia?
Hyperplasia without atypia (simple or complex=based on glandular complexity and amt of stroma)
Hyperplasia with atypia (simple or complex)
What classification type is most at risk for cancer?
Hyperplasia with atypia
What is the difference between hyperplasia and carcinoma?
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)
What is endometrial carcinoma?
Most common malignant tumor of female genital tract
What are the two types of endometrial carcinoma?
Type I: estrogen dependent (endometrioid type, related to hyperplasia)
Type II: estrogen independent (serous/clear cell type, not related to hyperplasia)
What is the difference between type I and type II with regards to unopposed estrogen?
I: present
II: absent
What is the difference between type I and type II with regards to menopausal status?
I: pre and peri
II: post
What is the difference between type I and type II with regards to precursor lesion?
I: Atypical hyperplasia
II: Intraepithelial carcinoma
What is the difference between type I and type II with regards to tumor grade?
I: Low
II: High
What is the difference between type I and type II with regards to myometrial invasion?
I: minimal
II: deep
(both are variable)
What is the difference between type I and type II with regards to histologic subtypes?
I: Endometrioid
II: Serous, clear cell
What is the difference between type I and type II with regards to behavior?
I: Indolent
II: Aggressive
What is the difference between type I and type II with regards to genetic alterations?
I: PTEN mut, K-ras mut, Microsatellite instability (proliferation)
II: P53 mut (no proliferation with abnormal nuclei)
What is stage I endometrial carcinoma?
Confined to uterus
IA: confined to endomet
IB: invades 50% myomet
What is stage II endometrial carcinoma?
Cervical involvement
IIA: Glandular involvement only
IIB: cervical and stromal involvement
What is stage III endometrial carcinoma?
Uterine serosa, adnexa, pos cytology, vaginal or pelvic LN metastases
What is stage IV endometrial carcinoma?
Invasion of bladder or bowel mucosa or distant metastases
