Gyn. Path. 2 Flashcards
What is endometrial hyperplasia? Is it invasive?
Non-physiologic, non-invasive proliferation of the endometrium.
What causes endometrial proliferation?
How does it present?
Too much estrogen. (and/or not enough progesterone)
Presents as bleeding.
What’s an exogenous risk factor for endometrial hyperplasia?
Exogenous estrogens, esp tamoxifen.
What are some endogenous risk factors for endometrial hyperplasia?
Ovarian lesions (stromal tumors, PCOS, etc.)
Obesity
Hypertension
Diabetes
Reproductive features like nulliparity etc. (less P4)
Cigarettes
Protective factors for endometrial hypeplasia?
Anything that increases progesterone:
Eg. having lots of babies.
How is endometrial going to look different, grossly, from a polyp?
Endometrial hyperplasia is going to be diffuse and all over the place, not focal like a polyp.
What can you see on an ultrasound of endometrial hyperplasia?
Thickening of the endometrial stripe.
Histological features of endometrial hyperplasia? (4 things)
Increased gland-to-stroma ratio.
Irregular gland shape.
Variation in gland size.
Frequent mitoses.
What are 2 different axes for classifying endometrial hyperplasia? Which axis is more important?
Which combination is worst?
Simple vs. complex.
No atypia vs. atypia. <- more important.
Complex with atypia is most likely to progress to cancer.
What does simple vs. complex refer to in endometrial hyperplasia?
Simple: nice, round glands
Complex: jagged, irregular gland architecture
What does atypia mean in the context of endometrial hyperplasia?
Atypia: nuclei look cancerous (open chromatin, prominent nuclei), not in one neat layer at the base of gland epithelium.
2 categories of criteria that distinguish endometrial carcinoma from hyperplasia?
Invasion of the myometrial.
Invasion of the stroma.
What are 3 histological manifestations of endometrial carcinoma invading the stroma?
Irregular infiltration of glands with altered fibroblastic stroma.
Cribriform glands (confluent, uninterrupted by stroma)
Extensive papillary pattern.
What’s in the papillae of the “papillary” pattern of endometrial carcinoma?
A fibrovascular core.
What are the two types of endometrial carcinoma? What sets them apart? What are each called based on histology?
Type I: Estrogen dependent. Endometrioid.
Type II: Not estrogen dependent. Serous type or clear cell type.
Who does Type I endometrial carcinoma tend to affect?
What is the precursor lesion?
What grade are the cancers, relative to Type II?
Pre-menopausal and peri-menopausal women.
Precursor lesion: Atypical hyperplasia
Cancers tend to be lower grade and indolent.
Who does Type II endometrial carcinoma tend to affect?
What is the precursor lesion?
What grade are the cancers usually, relative to Type I?
Post-menopausal women.
Precursor lesion: Intraepithelial carcinoma.
Tends to be higher grade and aggressive.
What genetic abnormalities are associated with Type I endometrial carcinomas? (3 things)
PTEN mutation
K-ras mutation
Microsatellite instability
What genetic abnormality is associated with Type II endometrial carcinoma?
Loss of p53.
Histologic progression of Type II endometrial carcinoma?
Goes straight from intraepithelial carcinoma to papillary growth.
What is the clinically relevant threshold for extent of myometrial invasion of endometrial carcinoma? What do you do if that threshold is crossed?
Invasion into 50% the thickness of the wall.
If more than that, sample the lymph nodes.
5 year survival rates for endometrial cancer overall?
For localized disease?
75-80% overall. 90% for localized disease.
By stage, Type I and Type II have similar prognoses, but Type I tend to be found at lower stages.
What’s the most common type of cervical carcinoma?
Common presentation?
Squamous carcinoma (adenocarcinoma and others are rare) Abnormal bleeding, post-coital bleeding.
What’s the strongest risk factor for cervical squamous carcinoma? (come on, you know this) What specific subtypes are linked with cervical squamous carcinoma?
HPV infection with subtypes 16 and 18
and several other subtypes… but 16 and 18 are most common
Micro review: What specific genes in high-risk HPV make them oncogenic?
E6 and E7 (they do a bunch a stuff, including interfering with P53)
Also, high risk integrates, low risk stays in episome.
Where in the cervix is usually the first site of pre-neoplastic lesions?
The squamo-epithelial junction / transition zone.
What are the 4 different possible results from a pap smear?
Normal
ASC-US: atypical squamous cell of undetermined significance
LSIL: Low-grade squamous intraepithelial lesion (“Low-SIL”)
HSIL: High-grade squamous intraepithlial lesion (“High-SIL”)
4 phases of cervical carcinoma progression you can see in cervical biopsy?
Normal
CIN1 - mild dysplasia
CIN3 - severe dysplasia, but no invasion
Microinvasion
How many women die a day of cervical carcinoma in the US? In the world?
About 10/day in the US. (better than it used to be, still pretty bad)
About 789/day in the world. (countries with good screening have a lot less mortality)
2 gross patterns of invasion of cervical carcinoma?
Invading entire cervix -> “barrel cervix”
Fungating growth, often into vagina.
