Gynecologic Pathology I Flashcards
Indications for endometrial biopsy
determine cause of abnormal uterine bleeding, evacuation of ectopic pregnancy, assess response of endometrium to hormone tx
____ phase is the first 36-48 hours between ovulation and first histologic changes due to ovulation
interval
What is the first histologic evidence of ovulation
abundant subnuclear vacuoles
Histologic features of proliferative endometrium
mitoses, round regular glands, stratified nuclei
Histologic features of early secretory endometrium
subnuclear vacuoles, single row of nuclei
Histologic features of mid secretory endometrium (day 20-21)
prominent spiral arteries and predecidual change around them
Histologic features of late secretory endometrium (day 26-27)
confluent sheets of predecidua (pink) and lymphocytes
Excessive bleeding in both amount and duration of flow occurring at regular intervals.
Menorrhagia
Bleeding, usually not heavy, occurring at irregular intervals.
Metrorrhagia
Excessive bleeding with prolonged period of flow occurring at frequent and irregular intervals.
Menometrorrhagia
Painful menses
Dysmenorrhea
Abnormal bleeding that occurs at least one year after menopause.
Postmenopausal bleeding.
Abnormal bleeding prior to puberty may indicate
precocious puberty
Adolescent abnormal bleeding may indicate
dysfunctional bleeding or complications of pregnancy
Abnormal bleeding during reproductive years may indicate
complications of pregnancy, endometritis, dysfunctional bleeding, lesions
Abnormal bleeding in later years may indicate
atrophy, carcinoma, lesions
Alteration of the normal cyclical hormonal stimulation of the endometrium that is not postmenopausal bleeding or that does not occur in the presence of a pathologic process.
Dysfunctional uterine bleeding DUB
Clinically, DUB indicates _____
ovulatory dysfunction
Common histologic finding of DUB
stromal and glandular breakdown
Pathophysiology of DUB
without progesterone, estrogen will result in continued proliferation –> gland enlargement, irregular, disordered –> insufficient vascular support –> breakdown and bleeding
Collapse of stroma form what histological feature?
stromal blue balls –> collapsed, condensed balls with attenuated epithelial surface
____ is a result of lack of estrogen stimulation causing 25-50% of abnormal uterine bleeding in postmenopausal women.
endometrial atrophy –> cystic change of glands is common
cystic atrophy of endometrium
stroma is less cellular and fibrotic; glands are cystically enlarged//no mitoses
localized hyperplasia of basal endometrium present with abnormal bleeding and with no malignant potential
endometrial polyps
Grossly, endometrial polyps can be ____ or ____ . (think jellyfish)
sessile or pedunculated
Histologic features of polyps
irregular glands, thick walled blood vessels
Benign smooth muscle tumor of the corpus, cervix, uterine ligaments, or ovaries.
leiomyoma/fibroids
T/F leiomyomas are more common in AAs
T
How are leiomyomas classified?
location
leiomyoma in wall of myometrium
intramural
leiomyoma under endometrium
submucosal
leiomyoma on outer surface of uterus
subserosal
symptoms of leiomyoma
uterine enlargement, multiple leiomyomas, abnormal bleeding, painful menses, infertility, spontaneous abortion
complications of a pedunculated fibroid
torsion, infarction, separation from uterus = parasitic leiomyoma
Difference between endometrial polyp and submucosal leiomyoma under hysteroscopy
submucosal leiomyoma has thinner membrane with visualizable blood vessel
Difference between submucosal leiomyoma and endometrial polyp
former is a tumor of the myometrium and the latter arises from the endometrium
Typical leiomyoma cut surface
well circumscribed, bulges from myometrium, solid white/tan, whorled appearance, no necrosis or hemorrhage
Typical leiomyoma histological features
uniform, bland spindled muscle cells with fascicular arrangement, abundant pink cytoplasm, uniform/oval/cigar nuclei, fine chromatin, rare mitoses
malignant counterpart of leiomyoma of the smooth muscle of uterus
leiomyosarcoma
Which groups have higher rate of leiomyosarcoma?
AAs and pts on tamoxifen
leiomyosarcoma gross features
loss of whorls, irregular margin, yellow, necrosis, hemorrhage
Diagnostic features of leiomyosarcoma
invasion of myometrium, vascular invasion, increased cellularity, nuclear atypia, increased mitotic activity, coagulative necrosis
Endometrial tissue (glands and stroma) outside uterine cavity in women of reproductive age –> pelvic peritoneum and ovaries.
endometriosis
Risk factors for endometriosis
genetic, increased exposure to menstruation (cervical stenosis, volume of retrograde menstruation, duration of flow)
3 theories of endometriosis pathophysiology
transplantation, metaplasia, induction
endometriosis transplantation
endometrial fragments migrate to ectopic sites
endometriosis metaplasia
metaplasia of peritoneum
endometriosis induction
induction of undifferentiated mesenchyme in ectopic sites to form endometriotic tissue
Chocolate cyst
endometriotic cyst of ovary –> thick brown cyst content
Symptoms of endometriosis
secondary dysmenorrhea, pelvic pain, ascites, dyspareunia, infertility
T/F there is no correlation between severity of symptoms and extent of endometriosis
T
Presence of endometrial tissue within the uterine wall.
adenomyosis –> downgrowth of tissue into and between smooth muscle fascicles
Symptoms of adenomyosis
menometorrhagia, dysmenorrhea, dyspareunia, pelvic pain
Gross features of adenomyosis
functional endometrial nests within myometrium producing foci of hemorrhagic cysts in uterine wall
