Gynecologic Pathology II Flashcards
Non-physiologic, non-invasive proliferation of endometrium
endometrial hyperplasia
endometrial hyperplasia is caused by _____
increased, unopposed estrogen effect
endometrial hyperplasia clinical presentation
abnormal bleeding
protective factors for endometrial hyperplasia
progesterone, large # births, old age at first birth, long birth period, short premenopausal delivery free period
Exogenous risk factor for endometrial hyperplasia
tamoxifen
histologic features of endometrial hyperplasia
abundant material with curettage, diffuse abnormality –> increased gland to stroma ratio, irregularities in gland shape, variation in gland size, mitotic activity
hyperplasia without atypia vs hyperplasia with atypia
gland architecture (simple vs complex)
Prominent nuclei in endometrial hyperplasia histology suggest
atypia
Risk of cancer after diagnosis of endometrial hyperplasia is highest among those with ____
complex with atypia = 29%–> risk doesn’t change if hysterectomy is done immediately after
Distinguishing endometrial hyperplasia from carcinoma
myometrial invasion or invasion of endometrial stroma suggest carcinoma (ie desmoplastic response, cribiform glands, extensive papillary pattern)
irregular infiltration of glands associated with altered fibroblastic stroma
desmoplastic response
confluent glandular pattern uninterrupted by stroma
cribiform glands
fibrovascular cores lined by epithelial cells
papillae indicative of papillary growth pattern
Most common malignant tumor of female genital tract
endometrial carcinoma
Type I endometrial carcinoma
estrogen dependent endometrioid type –> 80-85%
Type II endometrial carcinoma
non-estrogen dependent –>15-20%
2 types of Type II endometrial carcinoma
serous type, clear cell type
Type I or Type II endometrial carcinoma? unopposed estrogen
Type I
Type I or Type II endometrial carcinoma? pre and perimenopausal
Type I
Type I or Type II endometrial carcinoma? post menopausal
Type II
Type I or Type II endometrial carcinoma? precursor lesion = atypical hyperplasia
Type I
Type I or Type II endometrial carcinoma? precursor lesion = intraepithelial carcinoma
Type II
Type I or Type II endometrial carcinoma? low tumor grade
Type I
Type I or Type II endometrial carcinoma? high tumor grade
Type II
Type I or Type II endometrial carcinoma? variable/minimal myometrial invasion
Type I
Type I or Type II endometrial carcinoma? deep myometrial invasion
Type II
Type I or Type II endometrial carcinoma? indolent
Type I
Type I or Type II endometrial carcinoma? aggressive
Type II
Type I or Type II endometrial carcinoma? PTEN, kras, microsatellite instability
Type I
Type I or Type II endometrial carcinoma? p53
Type II
Psamomma bodies
calcifications in serous type ii endometrial carcinoma
Stage I endometrial cancer
confined to uterus –:> a= endometrium, b = 50% myometrial invasion
Stage II endometrial cancer
cervical involvement –> a = glandular, b = cervical stromal involvement
Stage III endometrial cancer
uterine serosa, adnexa, positive cytology, vaginal or pelvic LN metastases
Stage IV endometrial cancer
invasion of bladder or bowel mucosa or distant metastases
85% of cervical cancer are ___ type
squamous +15% adenocarcinoma
symptoms of cervical cancer
abnormal bleeding, post-coital bleeding
risk factor for cervical cancer
hpv, cigarette smoking, immunosuppression, multiple partners, early age at 1st intercourse
precursor lesion for cervical cancer
dysplasia of increasing severity
detection of cervical cancer
pap smear
low risk hpv subtypes can lead to genital warts called ___
condyloma cunimatum
high risk hpv subtypes for cancer
16 and 18
low risk hpv subtypes for cancer
6 and 11
viral ______ genes of high risk hpv can cause cellular transformation
E6 and E7
T/F HPV persistence is necessary for progression to cancer
T
if pap is negative and high risk hpv negative, the risk of CIN 3 or invasive carcinoma in the next three years is ___
can increase screening time interval
_____ is the site of first preneoplastic cervical cancer lesions
squamocolumnar junction
T/F low grade cervical cancer lesions are often reversible
T
At what age do we begin to screen for cervical cancer
21