L 70 - path of endometrium, myometrium, fallopian tubes Flashcards
Describe the two phase of the ovarian cycle
Ovarian:
1) Follicular phase – rising levels of FSH and LH stimulate oocyte selection and follicle maturation (some estrogen production from the follicular cells)
Day 14: LH Surge and Ovulation
2) Luteal Phase: remnants of the follicle form the corpus luteum producing progesterone (and estrongen)
Describe the three phases of the uterine cylce
2) days 4-14: Proliferative phase; estrogen productive from the Granulosa cells of the follicules stimulate regneration of functionalis layer of the endometrium
3) Days 14-28: Secretory phase; progesterone stimulation from the corpus luteum signals robust glandular development of the endometrium (preparing the uterus for potential implantation)
1) Days 1-4: In the absence of fertilization and implantation, no HCG production; CL degenerates to the Corpus Albicans; Functionalis layers sloughs off in the absence of progesterone
in the event of implantation and fertilization, what prevents the sloughing off of the functionalis
Embryo produces HCG which keeps the CL alive to keep producing progesterone
at 8-12 weeks of pregnancy, the placenta takes over the duties of estrogen and progesterone production
what histological findngs of the uterus provide evidence for the secretory phase?
High glycogen
Subnuclear vacuoles
Irregular bleeding – define the following:
Menorrhagia
Metorrhagic
+ mechanism of irregular bleeding
Menorrhagia – heavy bleeding
Metorrhagic – irregular bleeding
Irregular bleeding: Prevention of arterial contraction in the endometrium
Reasons for irregular bleeding:
Complications of pregnancy - -remannt products of conception
Organic Lesions – endometriosis, endometrial polyp, adenomyosis
Anovulation –
Causes of anovulation
what are these women at risk of developing
what is the driver of this manifestation
Stress, anxiety, weight loss, exercise, chronic disease, obesity, Polycystic ovarian syndrome, Thyroid disease and other endocrine disease
Risk of devloping endometrial hyperplasia, due to unopposed estrogen stimulation of the endometrium (no ovuluation = no CL = no progesterone)
What is PCOS
describe the typical PCOS patient
Obese women; +/- DM, high cholesterol, abnormal hair patterns, oligomenorrhea (rare periods), acne, etc
persistent cysts (follicle + CL) of ovaries; no regression of cysts = unopposed estrogen synthesis
what are the two types of endometrial hyperplasia ? describe the histo
Non atypical hyperplasia – glandular crowding but not atypia; no risk of progressing to carcinoma
Atypical Hypoerplasia – glandular crowding + atypia
what % of pts with Atypical Hyperplasia already have endometrial carcinoma?
Recommended treatment for women with atypical hyperplasia?
~30% have carcinoma at the time of bx
Tx: Hysterectomy
What is the most common type of endometrial cancer?
Endometrioid carcinoma (type 1)
Endometrioid carcinoma –
due to: mutation to: Treatmnet: stage at presentation: Prognosis:
due to: estrogen excess mutation to: PTEN Treatmnet: hysterectomy stage at presentation: Low Prognosis: 95% survival
Endometrial cancer: Serous Carcinoma
describe the typical patient:
Mutation to
Treatment:
Prognosis:
65-75 yo thin African American Female; no h/o unoppsed esterogens
Mutation: TP53
stage at presentation: high
Treatmnet: chemo, but response is poor
prognosis: poor
case: older AA female presents with necrotic mass prolapsing n to the vagina. Bx reveals de-differentiated cells with epithelial and myometrial compoenets; invasion into the myometrium
what is the prognosis?
Carcinosarcoma – (aka MMMT)
Poor prognosis
what is common benign lesion of the myometrium and the most common tumor in women overall
Leiomyomas (Uterine fibroids)
