Lecture 14: Gynecologic Pathology I Flashcards
If it is day 18 and you have proliferation, what does that mean?
It means it is an anovulating cycle, or she has yet to ovulate
What are the histological features of proliferative endometrium?
Mitoses
Stratified nuclei
Round REGULAR glands
What are the histological features
of secretory endometrium (right
after ovulation)?
Abundant subnuclear vacuoles Looks like the endometrium Is secreting shit Glandular appearance still there But ABNORMAL
What are the histological features of secretory endometrium 6 days after ovulation?
Loss of glands
SPIRAL ARTERIES
What does endometrium look like if she is about to menstruate?
Confluent sheets of predecidua
LYMPHOCYTES
What is dysfunctional uterine bleeding (DUB)?
A very specific (nonspecific) disorder where no ovulation occurs
Alteration of the normal cyclical hormonal stimulation of the endometrium
No underlying organic disorder!
Clinically DUB indicates ovulatory dysfunction
EXCLUDES
i. postmenopausal bleeding
ii. Presence of specific pathological processes
(inflammation, polyps, hyperplasia, carcinoma, exogenous, complications of pregnancy, exogenous hormones)
What is the histological sign that ovulation did not occur?
Stromal Blue Balls
What are the common histologic findings for Dysfunctional uterine bleeding (DUB)?
- Stromal breakdown
STROMAL BLUE BALLS - Glandular breakdown
- Non-secretory background
Why is there stromal and glandular breakdown in DUB?
No progesterone/no ovulation
Proliferation of glands OUTGROW blood supply
And when endometrium outgrows blood supply (because it couldn’t stop proliferating in the first place) then you have a problem
Breakdown of glands/stroma with bleeding
What are the causes of abnormal vaginal bleeding?
- Extrauterine causes (trauma)
- Menorrhagia
- Metrorrhagia
- Menometrorrhagia
- Dysmenorrhea
- Postmenopausal bleeding
What is Menorrhagia?
Excessive bleeding in both amount and duration of flow occurring at regular intervals
What is Metrorrhagia?
Bleeding, usually not heavy, occurring at irregular intervals
Kind of like the metro train stopping at irregular intervals
What is menometrorrhagia?
Excessive bleeding with prolonged period of flow occurring at frequent and irregular intervals
What is Dysmenorrhea?
Painful menses
What is abnormal uterine bleeding?
Any non-physiologic uterine bleeding Common sign of a number of different uterine disorders -infection -polyps, fibroids -pregnancy -neoplasia -clotting disorders
What are the three benign causes of ABNORMAL uterine bleeding?
- Endometrial atrophy
- Endometrial polyps
- Endometrial leiomyomas
What are the key characteristics of endometrial atrophy?
- Cause 25-50% of abnormal uterine bleeding in POSTMENOPAUSAL women
- Lack of estrogen stimulation
- Cystic change of glands is common
- result in thickened endometrial stripe
What are the histological features
Of endometrial atrophy?
- Stroma is less cellular and fibrotic
- glands are cystically enlarged
- no mitotic activity
- Thickened endometrial stripe
Little strips of glands and blood
What is an endometrial stripe?
The thickness of the endometrium
What is curettage?
A medical procedure where you scoop part of the uterus
What are the key characteristics of endometrial polyps?
- originates from localized hyperplasia
- Most common in 4th and 5th decades
- Present with abnormal bleeding
- No malignant potential, but carcinoma may be found within them
What are the gross features of endometrial polyps?
Vary greatly in size
Sessile (flat) or pedunculated (flapping around)
What are the histological features of endometrial
polyps?
Larger tissue fragments with dense stroma and
Thick walled arteries
Glands IRREGULAR, dilated, may be crowded focally
Separate fragments of normal endometrium
What is a leiomyoma?
Benign smooth muscle tumor
What are the key characteristics of Leiomyoma?
- Benign SMOOTH MUSCLE tumor occurs in
- corpus
- cervix
- uterine ligaments
- ovaries
- Most frequent tumor of female genital tract
- most common in African americans
- Etiology = tumor of the reproductive period
What is Intramural leiomyoma? Submucosal?
Subserosal?
Within wall of myometrium
Just underneath the endometrium
Outer surface of the uterus
Why do patients with myometrial tumor Present with bleeding?
Because myometrial leiomyoma will cause endometrium to slough off
What is the difference between endometrial polyp and submucosal leiomyoma?
Polyp is a hyperplasia rather than tumor
Polyp is hyperplasia from ENDOMETRIUM
Leiomyoma is TUMOR from MYOMETRIUM
What is a symptom of leiomyoma?
Enlarged uterus
You might think patient is pregnant
What are the histological features of
Leiomyoma?
Uniform bland spindled cells Fasccular arrangements Lack of glands Looks like it starts from myometrium Oval, cigar shaped nuclei
What is leiomyosarcoma?
MALIGNANT counterpart of leiomyoma
-most common pure sarcoma of uterus
Incidence = rare, 2-3 of 1000 women
Caused by tamoxifen
What is a sarcoma?
A malignant tumor of CONNECTIVE or NONEPITHELIAL TISSUE
Comes from mesenchymal cells
What are the histologic features of leiomyosarcoma?
- Invasion of surrounding myometrium
- vascular invasion BLOODY AS FUCK
- increased cellularity
- nuclear atypia
- increased mitotic activity
- coagulative necrosis
- LOSS of WHORLED pattern
- NO BULGE
What is endometriosis?
When cells from the uterine lining (endometrium) appear and flourish OUTSIDE the uterine cavity, most commonly in the abdominal cavity
Endometrial tissue outside the uterine cavity
Happens in women of reproductive years
Most frequent sites are pelvic peritoneum and ovaries
What are the theories of endometriosis pathogenesis?
- TRANSPLANTATION of endometrial fragments to ectopic sites
- retrograde flow of menses
- metaplasia of peritoneum
- INDUCTION of undifferentiated mesenchyme in ectopic sites to form endometriotic tissue
What is the gross appearance of endometriosis?
- black nodule
- vesicle formation
- red/blue nodules
- yellow/brown nodules
What are the classic symptoms of endometriosis?
- Secondary dysmenorrhea
- Dyspareunia (painful sexual intercourse)
- Pelvic pain
- Infertility
- Pelvic mass, ascites
- chocolate cyst
- hemoptysis, rectal bleeding, hematuria
What are the characteristics of adenomyosis?
A medical condition characterized by ECTOPIC glandular tissue found in muscle
So endometrium found in the myometrium
1. Presence of endometrial tissue within the uterine wall (myometrium)
2. remains in continuity with the endometrium, presumably representing downgrowth of endometrium tissue into and between smooth muscle fascicles of myometrium
3. microscopically, irregular nests of endometrial stroma, with or without glands
What are symptoms of adenomyosis?
- menometrorrhagia
- dysmenorrhea
- Dyspareunia
- Pelvic pain
