Lecture 30 - Uterus Flashcards
Paired Mullerian ducts fuse and give rise to the fallopian tubes, the _____, the cervix, and the upper 2/3 of the _____.
Uterus
2/3 of the vagina
Identify this Endometrial phase. Keep in mind the cells encompassing the glands are arranged in a _______ (stratified or pseudostratified?) layer. Think “Blue donuts.”
Which hormone is responsible for this phase?
Proliferative phase
Pseudostratified
Estrogen
Identify this endometrial phase.
Why do the cells have this characteristic “piano key” appearance?
Which hormones are responsible for this phase?
Secretory Endometrium
There are glycogen filled vacuoles that give the cells that appearance.
Estrogen AND Progesterone
Identify this Endometrial phase.
Menstrual
With abnormal uterine bleeding, you always want to consider if it is ______-related in females of reproductive age. If not, consider if it is a systemic disease. If neither of those, look to _____ causes (something wrong with the uterus, itself). Lastly, if none of the above, look to Dysfunctional uterine bleeding caused by _______ imbalance.
Pregnancy-related
Organic causes
Hormonal imbalance
Commonly, in young females (just before/at the beginning of puberty) and perimenapausal females, abnormal uterine bleeding can be caused by ______. If this occurs, ______ levels rise unopposed, creating the potential for Uterine hyperplasia and/or cancer.
Anovulation
Estrogen
_______ is defined by the presence of uterine tissue (BOTH glandular and stromal) outside the uterus. Look for patients with pain in the ______ during deep penetrative intercourse.
Endometriosis
Perineum
Adenomyosis is the term that describes the presence of ______ in the ______ of the uterus. It causes diffuse uterine enlargement with small _______ cysts. Look for patients with heavy periods and pain during their periods. Keep in mind this disease process is NOT the same as Endometriosis. Instead, it is more similar to _______ (think outpouchings).
Endometrium
Myometrium
Hemorrhagic
Diverticulosis
_______ are a fibroid growths of the Myometrium. It is the most common pelvic tumor in females.
_____ means it is present in the wall of the myometrium.
_____ means it can be felt on bimanual exam bc it is just below the serosa.
_____ means it will be encroaching on the endometrial cavity.
These are dependent on ______ (hormone) for growth, and they often outgrow their blood supply and degenerate. Keep in mind they have very MINIMAL ______ potential.
Leiomyomas
Intramural
Subserosal
Submucosal
Estrogen
Malignant
Endometrial Hyperplasia is defined by its architecture (keep in mind it results from unopposed ______).
Low Glandular to Stromal ratio w/out nuclear atypia = _____
Increased Glandular to Stromal ratio w/out nuclear atypia = _____
Nuclear atypia = _____
Which has the most malignant potential?
Estrogen
Simple
Complex
Atypical
Complex WITH Atypia has the most malignant potential (about 25% have or will develop cancer)
Endometrial cancer is the most common gynecological cancer in the US. There are two types: ______-related or NOT ______-related.
Which is more common?
Remember that ______, via unopposed _______, is an important risk factor.
Estrogen-related
NOT estrogen-related
Estrogen-related is more common
Obesity via unopposed estrogen
Imaging and Pap smears are not good diagnostic tools for Endometrial cancer. Then, what is?
Endometrial Sampling
Type I endometrial cancer (Estrogen-related) is often caused by a loss of function mutation in _____.
Type II endometrial cancer (NOT Estrogen-related) is often caused by a loss of function mutation in _____.
Which type is more often High Grade and affects Blacks more than Whites?
PTEN
p53
Type II is more often High Grade and affects Blacks more than Whites.
Type I Endometrial cancer metastasizes via ________ spread, which is in contrast to Cervical cancer that metastasized via _______ spread. Keep in mind Type II Endometrial cancer tends to metastasize via ______/______ spread.
Hematogenous spread
Lymphatic spread
Peritoneal/Omental spread
Early placental glandular tissue will show _____ layers, while placental tissue from later in the pregnancy will show _____ layer.
Remember when the placenta is MONOchorionic in the case of twins, they will ALWAYS be ______ twins, not ______. Dichorionic can be either
2
1
Identical twins
Fraternal
What is the big concern for Monochorionic placenta twins?
Twin-twin transfusion –> blood from one moves to the other, and both can die from complications.
Gestational Trophoblastic Diseaes referes to malignant disease progression from precursor lesions in the ______.
______ moles are the precursor lesion.
Placenta
Hydatidiform moles
Hydatidiform moles can be either Complete or Partial.
Which has higher malignant potential, shows greater uterine growth, and high levels of B-hCG?
How does the ploidy of Complete differ from Partial?
Complete
Complete is diploid (2 sets from father –> fertilization of empty ovum)
Partial is triploid (2 from father + 1 from mother) –> NO Age associated risk for Partial!
Choriocarcinoma is most often (50% of the time) preceded by a _____ mole (30% preceded by abortion and 20% preceded by term pregnancy).
Is the prognosis better or worse if it follows a term pregnancy?
Metastases to which organs show poor prognosis? (keep in mind mets to other organs aren’t as bad).
Is this cancer responsive to chemo?
Complete
Prognosis is worse with term pregnancy.
Mets to liver and brain
Yes, it was the first cancer cured by chemo!
