Lecture 30 - Uterus

Question 1

Paired Mullerian ducts fuse and give rise to the fallopian tubes, the _____, the cervix, and the upper 2/3 of the _____.

Answer 1

Uterus

2/3 of the vagina

Question 2

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?

Answer 2

Proliferative phase

Pseudostratified

Estrogen

Question 3

Identify this endometrial phase.

Why do the cells have this characteristic “piano key” appearance?

Which hormones are responsible for this phase?

Answer 3

Secretory Endometrium

There are glycogen filled vacuoles that give the cells that appearance.

Estrogen AND Progesterone

Question 4

Identify this Endometrial phase.

Answer 4

Menstrual

Question 5

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.

Answer 5

Pregnancy-related

Organic causes

Hormonal imbalance

Question 6

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.

Answer 6

Anovulation

Estrogen

Question 7

_______ 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.

Answer 7

Endometriosis

Perineum

Question 8

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).

Answer 8

Endometrium

Myometrium

Hemorrhagic

Diverticulosis

Question 9

_______ 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.

Answer 9

Leiomyomas

Intramural

Subserosal

Submucosal

Estrogen

Malignant

Question 10

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?

Answer 10

Estrogen

Simple

Complex

Atypical

Complex WITH Atypia has the most malignant potential (about 25% have or will develop cancer)

Question 11

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.

Answer 11

Estrogen-related

NOT estrogen-related

Estrogen-related is more common

Obesity via unopposed estrogen

Question 12

Imaging and Pap smears are not good diagnostic tools for Endometrial cancer. Then, what is?

Answer 12

Endometrial Sampling

Question 13

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?

Answer 13

PTEN

p53

Type II is more often High Grade and affects Blacks more than Whites.

Question 14

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.

Answer 14

Hematogenous spread

Lymphatic spread

Peritoneal/Omental spread

Question 15

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

Answer 15

2

1

Identical twins

Fraternal

Question 16

What is the big concern for Monochorionic placenta twins?

Answer 16

Twin-twin transfusion –> blood from one moves to the other, and both can die from complications.

Question 17

Gestational Trophoblastic Diseaes referes to malignant disease progression from precursor lesions in the ______.

______ moles are the precursor lesion.

Answer 17

Placenta

Hydatidiform moles

Question 18

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?

Answer 18

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!

Question 19

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?

Answer 19

Complete

Prognosis is worse with term pregnancy.

Mets to liver and brain

Yes, it was the first cancer cured by chemo!