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Pathology class notes > path of uterus 12/10 > Flashcards

path of uterus 12/10 Flashcards

1
Q

during proliferative phase

A

see increased mitotic figures in endometrium

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2
Q

after ovulation

A

See subnuclear vacuoles in ednometrium

also called piano keys

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3
Q

Day 21 of cycle

A

see increased stromal edema and secretions in glands

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4
Q

Day 23 (pre-implantation)

A

see pre-decidua around vessels

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5
Q

Day 26

A

entire stroma is decidualized

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6
Q

changes in usterus during the cycle

A
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7
Q

anovulatory bleeding

A

most common cause of DUB

excess estrogen and no progesterone–> endometrial hyperplasia and cells grow out of their blood supply and bleed

most are due to subtle hormonal changes

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8
Q

additional causes od DUB

A

inadequate luteal phase: inadequate progesterone from corpus luteum–> menstruation 6-9 days after LH surge

irregular shedding: heavy bleeding due to extended secretion of progesterone, see proliferative and secretory phases together

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9
Q

congenital usterus anomalies

A

septate: wedges of fibrous tissue dividing uterine cavity

asherman’s syndrome: adhesions (band-like) formations crossing the lining of uterus

bicornuate: incomplete uniting of uterus

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10
Q

leiomyoma

A

submucosal ones are most responsible for abnormal bleeding and infertility

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11
Q

histology of leiomyoma

A

whorled bundles of smooth muscle cells that resemble uninvolved myometrium

cells uniform in size and shape and have characteristic oval nucleus and long, slender ‘cigar-shaped’ cytoplasm

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12
Q

benign metastasizing leiomyoma

A

extend into vessels and migrate to other sites, most commonly lungs (benign)

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13
Q

disseminated peritoneal leiomyomatosis

A

multiple small nodules on peritoneum (benign)

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14
Q

endometrial hyperplasia

A

also endometrial intraepithelial neoplasia (EIN)

can cause abnormal bleeding

can progress from simple–>atypical–>carcinoma

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15
Q

conditions promoting EIN

A

menopause

PCOS

functioning granulosa cell tumors of ovary

excessive cortical function

estrogen replacement therapy

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16
Q

high grade or atypical EIN

A

from inactivation of PTEN tumor suppressor gene through deletion or inactivation

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17
Q

simple hyperplasia without atypia

A

lowest grade out of 4

increase in glands:stroma

rarely malignant

caused by persistent estrogen stimulation and usually becomes cystic atrophy if estrogen is withdrawn

18
Q

simple hyperplasia with atypia

A

uncommon

cells of glands are rounded and lose their perpendicular orientation to BM

8% progresses to CA

19
Q

complex hyperplasia without atypia

A

increase in number and size of glands

glands crowded and show branching:back-to-back with little stroma and lots of mitotic figure

epithelial cells normal

20
Q

complex hyperplasia with atypia

A

hard to distinguish from well-differentiated endometroid adenocarcinoma

35% of pts have CA of uterus

can treat with progestin if keeping uterus is important

21
Q

endometrial hyperplasia with squamous metaplasia

A

less easily classified

22
Q

endometrial adenocarcinoma

A

most common invasive CA of femal genital tract

mainly in post-menopausal as abnormal bleeding

23
Q

risk factors for endometrial adenocarcinoma

A

obesity

diabetes

HTN

infertility (anovulatory cycles)

24
Q

2 pathogenetic groups of endometrial CA

A

type I: in background of estrogen stimulation and endometrial hyperplasia

type II: sporadic

25
Q

type I endo. adenocarcinoma

A

estrogen-dependent: ovarian estrogen-secreting tumor increases risk

estrogen replacement therapy

tend to be well-differentiated and endometroid

more favorable prognosis

26
Q

grading of endometroid tumors

A

grade1: well-differentiated
grade2: moderately differentiated,well-formed glands mixed with solid sheets of malignant cells
grade3: poorly diff.,solid sheets of cells with few glands,more nuclear atypia with mitotic figures

27
Q

type2 endometrial adenocarcinoma

A

less estrogen-dependent and less often preceded by hyperplasia

pts are older and tumors more poorly differentiated

resemble serous carcinoma of ovaries

28
Q

why type2 have poor prognosis

A

tend to exfoliate,undergo tubal spread,and implant on peritoneal surfaces like their ovarian counterparts

29
Q

all non-endometriod carcinoma

A

classified as grade3

30
Q

staging of endometrial adenocarcinoma

A

1) confined to corpus uteri
2) involved corpus and cervix
3) outside uterus but not outside pelvis
4) outside of pelvis involving rectum or bladder

31
Q

malignant mixed muellerian tumors MMMT

A

endometrial adenocarcinoma that undergo stromal differentiation

32
Q

MMMT(carcinosarcoma)

A

bulky,polypoid tumors that can protrude through cervical os

adenocarcinoma mixed with stromal elements(muscle,fat,cartilage)

outcome depends on stage and grade of adenocarcinoma

see it in post-menopasual women and those with preveious radiation therapy

33
Q

adenosarcoma

A

large broad-based endometrial polypoid growths and may prolapse through cervical os

diagnosis based on malignant appearing stroma with benign but abnormally shaped glands

seen in women 4th-5th decades and is considered low grade

confined to pelvis

abnormal bleeding

34
Q

stromal nodule

A

well-circumscribed aggregate of endometrial stromal cells in myometrium.

mean age is 47

abnormal bleeding

35
Q

stromal sarcoma

A

neoplastic endometrial stroma lying between muscle bundles of myometrium

can infiltrate myometrium OR

goes to lymph–>mets

36
Q

leimyosarcoma

A

cells are spindled

main criterion for diagnosis is increased mitotic figures,need 10 mitoses/10 HPF

don’t originate from leiomyoma

37
Q

sites for endometriosis

A

ovary>uterine ligaments>rectovaginal septum>pelvic peritoneum>laporatomy scars>umbilicus,vulva,intestines

38
Q

diagnosis of endometriosis

A

see hemosideren-laden MQ plus correct clinical presentation–> presumptive endometriosis

39
Q

by 27th day of menstrual cycle

A

stroma is infiltrated by neutrophils and so-called stromal granulocytes

40
Q

Arias-Stella reaction

A

when nuclei of endometrial glands protrude beyond cytoplasmic limits and appear in lumen due to high mitotic activity during the secrtetory phase

dont confuse with adenocarcinoma

41
Q

enometrial polyps will appear in curretage as

A

polypoid-shaped fragments of tissue with epithelium on 3 sides

Pathology class notes (15 decks)

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