path of uterus 12/10

Question 1

during proliferative phase

Answer 1

see increased mitotic figures in endometrium

Question 2

after ovulation

Answer 2

See subnuclear vacuoles in ednometrium

also called piano keys

Question 3

Day 21 of cycle

Answer 3

see increased stromal edema and secretions in glands

Question 4

Day 23 (pre-implantation)

Answer 4

see pre-decidua around vessels

Question 5

Day 26

Answer 5

entire stroma is decidualized

Question 6

changes in usterus during the cycle

Answer 6

Question 7

anovulatory bleeding

Answer 7

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

Question 8

additional causes od DUB

Answer 8

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

Question 9

congenital usterus anomalies

Answer 9

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

Question 10

leiomyoma

Answer 10

submucosal ones are most responsible for abnormal bleeding and infertility

Question 11

histology of leiomyoma

Answer 11

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

Question 12

benign metastasizing leiomyoma

Answer 12

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

Question 13

disseminated peritoneal leiomyomatosis

Answer 13

multiple small nodules on peritoneum (benign)

Question 14

endometrial hyperplasia

Answer 14

also endometrial intraepithelial neoplasia (EIN)

can cause abnormal bleeding

can progress from simple–>atypical–>carcinoma

Question 15

conditions promoting EIN

Answer 15

menopause

PCOS

functioning granulosa cell tumors of ovary

excessive cortical function

estrogen replacement therapy

Question 16

high grade or atypical EIN

Answer 16

from inactivation of PTEN tumor suppressor gene through deletion or inactivation

Question 17

simple hyperplasia without atypia

Answer 17

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

Question 18

simple hyperplasia with atypia

Answer 18

uncommon

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

8% progresses to CA

Question 19

complex hyperplasia without atypia

Answer 19

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

Question 20

complex hyperplasia with atypia

Answer 20

hard to distinguish from well-differentiated endometroid adenocarcinoma

35% of pts have CA of uterus

can treat with progestin if keeping uterus is important

Question 21

endometrial hyperplasia with squamous metaplasia

Answer 21

less easily classified

Question 22

endometrial adenocarcinoma

Answer 22

most common invasive CA of femal genital tract

mainly in post-menopausal as abnormal bleeding

Question 23

risk factors for endometrial adenocarcinoma

Answer 23

obesity

diabetes

HTN

infertility (anovulatory cycles)

Question 24

2 pathogenetic groups of endometrial CA

Answer 24

type I: in background of estrogen stimulation and endometrial hyperplasia

type II: sporadic

Question 25

type I endo. adenocarcinoma

Answer 25

estrogen-dependent: ovarian estrogen-secreting tumor increases risk estrogen replacement therapy tend to be well-differentiated and endometroid more favorable prognosis

Question 26

grading of endometroid tumors

Answer 26

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

Question 27

type2 endometrial adenocarcinoma

Answer 27

less estrogen-dependent and less often preceded by hyperplasia pts are older and tumors more poorly differentiated resemble serous carcinoma of ovaries

Question 28

why type2 have poor prognosis

Answer 28

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

Question 29

all non-endometriod carcinoma

Answer 29

classified as grade3

Question 30

staging of endometrial adenocarcinoma

Answer 30

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

Question 31

malignant mixed muellerian tumors MMMT

Answer 31

endometrial adenocarcinoma that undergo stromal differentiation

Question 32

MMMT(carcinosarcoma)

Answer 32

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

Question 33

adenosarcoma

Answer 33

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

Question 34

stromal nodule

Answer 34

well-circumscribed aggregate of endometrial stromal cells in myometrium. mean age is 47 abnormal bleeding

Question 35

stromal sarcoma

Answer 35

neoplastic endometrial stroma lying between muscle bundles of myometrium can infiltrate myometrium OR goes to lymph--\>mets

Question 36

leimyosarcoma

Answer 36

cells are spindled main criterion for diagnosis is increased mitotic figures,need 10 mitoses/10 HPF don't originate from leiomyoma

Question 37

sites for endometriosis

Answer 37

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

Question 38

diagnosis of endometriosis

Answer 38

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

Question 39

by 27th day of menstrual cycle

Answer 39

stroma is infiltrated by neutrophils and so-called stromal granulocytes

Question 40

Arias-Stella reaction

Answer 40

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

Question 41

enometrial polyps will appear in curretage as

Answer 41

polypoid-shaped fragments of tissue with epithelium on 3 sides