Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

EndoRepro 2 Exam 1 > Path Pt 3: Uterus and Endometrium > Flashcards

Path Pt 3: Uterus and Endometrium Flashcards

1
Q

precocious puberty (hypothalamic, pituitary, or ovarian origin)

A

prepuberty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

dysfunctional uterine bleeding

  • anovulatory cycle
  • anatomic lesions (carcinoma, hyperplasia, polyps)
A

perimenopausal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

endometrial atrophy causing abnormal bleeding

- anatomic lesions (carcinoma, hyperplasia, polyps)

A

postmenopausal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

endometrial glands and stroma outside of the uterus

- the “ectopic” endometrial tissue may undergo cyclic bleeding

A

endometriosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the most common sites of endometriosis?

A

within the abdominal cavity, but occasionally it is found at distant sites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what are the proposed theories to explain the distribution of endometriosis?

A
  • regurgitation: endometrial tissue implants at ectopic sites via retrograde flow of menstrual endometrium
  • metaplasia: endometrium arises directly from coelomic epithelium, mesonephric ducts may undergo endometrial differentiation and give rise to ectopic endometrial tissue
  • metastasis: endometrial tissue from the uterus can “spread” to distant sites
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

bleeding produces nodules with a red-blue to yellow-brown appearance on or just beneath the mucosal and/or serosal surfaces at sites of involvement

A

endometriotic lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

when endometriotic lesions are extensive, organizing hemorrhage causes what?

A

extensive fibrous adhesions between tubes, ovaries, and other structures and obliterates the pouch of Douglas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are chocolate cysts/endometriomas?

A

the ovaries may become markedly distorted by large cystic masses (3-5cm in diameter), filled with brown fluid resulting from previous hemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

aggressive forms of endometriosis can invade tissues and what?

A

cause fibrosis and subsequent adhesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the likely precursor to endometriosis-related ovarian carcinoma?

A

atypical endometriosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the two morphologic appearances of atypical endometriosis?

A
  1. cytologic atypia of the epithelium lining the endometriotic cyst without major architectural changes
  2. glandular crowding due to excessive epithelial proliferation, often associated with cytologic atypia, producing an appearance that resembles complex atypical endometrial hyperplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the cardinal feature of non-atypical endometrial hyperplasia?

A

increase in gland-to-stroma ratio

- the glands show variation in size and shape and may be dilated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what causes non-atypical endometrial hyperplasia?

A

they are an endometrial response to persistent estrogen stimulation

  • they rarely progress to adenocarcinoma (1-3%)
  • may evolve into cystic atrophy when estrogen is withdrawn
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

composed of complex patterns of proliferating glands displaying nuclear atypia

  • glands are commonly back-to-back and often have complex outlines due to branching structures
  • individual cells are rounded and lose the normal perpendicular orientation to the basement membrane
A

atypical hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

the features of atypical hyperplasia have considerable overlap with what?

A

well-differentiated endometrioid adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

an accurate distinction between atypical hyperplasia and cancer may not be possible without what?

A

hysterectomy

- 23-48% of women with a dx of atypical hyperplasia are found to have carcinoma with a hysterectomy is performed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

metaplastic epithelium is benign and the diagnosis of hyperplasia is based on what?

A

the appearance of the nonmetaplastic areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

an increase in the number of glands relative to the stroma, appreciated as crowded glands, often with abnormal shapes

A

endometrial hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is most commonly caused by unopposed estrogen stimulation, and is an important cause of abnormal vaginal bleeding?

A

endometrial hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what type of hyperplasia is associated with an increased risk of endometrial carcinoma?

A

atypical hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what tumor suppressor gene is mutated in approximately 20% of endometrial hyperplasias?

A

PTEN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

age: 55-65 years
- unopposed estrogen, obesity, HTN, diabetes
- endometrioid morphology
- hyperplasia
- PTEN, ARID1A, PI3K, KRAS, FGF2, MSI, CTNNB1

A

Type I endometrial carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

age: 65-75 years
- atrophy, thin physique
- serous, clear cell, mixed mullerian morphology
- TP53, aneuploidy, PI3K, FBXW7, CHD4
- aggressive behavior, intraperitoneal and lymphatic spread

A

Type II endometrial carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

can take the form of a localized polypoid tumor that diffusely infiltrates the endometrial lining
- spread generally occurs by myometrial invasion followed by direct extension to adjacent structures/organs

A

endometrioid carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

endometrioid carcinoma invasion of the broad ligaments may create what?

A

a palpable mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

dissemination to the regional lymph nodes eventually occurs, and in the late stages, the tumor may metastasize to where?

A

lungs, liver, bones, and other organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what type of endometrioid cancer demonstrates glandular growth patterns resembling normal endometrial epithelium?

A

adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what grade of endometrioid adenocarcinoma is composed almost entirely of well-formed glands?

A

well differentiated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what grade of endometrioid adenocarcinoma show well-formed glands mixed with areas composed of solid sheets of cells, which by definition make up 50% or less of the tumor?

A

moderately differentiated

31
Q

what grade of endometrioid adenocarcinoma is characterized by greater than 50% solid growth pattern?

A

poorly differentiated

32
Q

how can you distinguish well differentiated endometrioid tumors from hyperplasias?

A

lack of intervening stroma

33
Q

up to 20% of endometrioid carcinomas contain foci of what?

A

squamous differentiation
- squamous elements may be histologically benign-appearing when they are associated with well-differentiated adenocarcinomas

34
Q

less commonly, moderately or poorly differentiated endometrioid carcinomas contain squamous elements that appear what?

A

frankly malignant

35
Q

what stage of endometrioid adenocarcinoma is confined to the corpus uteri itself

A

Stage I

36
Q

what stage of endometrioid adenocarcinoma involves the corpus and the cervix?

A

Stage II

37
Q

what stage of endometrioid adenocarcinoma extends outside the uterus but not outside the true pelvis?

A

Stage III

38
Q

what stage of endometrioid adenocarcinoma extends outside the true pelvis or involves the mucosa of the bladder or the rectum?

A

Stage IV

39
Q

mutations in what, are present in at least 90% of serous endometrial carcinomas?

A

TP53

40
Q

these cancers arise in small atrophic uteri and are often large bulky tumors or deeply invasive into the myometrium

A

serous carcinoma

41
Q

what is the precursor lesion to serous endometrial carcinoma?

A

serous endometrial intraepithelial carcinoma

42
Q

these lesions consist of malignant cells identical to those of serous carcinoma that are confined to the epithelial surfaces
- the invasive lesions may have a papillary growth pattern composed of cells with marked cytologic atypia including high nuclear-to-cytoplasmic ratio, atypical mitotic figures, hyperchromasia, and prominent nucleioli

A

serous endometrial intraepithelial carcinoma

43
Q

how are serous endometrial intraepithelial carcinoma distinguished from endometrioid carcinoma?

A

they have a predominantly glandular growth pattern

NOTE: all tumors in this category are classified as grade 3 irrespective of histologic pattern

44
Q

what is serous carcinoma associated with, despite relatively superficial endometrial involvement?

A

extensive peritoneal disease

- suggesting spread by routes, other than direct invasion

45
Q

bulky and polypoid, and may protrude through the cervical os
- tumors usually consist of adenocarcinoma (endometrioid, serous, or clear cell), mixed with the malignant mesenchymal (sarcomatous) elements

A

malignant mixed mullerian tumors (MMMT)

- tumor may contain two distinct and separate epithelial and mesenchymal components

46
Q

sarcomatous components of MMMT’s may also mimic what?

A

extrauterine tissues

  • striated muscle, cartilage, adipose tissue, and bone
  • metastases usually only contain epithelial components
47
Q

what is the most common malignant of the female genital tract?

A

endometrial carcinoma

48
Q

these endometrial carcinomas are low-grade, and usually indolent

A

Type I

49
Q

these endometrial carcinomas are high-grade aggressive tumors that have a poor prognosis

A

Type II

50
Q

which grade of endometrial carcinoma is often preceded by atypical hyperplasia and commonly has mutations in the PTEN, PIK3CA, KRAS, and ARID1A genes?

A

Type I

51
Q

which grade of carcinoma is associated with serous endometrial intraepithelial carcinoma and the most common mutations are in TP53

A

Type II serous carcinoma

- TP53 mutations also found in the precursor lesion

52
Q

what remains the most important factor in outcome?

A

stage

53
Q

which tumor type is more likely to present at advanced stages and have a decidedly worse prognosis?

A

serous tumors

54
Q

carcino-sarcomas that resemble endometrial carcinoma genetically and have poor outcomes with current therapies

A

MMMT’s

55
Q

sharply circumscribed, discrete, round, firm, gray-white tumors varying in size from small, barely visible nodules to massive tumors that fill the pelvis

A

leiomyomas

56
Q

except in rare instances, leiomyomas are found where?

A

within the myometrium of the corpus

- infrequently, they involve the uterine ligaments, lower uterine segments, or cervix

57
Q

these tumors can occur within the myometrium (intramural), just beneath the endometrium (submucosal) or beneath the serosa (subserosal)

A

leiomyomas

58
Q

characteristic whorled pattern of smooth muscle bundles (resembling myometrium) on cut section usually makes these lesions readily identifiable

A

leiomyomas

  • large tumors may develop areas of yellow-brown to red softening
  • individual muslce cells are uniform in size and shape and have the characteristic oval nucleus and long, slender bipolar cytoplasmic process
  • mitotic figures are scarce
59
Q

these variants include atypical or bizarre (symplastic) tumors with nuclear atypia and giant cells, and cellular leiomyomas
- both have a low mitotic index, helping to distinguish these from leiomyomas

A

benign variants of leiomyomas

60
Q

uterine leiomyoma that extends into vessels and spreads hematogenously to other sites, most commonly the lung

A

benign metastasizing leiomyoma

- extremely rare variant

61
Q

this variant presents as multiple small peritoneal nodules

- considered benign despite its unusual behavior

A

disseminated peritoneal leiomyomatosis

62
Q

these tumors grow within the uterus in two somewhat distinctive patterns

  1. bulky, fleshy masses that invade the uterine wall
  2. polypoid masses that project into the uterine lumen
A

leiomyosarcomas

- exhibit a wide range of cytologic atypia, from extremely well differentiated to highly anaplastic

63
Q

the distinction from what, is based of nuclear atypia, mitotic index, and zonal necrosis

A

leiomyoma from leiomyosarcoma

64
Q

the presence of 10 or more mitoses per 10 high power fields indicates what?

A

malignancy, particularly if accompanied by cytologic atypia and/or necrosis

65
Q

if the tumor contains muclear atypia or large (epithelioid) cells, and five mitoses per 10 high power fields?

A

malignant

66
Q

what are the rare exceptions of leiomyomas?

A

mitotically active leiomyomas in young or pregnant women

- caution should be exercised in interpreting such neoplasms as malignant

67
Q

a portion of smooth muscle neoplasms may be impossible to classify and are called what?

A

smooth muscle tumors of “uncertain malignant potential”

68
Q

these tumors include stromal nodules, low-grade stromal sarcomas, and high-grade stromal sarcomas

A

endometrial stromal tumors

69
Q

stromal nodules are what?

A

benign, well-circumscribed tumors

70
Q

these resemble stromal nodules, but infiltrate into the surrounding myometrium
- associated with fusion of JAZF1 gene and various polycomb factor genes, usually SUZ12

A

low-grade stromal sarcomas

71
Q

these show marked atypia and are associated with other fusion genes

A

high-grade stromal sarcomas

72
Q

both low and high-grade stromal sarcomas are prone to what?

A

late recurrences

73
Q

common, benign smooth muscle tumors that cause significant morbidity and are often associated with MED12 mutations

A

leiomyomas

74
Q

malignant smooth muscle tumors that are uncommon, highly malignant myometrial tumors that usually arise de novo

A

leiomyosarcomas

EndoRepro 2 Exam 1 (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions