Path - Uterine

Question 1

what is the most common cause of dysfunctional uterine bleeding?

Answer 1

anovulatory cycle

Question 2

what is acute endometritis, what is the common cause and how does it present? how does it histologically differ from chronic endometritis?

Answer 2

bacterial infection of endometrium
retained products of contraception
fever, abnormal uterine bleeding, pelvic pain
chronic will have lymphocytes and PLASMA cells

Question 3

what is Asherman Syndrome?

Answer 3

secondary amenorrhea due to loss of BASALIS (regenerative layer) and scarring
can be due to overaggressive D&C

Question 4

what drug is associated with endometrial polyps?

Answer 4

Tamoxifen - has anti-estrogen effects on breast but weak pro-estrogen effects on endometrium

Question 5

what is endometriosis and how is a diagnosis made? where is the most common site?

Answer 5

ectopic endometrial tissue at site outside of uterus
pathologic Dx when 2 of 3 are present in lesion: glands, stroma, hemosiderin
ovary

Question 6

what will ovarian endometriosis look like? what do implants elsewhere look like classically?

Answer 6

chocolate cyst

“gun powder” nodules - soft tissue

Question 7

most likely pathogenesis of endometriosis

what does the endometriotic tissue release to promote inflammation?

Answer 7

retrograde menstruation - regurgitation of flow into fallopian tube
PGE2

Question 8

what is adenomyosis?

Answer 8

endometriosis in myometrium

Question 9

what causes endometrial hyperplasia? what is a common genetic alteration shared between endometrial hyperplasia and carcinoma? what is the most important predictor for progression to carcinoma?

Answer 9

unopposed estrogen (obesity, PCOS, ERT)
inactivation of PTEN tumor suppressor gene –> PI3K/AKT pathway becomes overactive
cellular atypia

Question 10

what is the most common invasive carcinoma in female genital tract?

Answer 10

endometrial carcinoma

Question 11

two pathways endometrial carcinoma arises, who is affected by each, what are the histological findings?

Answer 11

1. hyperplasia - endometrial hyperplasia; average age is 60; histology is endometrioid (looks like normal endometrium) –> indolent
2. sporadic - no evident precursor lesion; average age is 70; histology is serous and characterized by papillary structures with psammoma body formation –> more aggressive

Question 12

clinical setting, mutated genes in hyperplasia (type I) vs sporadic (type II) endometrial cancer

Answer 12

type I: obesity, HTN, DM (unopposed estrogen); PTEN

type II: thin, atrophy; TP53

Question 13

malignant mixed mullerian tumor

Answer 13

endometrial adenocarcinoma with a component of malignant mesenchymal tissue
homologous stroma - resembles normal uterine storma
heterologous stroma - can have sk muscle, cartilage, bone, etc

Question 14

explain the staging of endometrial carcinoma

Answer 14

1a - invading < 1/2 myometrium (low grade)
1b - invading > 1/2 myometrium
2 - cervix involvement
3a - tumor involves serosa and/or adnexa
3b - vaginal involvement or parametrial involvement
4 - bladder and/or bowel involvement

Question 15

what is a Leiomyoma (fibroid)? what does it look like grossly? what is the typical presentation? genetic mutation?

Answer 15

benign neoplasm of smooth muscle (histo shows cigar shaped nuclei) arising from myometrium - most common tumor in females - PREmenopausal
multiple well defined white whorled masses
ASYMPTOMATIC
70% contain MED12 mutations

Question 16

what is a leiomyosarcoma? from what does it arise? what does gross exam and histo show?

Answer 16

malignant proliferation of sm muscle of myometrium
does NOT arise from leiomyoma
POSTmenopausal women
single lesion with hemorrhage and necrosis, histo shows nuclear atypia, mitotic activity, zonal tumor necrosis