Path: Uterus, Fallopian Tubes, Ovaries Flashcards
What does this sample from a D&C show?
Slide of endometrial tissue in the early secretory phase. No pathology, I think it’s just important to remember “Piano Keys” with this endometrial phase.
Main cause of an anovulatory cycle.
Excessive and prolonged estrogen stimulation with unopposed progesterone.
The endometrial stroma starts to break down
How does an inadequate luteal phase cause abnormal uterine bleeding?
Inadequate corpus luteum secretes low levels of progesterone. The result is early uterine contraciton and menses.
A women presents with severe dysmenorrhea (pain with menses)
Endometriosis:
Presence of endometrial glands and stroma outside the uterus
Most common site of endometriosis.
Ovaries
Most accepted theory of the mechanism of endometriosis.
Retrograde menses
Name for endometriosis when the ectopic tissue is found beneathe the surface in an ovary.
Endometrioma or “chocolate cyst”
-the tissue bleeds and becomes dark in color and viscous so it is called “chocolate”
A woman presents with irregular uterine bleeding that doesn’t seem to respond to any hormonal medication. Ultrasound shows no cystic growths or nodules and D&C reveals no abnormal cells and no endometrial hyperplasia. A hysterectomy is performed and reveals this picture. What’s the diagnosis?
Dx: the woman had a picture of a uterus with adenomyosis in her own uterus that caused irritation and abnormal bleeding.
Adenomyosis is the presence of endometrial tissue in the myometrium which causes irregular bleeding. It is only diagnosed upon pathological examination after a hysterectomy.
What are endometrial polyps and the two types?
Exophytic masses (tissue of subepithelium that grows out beyond the epithelium) in the uterus that project into the uterine cavity.
- Hyperplastic polyps: seen in general endometrial hyperplasia
- Atrophic Polyps: seen in postmenopausal women
What is the morphology of endometrial hyperplasia?
Increased proliferation of the parenchyma (glands) relative to the stroma (supportive tissue)
Associated with increased estrogen stimulation and either decreased progesterone levels or endometrial insensitivity to progesterone.
What are the 4 categories of endometrial hyperplasia?
- Simple Hyperplasia w/o atypia
- Simple Hyperplasia w/ atypia
- Complex Hyperplasia w/o atypia
- Complex Hyperplasia w/ atypia
A woman presents with irregular uterine bleeding, bloating, and infertility. Ultrasound shows no masses but a slightly enlarged uterus. D&C reveals:
Complex Endometrial Hyperplasia without atypia.
Increased crowding the glands with back to back cells
A woman presents with irregular uterine bleeding, bloating, and infertility. Ultrasound reveals no masses but the uterus appears slightly enlarged. D&C reveals:
Simple Endometrial Hyperplasia without atypia.
There is proliferation of the cells (back to back appearance) but there is NO crowding of the glands.
A woman presents with irregular uterine bleeding, bloating, and infertility. Ultrasound reveals no masses but a slightly enlarged uterus. D&C reveals:
Complex Endometrial Hyperplasia with atypia.
The nuclei have lost their polarity (become fragmented and are not centrally located in the cell) and the nucleoi are prominent.
Describe the 2 types of endometrial carcinoma.
Type 1: most common, arises in settings of unopposed estrogen, obesity, diabetes, HTN, and infertility. Spread of endometrial tumor into myometrium and lymph node invasion, that will spread into the lungs, liver, or brain.
Type 2: arises in settings of endometrial atrophy, papillary growth with marked atypia
What are Malignant Mixed Mullerian Tumors (Craniosarcomas)?
Adenocarcinomas with stromal differentiation into muscle, cartilage, or osteiod. Tumors arise from Mullerian embryologic derived tissue.
What is a Uterine Leiomyoma and what is its morphology?
Fibroids: smooth muscle tumors usually in the uterine myometrium. Have a characteristic whorled pattern of smooth muscle fibers
Describe leiomyosarcomas.
De novo forming tumors that have two growth patterns: bulky fleshy pattern, and polypoid mass pattern. Notable atypia and increased mitotic index compared to leiomyomas.
2 most common fallopian tube infections.
- Gonococcal (most common)
- Chlamydia (more destructive and more commonly progresses to PID)
Main complication of Tuberculous Salpingitis.
Infertility
Name this growth that is filled with clear serous fluid. The patient had no complaints and no irregular bleeding.
Benign paratubal cyst. They are often found incidently on Ultrasound or after hysterectomy.
What is Stein Leventhal Sydrome?
Polycystic Ovarian Syndrome (POCS) or Disease
-numerous cystic follicles associated with oligomenorrhea, persistent anovulation, obesity, hirsutism, virilism
Condition often linked with PCOS.
Endometrial Hyperplasia: The cysts in the ovaries release high levels of estrogen causing endometrial thickening.
What is ovarian stromal hyperthecosis?
Hyperplasia of the cortical stroma of the ovary. Usually bilateral and the patients present very similar to PCOS.
Name the 3 types of ovarian Surface Epithelial Tumors and the 3 classifications of these 3 types.
- Serous
- Mucinous
- Endometrioid
Classifications: benign, borderline, malignant
Ovarian Surface Epithelial Tumor lined by columnar epithelium.
Serous Tumor
Ovarian Surface Epithelial Tumor lined with tall columnar epithelial cells without cilia. The cyst contains sticky fluid rich in glycoproteins.
Mucinous Tumor
Ovarian Surface tumor with central necrosis.
Cystadenocarcinoma
Name the ovarian tumor that results in extensive mucinous ascites.
Pseudomyxoma peritonei
Ovarian Tumor that contains transitional-like epithelium.
Brenner Tumor
(brenner bladder: both have transitional epithelium)
Name the 3 categories of teratomas.
Mature
Immature
Monodermal
Which teratoma is malignant?
Immature
Name the 2 types of specialized teratomas.
- Struma Ovarii (has mature thryoid tissue)
- Ovarian Carcinoid
Ovarian germ cell tumor with large vesicular cells, clear cytoplasm, central nuclei. Composed of sheets of fibrous stroma often with malignant atypical cells.
Dysgerminoma
Ovarian Germ Cell tumor that is rich in alpha-fetoprotein and alpha-1-antitrypsin.
Endodermal Sinus Tumor
Characteristic Appearance of Endodermal Sinus Tumors.
Shiller-Duval Body
-glomerulus like cell structure
Most common manifestation of granulosa-thecal cell tumors based on age.
Pre-pubertal: precocious puberty
Reproductive Age: menorrhagia
Post-menopausal: endometrial hyperplasia
Composition of fibromas and thecomas.
Fibroma: arises in ovarian stroma and composed of fibroblasts
Thecoma: arises in ovarian stroma and composed of spindle cells and lipid droplets
What is Meigs Syndrome?
Conditions with ascites, right hydrothorax and ovarian fibromas
Ovarian tumor that causes defeminization, or masculinization in women.
Sertoli-Leydig Cell Tumor
Bilateral metastasis composed of mucin-producing, signet-ring of cancer cells most often gastric in origin.
Krukenberg Tumor
