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UROGENITAL > [PATHO] DISEASES OF BODY OF UTERUS > Flashcards

[PATHO] DISEASES OF BODY OF UTERUS Flashcards

1
Q

most common genital tract infection following delivery/abortion

A

acute endometritis (puerperal sepsis

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2
Q

puerperal sepsis

A

acute endometritis

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3
Q

acute endometritis gross picture

A

uterus: enlarged, soft, lined by purulent exudate

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4
Q

acute endometritis microscopic picture

A

endometrium: edematous, neutrophils, pus cells
later: endometrium becomes necrotic + myometritis

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5
Q

clinical picture of acute endometritis

A

abdominal pain
fever
purulent vaginal discharge

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6
Q

inflammation
abdominal pain
fever
purulent vaginal discharge
following abortion/delivery
uterus is enlarged, soft, edematous, lined by purulent exudate, neutrophils, pus cells

A

acute endometritis

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7
Q

follows abortion
assoc w/ retention of products of conception

A

postabortive endometritis

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8
Q

post-menopausal endometrial atrophy
postmenopausal bleeding
infiltration by lymphocytes & plasma cells

A

senile endometritis

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9
Q

types of chronic non specific endometritis

A

post-abortive
senile

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10
Q

most important diagnostic feautre of chronic NON SPECIFIC endometritis

A

plasma cells

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11
Q

TB endometritis occurs 2ry to

A

TB salpingitis

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12
Q

TB endometritis leads to

A

sterility

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13
Q

in TB endometritis endometrium is infiltrated by

A

multiple tubercles

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14
Q

in senile endometritis,
the endometrium is infiltrated by

A

lymphocytes
plasma cells

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15
Q

actinomyces israeli is common with

A

IUD

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16
Q

clinical feautres of endometritis

A

abdominal pain
fever
menstrual abnormalities

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17
Q

infertility & ectopic pregnancies can occur in chronic endometritis due to

A

damage & scarring of fallopian tubes

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18
Q

pyometria occurs due to

A

1-obstruction + infection
2-carcinoma
3-benign cervical stricture from senile atresia
4-after surgery
5-after cauterization

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19
Q

endometriosis definition

A

presence of endometrial tissue (stroma & glands) outside uterus

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20
Q

regurgitation theory of endometriosis

A

menstrual backflow through fallopian tube & subsequent implantation

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21
Q

metaplastic theory of endometriosis

A

endometrial differentiation from coelomic epithelium

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22
Q

extrapelvic endometriosis is explained by which theory

A

vascular/lymphatic dissemination theory

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23
Q

extrauterine stem/progenitor cell theory of endometriosis

A

circulating stem/progenitor cells from bone marrow differentiate into endometrial tissue

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24
Q

endometriotic tissue exhibits

A

1-↑inflammatory mediators (PGE2)
2-inflammation due to MQ recruitment + activation by stromal cells
3-stromal cells make aromatase–>estrogen production
4-

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25
endometriotic tissue survival is enhanced by
inflammatory mediators estrogen production inflammation by MQ activation
26
endometriosis can be treated by
COX-2 inhibitors Aromatase inhibitors
27
pelvic endometriosis sites (7)
1-ovaries 2-cervix 3-tubes 4-uterine ligaments 5-vagina 6-rectovaginal wall 7-pelvic peritoneum
28
A.chocolate cysts are seen in? B. reason for their formation?
A.ovarian endometriosis B.periodic bleeding at site of ovarian endometriosis
29
extrapelvic endometriosis sites (4)
1-laparotomy scars 2-vulva 3-umbilicus 4-appendix
30
Cl/P of endometriosis (3)
1-severe dysmenorrhea 2-pelvic pain 3-possible infertility
31
pelvic pain in endometriosis is due to
intrapelvic bleeding & intrabdominal adhesions
32
adenomyosis definition
growth of basal layer of endometrium down into myometrium
33
microscopic picture of adenomyosis
nests of stroma +/- glands in myometrium
34
what causes uterine wall thickening in adenomyosis
endometrial tissue triggers reactive hypertrophy of myometrium
35
adenomyosis effects (3)
-uterine enlargement & thickening -dysmenorrhea -pelvic pain
36
aetiology of endometrial hyperplasia
excess estrogen relative to progestin--->excessive endometrial proliferation
37
causes of excess estrogen in endometrial hyperplasia (4)
1-failure of ovulation w/ persistence of graafian follicle 2-prolonged estrogenic steroids use 3-estrogen producing lesions 4-obesity
38
estrogen producing lesions
polycystic ovary granulosa-theca cell tumors
39
why does obesity lead to ↑estrogen
adipose tissue converts steroid precursors--->estrogen
40
gross picture of endometrial hyperplasia
uterus: moderately enlarged endometrium:thickened, abundant, polyploid
41
types of endometrial hyperplasia
hyperplasia without atypia hyperplasia with atypia
42
glands in hyperplasia w/o atypia are lined by
columnar epithelium w/ ↑mitosis
43
glands in hyperplasia w/atypia are lined by
atypical cells
44
endometrial intraepithelial neoplasm
(endometrial) hyperplasia with atypia
45
which type of endomertrial hyperplasia is associated w/ progression to cancer
hyperplasia w/ atypia
45
which type of endomertrial hyperplasia is associated w/ progression to cancer
hyperplasia w/ atypia
46
TTT in case of: hyperplasia w/ atypia patient no longer desiring fertility
hysterectomy
47
TTT in case of: hyperplasia w/ atypia young patient desiring fertility
high dose progestins
48
swiss cheese appearance is seen in
simple form endometrial hyperplasia
49
microscopic configuration of glands in endometrial hyperplasia
1.simple=↑size, number + cystic dilatation 2. complex= crowded back to back arrangement w/ outpouching & infoldings
50
microscopic picture of endometrial hyperplasia
1-stroma is cellular w/ ↑mitotic activity 2-glands: a.lined by columnar epithelium+ ↑mitosis OR b.lined by atypical cells i.simple type OR ii.complex type
51
benign polyploid mass that arises from endometrial mucosa
endometrial polyp
52
presence of endometrial tissue outside uterus
endometriosis
53
presence of pus in endometrial cavity
pyometria
54
inflammation of endometrium
endometritis
55
growth of basal layer of endometrium down into myometrium
adenomyosis
56
exaggerated endometrial proliferation due to excessive estrogen relative to progestin
endometrial hyperplasia
57
neoplastic component of endometrial polyp
monoclonal stromal cells
58
menopause irregular uterine bleeding polyploid mass glands are cystically dilated endometrium resembling basalis small muscular arteries monoclonal stromal cells
endometrial polyp
59
malignant transformation of endometrial polyp
RARE
60
malignant transformation of endometrial hyperplasia
endometrial carcinoma
61
malignant transformation of leiomyoma
RARE
62
most common tumor in women
leiomyoma
63
endometrial polyps arise from
endometrial mucosa
64
leiomyoma arises from
uterine muscles
65
genetic predisposition in endometrial polyps
rearrangements of chromosomes 6 & 12
66
genetic predispositions in leiomyoma
rearrangements of chromosomes 6 & 12
67
leiomyoma is associated w/
estrogenic stimulation chromo 6 & 12 rearrangement
68
leiomyoma gross picture (8)
1-uterus: enlarged, irregular, firm 2-sharply circumscribed 3-grey-white 4-rounded nodules 5-whorly cut surface!! 6-pseudocapsule!! 7-cystic degeneration 8-calcification
69
leiomyomas microscopic picture
-vascular stroma -interlacing bundles of smooth muscle fibers & dense collagen bundles
70
cellular stroma seen in
endometrial hyperplasia
71
vascular stroma seen in
leiomyoma
72
whorly cut surface seen in
leiomyoma
73
pseudocapsule seen in
leiomyoma
74
pseudocapsule in leiomyoma is due to
compression of adjacent muscles
75
pathological changes in leiomyomas
1-hyaline changes + cystic degeneration 2-necrosis 3-infection & suppuration 4-calcification 5-red degeneration 6-rare malignant change
76
MC site of necrosis in large leiomyomas
center
77
red degeneration seen in
leiomyomas
78
red degeneration occurs due to
-thrombosis of vessels -torsion of pedicle
79
red degeneration is associated with
pregnancy oral contraceptives
80
red degeneration is associated with
pregnancy oral contraceptives
81
a soft not firm hemorrhagic, necrotic leiomyoma has undergone
red degeneration
82
types of leiomyoma (3)
1-interstitial 2-submucous 3-subserous
83
interstitial leiomyoma site
within myometrium
84
submucous leiomyoma site
protruding into uterine cavity
85
subserous leiomyoma site
beneath serous covering
86
menopause abdominal pain vomiting fever enlarged firm uterus greyish white sharply circumscribed whorly cut surface interlacing bundles of smooth muscles & dense collagen
leiomyoma
87
clinically leiomyomas are associated with
-uterine bleeding -urinary bladder disorders -impaired fertility -spontaneous abortion, fetal malpresentation, postpartum hg
88
leiomyoma of cervix
less common solitary cervical canal obstruction
89
MC invasive tumor of female genital tract
endometrioid carcinoma
90
endometrioid carcinoma is related to
-excess estrogen -endometrial hyperplasia -mutations: PTEN & DNA mismatch repair genes
91
Cowden syndrome
germline mutations in PTEN genes
92
Lynch syndrome
germline mutations in DNA mismatch repair genes
93
serous carcinoma arises in setting of
endometrial polyps
94
serous carcinoma is related to
mutations in TP53
95
TP53 mutatuons are detected by
immunostaining
96
After menopause 55-65 yo leukorrhea irregular uterine bleeding localized polyploid mass OR diffuse irregular ulcerated necrotic endometrium
endometrioid carcinoma
97
risk factors of endometrioid carcinoma (5)
1-↑estrogen stimulation 2-infertility 3-diabetes 4-HTN 5-obesity
98
microscopic picture of endometroid carcinoma
normal glands squamous differentiation mucinous, serous differentiation
99
endometrioid carcinoma: squamous elements are benign
adenoacanthoma
100
endometrioid carcinoma: squamous elements are malignant
adenosquamous carcinoma
101
forms small tufts papillae high nuclear atypia highly aggressive
serous carcinoma
102
Cl/P of carcinoma of endometrium
leukorrhea irregular uterine bleeding symptoms of spread
103
local spread of carcinoma of endometrium
cervix ovaries bladder
104
leiomyosarcoma arises
de novo from myometrium
105
gross picture of leiomyosarcoma
uterus: enlarged, soft solitary bulky fleshy mass invades wall/protrudes into uterine cavity
106
post-menopausal patient soft enlarged uterus solitary bulky fleshy mass invades uterine wall OR protrudes into uterine cavity as polyploid mass necrotic atypia ↑mitotic activity
leiomyosarcoma
107
microscopic picture of leiomyosarcoma
necrosis atypia ↑mitotic activity
108
leiomyosarcoma is differentiated from leiomyoma by
-necrosis -atypia -↑mitotic activity
109
causes of uterine bleeding in prepuberty
-precocious puberty -hypothalamic, pituitary, ovarian disorders
110
causes of uterine bleeding in adolescence
anovulatory cycles
111
causes of uterine bleeding in reproductive age (4)
1-anovulatory cycles 2-ovulatory dysfunctional bleeding (inadequate luteal phase) 3-pregnancy complications (abortion, trophoblastic diseases, ectopic pregnancy) 4-organic lesions (leiomyoma,adenomyosis,polyps..)
112
causes of uterine bleeding in perimenopausal women
1-anovulatory cycle 2-irregular shedding 3-organic lesions (carcinoma, hyperplasia, polyps)
113
causes of uterine bleeding in postmenopausal women
1-organic lesions (carcinoma, hyperplasia, polyps) 2-endometrial atrophy

UROGENITAL (22 decks)

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