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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
Q

endometriotic tissue survival is enhanced by

A

inflammatory mediators
estrogen production
inflammation by MQ activation

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26
Q

endometriosis can be treated by

A

COX-2 inhibitors
Aromatase inhibitors

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27
Q

pelvic endometriosis sites (7)

A

1-ovaries
2-cervix
3-tubes
4-uterine ligaments
5-vagina
6-rectovaginal wall
7-pelvic peritoneum

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28
Q

A.chocolate cysts are seen in?
B. reason for their formation?

A

A.ovarian endometriosis
B.periodic bleeding at site of ovarian endometriosis

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29
Q

extrapelvic endometriosis sites (4)

A

1-laparotomy scars
2-vulva
3-umbilicus
4-appendix

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30
Q

Cl/P of endometriosis (3)

A

1-severe dysmenorrhea
2-pelvic pain
3-possible infertility

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31
Q

pelvic pain in endometriosis is due to

A

intrapelvic bleeding & intrabdominal adhesions

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32
Q

adenomyosis definition

A

growth of basal layer of endometrium down into myometrium

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33
Q

microscopic picture of adenomyosis

A

nests of stroma +/- glands in myometrium

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34
Q

what causes uterine wall thickening in adenomyosis

A

endometrial tissue triggers reactive hypertrophy of myometrium

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35
Q

adenomyosis effects (3)

A

-uterine enlargement & thickening
-dysmenorrhea
-pelvic pain

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36
Q

aetiology of endometrial hyperplasia

A

excess estrogen relative to progestin—>excessive endometrial proliferation

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37
Q

causes of excess estrogen in endometrial hyperplasia (4)

A

1-failure of ovulation w/ persistence of graafian follicle
2-prolonged estrogenic steroids use
3-estrogen producing lesions
4-obesity

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38
Q

estrogen producing lesions

A

polycystic ovary
granulosa-theca cell tumors

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39
Q

why does obesity lead to ↑estrogen

A

adipose tissue converts steroid precursors—>estrogen

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40
Q

gross picture of endometrial hyperplasia

A

uterus: moderately enlarged
endometrium:thickened, abundant, polyploid

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41
Q

types of endometrial hyperplasia

A

hyperplasia without atypia
hyperplasia with atypia

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42
Q

glands in hyperplasia w/o atypia are lined by

A

columnar epithelium w/ ↑mitosis

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43
Q

glands in hyperplasia w/atypia are lined by

A

atypical cells

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44
Q

endometrial intraepithelial neoplasm

A

(endometrial) hyperplasia with atypia

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45
Q

which type of endomertrial hyperplasia is associated w/ progression to cancer

A

hyperplasia w/ atypia

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45
Q

which type of endomertrial hyperplasia is associated w/ progression to cancer

A

hyperplasia w/ atypia

46
Q

TTT in case of:
hyperplasia w/ atypia
patient no longer desiring fertility

A

hysterectomy

47
Q

TTT in case of:
hyperplasia w/ atypia
young patient desiring fertility

A

high dose progestins

48
Q

swiss cheese appearance is seen in

A

simple form endometrial hyperplasia

49
Q

microscopic configuration of glands in endometrial hyperplasia

A

1.simple=↑size, number + cystic dilatation
2. complex= crowded back to back arrangement w/ outpouching & infoldings

50
Q

microscopic picture of endometrial hyperplasia

A

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
Q

benign polyploid mass that arises from endometrial mucosa

A

endometrial polyp

52
Q

presence of endometrial tissue outside uterus

A

endometriosis

53
Q

presence of pus in endometrial cavity

54
Q

inflammation of endometrium

A

endometritis

55
Q

growth of basal layer of endometrium down into myometrium

A

adenomyosis

56
Q

exaggerated endometrial proliferation due to excessive estrogen relative to progestin

A

endometrial hyperplasia

57
Q

neoplastic component of endometrial polyp

A

monoclonal stromal cells

58
Q

menopause
irregular uterine bleeding
polyploid mass
glands are cystically dilated
endometrium resembling basalis
small muscular arteries
monoclonal stromal cells

A

endometrial polyp

59
Q

malignant transformation of endometrial polyp

60
Q

malignant transformation of endometrial hyperplasia

A

endometrial carcinoma

61
Q

malignant transformation of leiomyoma

62
Q

most common tumor in women

63
Q

endometrial polyps arise from

A

endometrial mucosa

64
Q

leiomyoma arises from

A

uterine muscles

65
Q

genetic predisposition in endometrial polyps

A

rearrangements of chromosomes 6 & 12

66
Q

genetic predispositions in leiomyoma

A

rearrangements of chromosomes 6 & 12

67
Q

leiomyoma is associated w/

A

estrogenic stimulation
chromo 6 & 12 rearrangement

68
Q

leiomyoma gross picture (8)

A

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
Q

leiomyomas microscopic picture

A

-vascular stroma
-interlacing bundles of smooth muscle fibers & dense collagen bundles

70
Q

cellular stroma seen in

A

endometrial hyperplasia

71
Q

vascular stroma seen in

72
Q

whorly cut surface seen in

73
Q

pseudocapsule seen in

74
Q

pseudocapsule in leiomyoma is due to

A

compression of adjacent muscles

75
Q

pathological changes in leiomyomas

A

1-hyaline changes + cystic degeneration
2-necrosis
3-infection & suppuration
4-calcification
5-red degeneration
6-rare malignant change

76
Q

MC site of necrosis in large leiomyomas

77
Q

red degeneration seen in

A

leiomyomas

78
Q

red degeneration occurs due to

A

-thrombosis of vessels
-torsion of pedicle

79
Q

red degeneration is associated with

A

pregnancy
oral contraceptives

80
Q

red degeneration is associated with

A

pregnancy
oral contraceptives

81
Q

a soft not firm hemorrhagic, necrotic leiomyoma has undergone

A

red degeneration

82
Q

types of leiomyoma (3)

A

1-interstitial
2-submucous
3-subserous

83
Q

interstitial leiomyoma site

A

within myometrium

84
Q

submucous leiomyoma site

A

protruding into uterine cavity

85
Q

subserous leiomyoma site

A

beneath serous covering

86
Q

menopause
abdominal pain
vomiting
fever
enlarged firm uterus
greyish white
sharply circumscribed
whorly cut surface
interlacing bundles of smooth muscles & dense collagen

87
Q

clinically leiomyomas are associated with

A

-uterine bleeding
-urinary bladder disorders
-impaired fertility
-spontaneous abortion, fetal malpresentation, postpartum hg

88
Q

leiomyoma of cervix

A

less common
solitary
cervical canal obstruction

89
Q

MC invasive tumor of female genital tract

A

endometrioid carcinoma

90
Q

endometrioid carcinoma is related to

A

-excess estrogen
-endometrial hyperplasia
-mutations: PTEN & DNA mismatch repair genes

91
Q

Cowden syndrome

A

germline mutations in PTEN genes

92
Q

Lynch syndrome

A

germline mutations in DNA mismatch repair genes

93
Q

serous carcinoma arises in setting of

A

endometrial polyps

94
Q

serous carcinoma is related to

A

mutations in TP53

95
Q

TP53 mutatuons are detected by

A

immunostaining

96
Q

After menopause 55-65 yo
leukorrhea
irregular uterine bleeding
localized polyploid mass OR diffuse irregular ulcerated necrotic endometrium

A

endometrioid carcinoma

97
Q

risk factors of endometrioid carcinoma (5)

A

1-↑estrogen stimulation
2-infertility
3-diabetes
4-HTN
5-obesity

98
Q

microscopic picture of endometroid carcinoma

A

normal glands
squamous differentiation
mucinous, serous differentiation

99
Q

endometrioid carcinoma: squamous elements are benign

A

adenoacanthoma

100
Q

endometrioid carcinoma: squamous elements are malignant

A

adenosquamous carcinoma

101
Q

forms small tufts
papillae
high nuclear atypia
highly aggressive

A

serous carcinoma

102
Q

Cl/P of carcinoma of endometrium

A

leukorrhea
irregular uterine bleeding
symptoms of spread

103
Q

local spread of carcinoma of endometrium

A

cervix
ovaries
bladder

104
Q

leiomyosarcoma arises

A

de novo from myometrium

105
Q

gross picture of leiomyosarcoma

A

uterus: enlarged, soft
solitary bulky fleshy mass
invades wall/protrudes into uterine cavity

106
Q

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

A

leiomyosarcoma

107
Q

microscopic picture of leiomyosarcoma

A

necrosis
atypia
↑mitotic activity

108
Q

leiomyosarcoma is differentiated from leiomyoma by

A

-necrosis
-atypia
-↑mitotic activity

109
Q

causes of uterine bleeding in prepuberty

A

-precocious puberty
-hypothalamic, pituitary, ovarian disorders

110
Q

causes of uterine bleeding in adolescence

A

anovulatory cycles

111
Q

causes of uterine bleeding in reproductive age (4)

A

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
Q

causes of uterine bleeding in perimenopausal women

A

1-anovulatory cycle
2-irregular shedding
3-organic lesions (carcinoma, hyperplasia, polyps)

113
Q

causes of uterine bleeding in postmenopausal women

A

1-organic lesions (carcinoma, hyperplasia, polyps)
2-endometrial atrophy

UROGENITAL (22 decks)

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