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MHD II Test 3 > Pathology of the Body of the Uterus and Endometrium > Flashcards

Pathology of the Body of the Uterus and Endometrium Flashcards

1
Q

Uterus Wall

  1. Histo of Endometrium
  2. Histo of Myometrium
  3. 4 phases of menstrual cycle
A
  1. glands and surrounding stroma
  2. smooth muscle
  3. Menstrual, Proliferative, Ovulation, Secretory
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2
Q

Menstrual Cycle

  1. Menstrual phase- time and what happens
  2. Proliferative phase- time and what happens
  3. When does ovulation occur?
  4. Secretory phase- timing
A
  1. day 1, lasts 3-7; sloughing of 2/3 of mucosa
  2. variable, usually 10 days; rapid proliferation of endometrail glands and stromal tissue
  3. day 14
  4. day 15-28: 2 weeks
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3
Q

Proliferative Phase

  1. What happens?
  2. What can be seen histologically?
  3. What 2 things don’t occur?
  4. What is the driving hormone?
A
  1. rapid growth of both glands and stroma
  2. straight tubular glands, tall, pseudostratified columnar cells, mitoses
  3. secretion or vacuolization
  4. Estrogen
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4
Q

Secretory Phase

  1. What develop? Where?
  2. What eventually occurs?
  3. How does the stroma change?
  4. What is the driving hormone?
A
  1. vacuoles; sub and supranuclear
  2. secretory exhaustion (saw-toothed appearance)
  3. has lots of edema, (maximum @ day 21); predicidual changes starting around spiral arteries (day 23)
  4. Progesterone
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5
Q

Menstrual Phase

  1. What happens?
  2. What is seen histologically?
A
  1. disintegrationof endometrium, stroma and glands breakdown; endometrial shedding
  2. Blood in stroma, inflammatory cell infiltrate
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6
Q

Dysfunction (Abnormal) Uterine Bleeding (AUB)

  1. Define
  2. What predicts the underlying causes?
  3. Most Common clinical presentation
  4. What is a functional cause in young women?
  5. What happens in an anovulatory cycle?
A
  1. spectrum of changes that can occur during the active reproductive life
  2. age group
  3. excessive and abnormal uterine bleeding during or between menstrual cycles
  4. alterations in the pituitary-ovarian-endometrail hormonal axis
  5. excessive and prolonged estrogenic stimulation w/o ovulation, no progestational phase
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7
Q

AUB Causes by Age Group

  1. Pre-menopausal: common
  2. Pre-menopausal: rare
  3. Menopausal/Post-menopausal
A
  1. anovulatory cycle, irregular shedding due to hormonal imbalance
  2. organic lesions (carcinoma, hyperplasia, polyps)
  3. organic lesions, endometrial atrophy (more common in this age group)
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8
Q

AUB Causes in Premenopausal women

  1. Prepuberty
  2. Adolescence
  3. Reproductive age (4)
A
  1. precocious puberty
  2. anovulatory cycle
  3. complications of pregnancy (abortion, trophoblastic disease, ectopic pregnancy)
    Organic lesions
    anvoluatory cycle
    Ovulatory dysfunctional bleeding: inadequate luteal phase
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9
Q

Inflammatory Lesions of Endometrium

  1. How common is acute endometritis? What causes it?
  2. How common is chronic endometritis? What causes it (5)
  3. How does chronic endometritis present?
  4. What is the pathologic finding?
A
  1. uncommon, bacterial infection after delivery or miscarriage
  2. common, pelvic inflammatory disease, retained gestational tissue, intrauterine devices, tuberculous salpinigitis, Non-specific
  3. abnormal bleeding, pain, vaginal discharge, infertility
  4. plasma cells w/in endometrial stroma, lymphoid follicles, lymphoid infiltrates, histiocytes
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10
Q

Acute Endometritis

1. Pathology

A
  1. moderate to large #’s of PMNs in non-bleeding endometrium
  2. microabscess in stroma
  3. PMNs may fill and disrupt glands
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11
Q

Endometrial Actinomycosis

  1. What is seen on histo? (2)
  2. Associated with what?
  3. What is it usually not associated with?
A
  1. neutrophils (acute inflammation)
  2. cluster of sulphur granules
  3. intrauterine devices (10%)
  4. IUD, frequently cultured in female genital tract w/o IUD
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12
Q

Endometrial Adenomyosis

1. Define

A
  1. presence of endometrial glands and surrounding stroma within the myometrium
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13
Q

Endometriosis

  1. Define
  2. Common locations
  3. Incidence
  4. Clinical Complaints
  5. Potential Origins
A
  1. endometrium in abnormal locations outside uterus
  2. ovaries, uterine ligaments, retrovaginal septum, laparotomy scars
  3. 10%
  4. severe dysmenorrhea, dyspareunia, pelvic pain, menstrual irregularities, infertility (30-40%), and malignancies
  5. Regurgitation Theory, Metaplastic Theory, Vascular/lymphatic dissemination Theory
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14
Q

Endometrial Polyps

  1. Define
  2. May cause
  3. What do they respond to?
  4. How often do they cause malignancy?
  5. Histo (3)
A
  1. masses of endometrial mucosa of variable sizes, projecting into the endometrail cavity
  2. asymptomatic, abnormal bleeding
  3. estrogen stimulation
  4. rare
  5. irregular glands, thick walled blood vessels, stromal fibrosis
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15
Q

Endometrial Hyperplasia

  1. Related to what?
  2. Presentation
  3. Types (2)
A
  1. high, prolonged estrogenic exposure
  2. abnormal uterine bleeding, post-menopausal bleeding
  3. Simple hyperplasia w/ or w/o atypia
  4. Complex hyperplasia w/ or w/o atypia
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16
Q

Endometrial Hyperplasia

  1. Histology
  2. What gene is lost?
  3. What is it assocaited with?
A
  1. architectural change: glands increased in number and size, crowded and irregularly shaped, glands/stroma ratio increased
  2. PTEN
  3. endometrail carcinoma
17
Q

Simple Hyperplasia

  1. most commonly associated with what?
  2. Microscopic (3)
A
  1. anovulatory cycle
  2. mildly increased gland-to-stromal ratio
  3. distorted endometrial glands with cystic alteration
  4. Nuclei of endometrial glands similar to proliferative endometrium (no atypia)
18
Q

Atypical Complex Hyperplasia

  1. What is it?
  2. Micro look (3)
  3. What do 1/4 to 1/3 also have?
A
  1. adenomatous hyperplasia with atypia
  2. markedly incresed glands/stroma ratio
  3. glandular crowding and complexity
  4. Irregular epithelial lining cells, nuclear stratification, atypia, scalloping, and tufting
  5. adenocarcinoma
19
Q

PTEN Gene

  1. role
  2. how often is it inactivated in endometrial carcinoma?
  3. PTEN staining
A
  1. gene product, phosphatase protein, which is involved in the regulation of the cell proliferation, growth and apoptosis
  2. most frequently altered gene (also common premalignant endometrial hyperplasia, type I endometrial carcinomas)
  3. will reveal lack of functional gene in hyperplastic tissue
20
Q

Endometrial Carcinoma

  1. What is it?
  2. Endometrioid type (type I)
  3. Non-endometrioid type (type II)
A
  1. most common invasive cancer of the female genital tract, typically occur in postmenopausal women
  2. estrogen related, tumor is mimicking the appearance of endometrail glands
  3. non-endometrioid type, high grade, serous papillary, clear cell
21
Q

Endometrial Carcinoma

  1. what % of endometrial carcinoma
  2. associated with what? (2 main things)
  3. common mutation
A
  1. 85%
  2. unopposed estrogen: polycystic ovary syndrome, Obesity, diabetes, HTN, infertility, estrogen secreting ovarian tumor, exogenous estrogen;
    endometrial hyperplasia
  3. PTEN
22
Q

Type I Endometrial Carcinoma

  1. Gross look
  2. Micro look
A
  1. polypoid mass (exophytic) or tumor diffusely involving the endometrial surface (may involve myometrial)
  2. mixture of: confluent gland pattern (lined by malignant stratified columnar epithelium), solid growth pattern (sheets of malignant cells)
23
Q

Histologic Grading

  1. Based on what?
  2. What is grade 1?
  3. Grade 2?
  4. Grade 3?
  5. What increases the grade by 1?
  6. Architectural grade 1, cytologic grade 3: what is it?
A
  1. proportion of solid component
  2. 50% solid growth
  3. conspicuously enlarged nuclei and prominent nucleoli
  4. papillary serous carcinoma
24
Q

Non-endometrioid Carcinoma (Type II)

  1. What % of endometiral carcinomas?
  2. Who gets it?
  3. Is it associated with estrogen?
  4. Prognosis
  5. What do 40-70% of cases have?
  6. Where does it spread?
A
  1. 5-10% of endometrial carcinomas
  2. older women
  3. no
  4. aggressive, stage II-III disease
  5. deep myometrial invasion
  6. peritoneum, early lymphatic invasion
25
Q

Histo look

  1. Papillary Serous Carcinoma
  2. Clear cell carcinoma
A
  1. papillary growth pattern, tumor cells are highly atypical and pleomorphic, high nuclear grade
  2. highly atypical and pleomorphic nuclei with clear cytoplasm
26
Q

Carcinosarcoma

  1. aka
  2. How common?
  3. How do pts present?
  4. Gross appearance
  5. Histo Look
A
  1. Malignant Mixed Mullerian Tumor (MMMT)
  2. rare, 0.1-2% of all uterine cancers
  3. post-menopausal bleeding and enlarged uterus on physical exam
  4. fleshy, bulky, polypoid tumor
  5. adenocarcinoma with malignant mesenchymal elements (sarcomatous components, could be smooth muscle, cartilage, skeletal)
27
Q

Endometrial Carcinoma: Staging

  1. Stage I
  2. Stage II
  3. Stage III
  4. Stage IV
A
  1. confined to uterous corpus
  2. uterus and cervix
  3. extends outside uterus but not the true pelvis
  4. extends outside true pelvis or involves bladder mucosa and rectum
28
Q

Tumors of Myometrium

  1. Benign
  2. Malignant
A
  1. Leiomyomas, smooth muscle tumor (fibroids), the most common tumor in women
  2. Leiomyosarcoma, uncommon
29
Q

Leiomyomas

  1. How common?
  2. who tends to get it?
  3. Does it respond to estrogen?
  4. Gross look
  5. Histo look
  6. Linked with what?
A
  1. most common tumor in women
  2. women of reproductive age, African Americans
  3. yes
  4. sharply circumscribed, round, firm nodules; bulging, tan-white, whorled appearance, variable in size
  5. well-delineated, whorled bundles of smooth muscle cells/bland spindle cells, resembling the surrounding normal myometrium,
  6. linked with chromosomal abnormality
30
Q

Leiomyoma

1. Clinical presentation

A
  1. asymptomatic, abnormal uterine/excessive bleeding (submucosal leiomyoma); may cause bladder compression, sudden pain (due to disruption of blood supply), impaired fertility, in pregnancy (spontaneous abortion, fetal malpresentation, post-partum hemorrhage)
31
Q

Leiomyosarcoma

  1. How common?
  2. Peak incidence?
  3. Gross morphology
  4. Histo
A
  1. uncommon, arise de novo from either myometrial layer or endometrial stroma
  2. 40s-60s
  3. bulky, fleshy, hemorrhagic, and necrotic
  4. nuclear atypia, mitoses (brisk mitoses), zonal necrosis (abrupt change) or tumor cell necrosis

MHD II Test 3 (14 decks)

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