Pathology of the Uterus Flashcards
Menstrual Cycle
What is the most significant feature of chronic endometritis when examining a biopsy of the stroma of the endometrium? It’s associated with what?
plasma cells; neutrophils; retained products of conception
Leiomyomas
Do leiomyosarcomas tumor arise de novo or through a transformation from leiomyosarcoma? What is the gross description of a leiomyosarcoma?(hardness, surface, appearance, borders)
They arises de novo; their soft, bulky, hemorrhagic and have irregular borders
What disease is the most common cause if infertility?
Polycystic Ovary Disease (Stein-Leventhal Syndrome)
Psuedomyxoma Peritoniei
What is the ovarian counterpart of male seminoma? 90% occurs under what age? 50% of what general type of germ cell tumors?(benign or malignant)
dysgerminoma; under the age of 30 years old; 50% of malignant germ cell tumor
What are the clinical features of endometriosis?(3-5 points)
crippling dysmenorrhea, severe dyspareunia, pelvic pain, infertility and bladder involvement may cause dysuria
Endometriotic Cyst
Endometrial hyperplasia with atypia
the nuclei is clearing out.
You have the prominent nucleioli
The nucleus has gotten bigger.
Leiomyosarcoma
Fibroma, a germ cell line tumor in the female genital tract
Mucinous Cystadenoma
What is the amount of endometroid tumors that are bilteral? What is the percentage of ovarian tumors that are endometroid tumors? Does it involve an older or younger age group than epithelial serous ovarian tumors?Q
Older age group
Brenner Tumor
What is an example of a disease that is an example of a functional endometrial disorder?
Polycystic-ovary syndrome
What is the most common ovarian epithelial tumor generally occurring under 40 years of age?
Serous cystadenomas
What is a general condition of the endomterium which is believed to be a precancerous condition, occurs aounrd the time of or after menopause and thought to be a precursor of endometrial carcinoma?
Endometrial Hyperplasia
Leiomyosarcoma
it gives you the opportunity to looks at colonic glands, at the bottom of the image, versus endometrial glands, at the top of the image
Type I Endometrial Adenocarcinoma
What type is uterine bleeding the most likely in Leiomyoma Uteri?
submucosal type
Benign Cystic Teratoma, a type of germ cell tumor
Leiomyomas
The endometrium in a person suffering from endometrial polyps microscopically contain what?(1-2 points)** **Which one of these histological features are more common? In, 0.5-3.0% of the caes, what may develop in a polyp?
Microscopically you will see a hyperplastic polyp which contain dilated cystic glands. The dilated cystic glands are more common; In rare cases, adenocarcinoma may develop in the polyp
Thecoma
What is psuedomyxoma peritonei? How can this affect the GIT?
The flood of mucus in the peritoneal cavity; It can cause bowel obstruction
Mucinous adenomas of low malignant poetntial may flood what cavity in the body with pools of mucin? 85% of mucinous adenomas are benign, borderline or invasive? What about 5% or 10%?
peritoneal cavity; 85% are benign, 10% of borderline and 5% are invasive
Endometrial adenocarcinoma usually occurs in what age group? What are risk factors for adenocarcinoma?(2-4 points)
post-menopausal women; obesity, hypertension, nulliparity and diabetes
Firm, white tumors made up of fibroconnective tissue in the female genital tract? It is a germ cell tumor.
fibromas
Proliferative Stage of Menstrual Cycle
The gland are straight tubular structures lined by regular tall psuedostratified columnar cells
Sertoli Cell Tumor
Chocolate cysts are typically seen in what female genital tract disease?
endometriosis
What are variants of endometrial adenocarcinoma?(1-3 points)
Clear Cell Carcinoma, papillary serous carcinoma and mucinous carcinoma
The most common is dysfunctional uterine bleeding, seen here as anovulatory endomertium with stromal breakdown
Chronic endometritis is associated with what conditions?**(2-4points) **What type of cellular features do you find in the stroma of the endometrium?
rentention of products of conception, TB, IUD and pelvic inflammtory disease; you find plasma cells in the stroma
What are the four categories of ovarian tumors?**(4 points) **Which one is the most common?
Epithelial, germ cell, gonadal and metastatic; epithelial
BORDERLINE SEROUS CYSTADENOMA
The upper right picture is Grade I
The picture to the lower left is Grade II
The picture to the lower right is Grade III
Granulosa Cell Tumor
PAPILLARY SEROUS CYSTADENOMA
What is the relative percentage of cases of endometrial tumors that are associated with endometriosis? Are most endometroid tumors carcinomas?
Low percentage; about 15-20%; yes
Endometrial Polyp
Granulosa Cell Tumor
What is often seen in post-menopausal period and typically present with bleeding?
Endometrial polyps
What is the most common malignant tumor of the female genital tract? What is the pathogenesis of this disease?(3 points)
Endometrial Adenocarcinoma; there is prolonged unopposed estrogen stimulation of the endometrium leading to hyperplasia resulting in adenocarcinoma
Anovulatory Endometrium
Most Brenner Tumors are benign or malignant? What is the histological description of the cells in Brenner Tumors?(3 points)
most are benign; the cells nest with cells resembling transitional cells embedded in abundant stroma
Type I Endometrial Carcinoma
here is a papillary lesion going into the endometrial cavity.
Type II tends to be more common in African American Woman. The statistics changes, she is going to ask us worsens that don’t change at all over time. We should be able to figure out benign from malignant.
She wants to make sure we understand staging determines prognosis.
Sertoli Cell Tumor
Immature teratoma, malignant usually occur in women under what age?(one number) They’re composed of what type of tissue? They’re particularly what type of tissue?
20 years old; primitive embryonal tissue, primitive neuroglial tissue
How is endometrial adenocarcinoma graded?(3 points)
Grade I is well differentiated
Grade II is moderately differentiated
Grade III is poorly differentiated
What is the most freuent cancer of the female genital tract but hte most lethal of all gynecologic malignancies?(general cnacer)
Ovarian Cancers
What tumor has Cell-Exner bodies?
Granulosa Cell Tumor
Endodermal Sinus (Yolk Sac) Tumor
What are the causes of abnormal uterine bleeding?(1-2 points)
Dysfunctional Uterine Bleeding; Uterine bleeding secondary to organic disorders
CYSTADENOCARCINOMA
Low Grade Hyperplasia
Immature Teratoma, a germ cell tumor that is malignant
Mucinous tumors can grow to a small size or a large size? How much do they usually weigh? What type of mucinous tumors are multiloculated: benign or malignant?
They can grow to a very large size; they usually weigh more than 25kg; both of them
What is the severity and incidence of uterine sarcomas? What is an example of one that affect the myometrium?
Their all malignant and the incidence is very low; leiomyosarcoma
Early Secretory Phase with subnuclear vacuoles
Mucinous Cystadenoma
What is the incidence of Brenner tumors? What is the hardness? Are they commonly unilateral or bilateral?
They’re uncommon; they’re solid tumors; they’re commonly unilateral
What determines the prognosis of endometrial adenocarcinoma: staging or prognosis?
Staging
Endometroid tumors histologically resemble what type of tumors? Does endometroic tumors have a better prognosis than mucinous carcinomas? What about serous carcinomas?
endometrial adenocarcinoma
Granulosa cell tumor can occur at any age but they’re the most frequent after what age? What type of grade/general type of tumor(low, middle, high; benign or malignant)
Granuloas cell tumors usually occur after menopause; they’re considered a low-grade malignant tumor
BORDERLINE SEROUS CYSTADENOMA
Anovulatory Cycles are more common in what general time period in a owmen’s life?**(2 points) **What hormonal imbalance is known to contribute to anovulatory cycles? How does this affect the uterus?
Menopause or puberty; There is estrogen stimulation without progesterone opposition; there is endometrial proliferation without secretory activity
Leiomyomas
What are the biochemical causes of polycystic ovary disease?(3 points)
High LH/FSH ratio, raised adrenal and ovarian androgen and raised testosterone
What is the most common symptom of endometrial hyperplasia? In 10% of the cases, the disease may be what?
abnormal vaginal bleeding; asymptomatic
What is the prognosis of ovarian tumors? Why?
They have a poor prognosis; they’re discovered in stage III or stage IV cases
Stromal Breakdown at the onset of Mensesa
Cortical inclusion cysts
Polycystic Ovarian Disease
Chronic Endometritis
how is endometrial carcinoma stage? What stage has the poorest prognosis?(2 points)
Stage I-IV; Stage III and IV have the poorest prognosis
Endometrial Polyps typically present in women in what phase of their life cycle? They typically present with what?
They typically present with bleeding in post-menaopaulsal women
Submucosal Leiomyoma
The first thing you do when you look at the slide is identify the tissue.
This is glandular.
We’re not sure about what we’re looking at.
You’re going to see a lot of gland at first. You’re going to see lamina propria
You see submucosa
These are glands in the colon. This is the colon. The glands aren’t right for gastric. Gastric, there are smaller glands and they’re not smaller.
Basically, you identify the tissue, this is colon. You have no idea what is going on to the let of the picture. The lands and stroma are not what we see to the right. The glands and stroma on the left don’t have that type of structure.
Mature Cystic Teratoma; a type of germ cell tumor
Are follicular cysts neoplastic or non-neoplastic? The folicular cysts are due to what morphological changes of the follicles? How common are follicular cysts? What type of symptoms do they produce?
non-neoplastic; cystic diltations of the follicles; they’re very common; they rarely produce symptoms unless they’re larger than 5mm or they rupture
Serous cystadenocarcinoma or invasive serous carcinomas prognosis? Survival rate?
20%, five year survivial rate
A germ cell tumor that contains spindle cells and plump lipidized cells? They look grossly yellow. They’re often estrogenic tumors.
Thecomas
Malignant Mixed Mullerian Tumors (Carcinosarcoma)
How do you diagnose uterine sarcomas? What age range has the higest incidence?(age range)
The mitotic figure count; 10 more mitoses per 1- HPF for leiomyosarcoma diagnosis; 40-60 years old
What is the gross apperance of a Leiomyoma Uteri? What are the degernative changes you see?(1 -3 points) How likely is malignant transformation?
A well-circumcised, gray-white rubbery and spheroidal and shell out easily; hyaline, cystic and calcific changes; unlikely
An androgen producing tumor that is virlizing in the female genital tract? Tumor of low malignant potentail. Tumor contains variable admixture of what type of cells?
Sertoli-Leygid Cell Tumor; they contain cells resembling sertoli or leydig cells of the testis
Atypiical Hyperplasia
Presence of endometrial glands and stroma within myometrium at least 3mm benath endomyometrial junction. How does this particular disease affect the size and symmetry of the uterus?(2 points)
Adenomyosis; uterine enlargement and irregular thickening
Adenomyosis occurs in what age group?(Range) What is usually present in this disease?(2-3 points)
30-40 years old; there are varying degrees of dysmenorrhea, dysfunctional uterine bleeding and premenstrual congestion
What is the main pathogenesis of endometrial hyperplasia? Endomertrial hyperplasia can also occur with what other conditions?(3-4 points)
Chronic unopposed stimulation of the endometrium by estrogen; chronic anovulation, polycystic ovary disease, granulosa cell tumor and exogenous unopposed estrogen therapy
Adenomyosis
Leiomyomas
What are characteristic fingins of endometriosis?**(2-3 points) **What are findings typically seen in the Uterus?
beading, nodularity and tenderness of uterosacral ligaments; choclate cysts
Psamomma bodies can be seen in what type of female genital tract cancr?
Invasive Serous Carcinomas or Serous Cystadenocarcinoma
What are the three most common symptoms of Polycystic Ovary Disease?(3 points) What are the other clinical features of Polycystic Ovary Disease?(1-3 points)
Secondary amenorrhea, hirsutism and infertility; obesity, abnormal bleeding and palpable ovary
How likely is stroma invasion in ovarian serous epithelial tumors? 1/3rd if serous tumors are bilateral or unilateral? What is the prognosis? What is the survival rate?
It is unlikely; 1/3rd of the serous tumors are bilateral; good prognosis, 75-80% 10 year survivial rate
Endometrial hyperplasia is usually the result as a unopposed action of what hormone?
estrogen
What is the most common cause of uterine bleeding?
Dysfunctional uterine bleeding
What is endometriosis?
Presence of endometrial tissue outside of the uterus
Simple Hyperplasia with Atypia
Loss of PTEN Gene Expression
The arrows are pointing to glands who are lined with cells that are expressing the gene
What is dysfunctional uterine bleeding? It is generally the result of what? What could be the causes of this?(2-3 points)
uterine bleeding in the absence of organic lesions; It is generally the result of anovulatory cycles. It could be diopathic, subtle hormonal imbalance or hormonally functional ovarian lesion. ]
MICROPAPILLARY SEROUS CARCINOMA
What is the most common tumor( amon benign and malignant) tumor of the female genital tract? How could if affect that location of the female genital tract when you consider the structures that could be invaded?
Leiomyoma Uteri; submucosal, intramural and subserosal
What is the microscopic apperance of the capsule: density of capsule, tissue making up the capsule, make up of the follicles(2 points)
dense; collagenous, cystic follicle lined by thick zone of theca interna
Dysgerminoma, a germ cell tumor
Polycystic Ovarian Disease
PAPILLARY SEROUS CYSTADENOCARCINOMA
BORDERLINE SEROUS CYSTADENOMA
Type I Ovarian Epithelial tumors are derived from what location of the ovaries? Type II ovarian epithelial tumors are derived from what location of the ovaries?
Type I are from the surface of the ovary and type II is from the follicular epithelial cells
Endometriotic Lining
Seen with pateints suffering with endometriosis
Occurs in Young women
Unilateral solid markedly hemorrhagic tumor
admixture of synctio-cytothrophoblasts
tumor elaborates β-hCG and is highly aggresive
choriocarcinoma
What is the gross apperance of the ovaries when a person has polycystic ovarian disease?(size, color, covering, texture and description)?
Large, pearly white, thick capsule, smooth and numerous subcapsular cysts
What is more likely to be bilateral, mucinous ovarian tumors serous epithelial ovarian tumors? Mucinous tumors have a high incidence at what age in adult life?(general)
serous ovarian tumors; mucinous tumors have a high incidence at the middle adult life
What is the most commo ovarian epithelial tumors? What is incidence of the severity of each?(65%, 15% and 20%)
Serous; benign is 65%, borderline is 15% and invasive is 20%
What are the types of endometrial hyperplasia(2 points)
Simple endometrial hyperplasia with atypia simple endometrial hyperplasia without atypia
Acute endomeritis is usually due to infections of what pathogenesis(2 points). What cells do you find in the stroma of the endometrium?
Group A Hemolytic Streptococci and Staphloccus; neutrophils
What is the metastatic theory in reference to endometriosis?
regurgiration of endometrial tissue (retrograde flow) and lymphatic or hematogenous spread
What are generalized metabolic disturbances that can cause functional endometrial disorders?(1-2 points)
Obesity and malnutrition
Endometrial Stromal Sarcoma
Endometrial Hyperplasia with Squamous Metaplasia
Defined under the new system as Endometrial Hyperlasia with atypia
What is the most common, benign cystic germ cell tumor with structures from ecto-, endo-, and mesoderm layers of germ cells?
Teratoma
Polycystic Ovarian Disease
When a tumor has benign-looking squamous differentiation it isn’t called endometrial adenocarcinoma, it is referred to as what? When the squamous component is malignant, it is called what?
adenocanthoma; adenosquamous carcinoma
Endometrial hyperplasia with atypia
the cells are too clear
Ovarian metastatic tumors w ith primary sites in the stoamch (80%) or colon (20%)
Signet ring cancer cells with peripherally compressed nuclei
Large amounts of mucin distend the tumor cells?q
Krukenbnerg Tumor
What is the metaplastic theroy in reference to the pathogenesis to endometriosis?
coelomic epithelial metaplasia
Leiomyosarcoma
What is the most common tumor of the ovary, comprising 40% of ovarian cancers?
Invasive serous carcinomas
What is the peak age of incidence for teratomas?(age range)? Why are teratomas referred to as dermoid cyst?(2 points) How often do they undergo malignant change?
20-30 years of age; They’re referred to as dermoid cysts because they contain sebaceous material and hair; they rarely undergo malignant change
What is the result of endometriosis? What are general description of the pathogenesis?(2 points)
Significant pelvic adhesions; metastatic theory and metaplasic theory
