Pathology of the Uterus

Question 1

Acute Endometritis

• Causes?
• diagnosed by?

Answer 1

Acute Endometritis is an acute swelling of the endometrium.

• It is caused by bacteria and arises after delivery or miscarriage. The inflammatory response is limited to the stroma
• on histology you will see neutrophils in the stroma or glands

Question 2

Chronic Endometritis

• causes
• dx based on?

Answer 2

Chronic Endometritis occurs with the following:

• pelvic inflammatory disease (PID)
• prolonged IUD use
• TB (rare in western countries)
• products of conception left in the uterus

The dx of chronic endometritis is based on the presence of plasma cells in the stroma

Question 3

Endometrial Hyperplasia (benign):

• Definition
• causes
• genetic factors involved

Answer 3

Endometrial hyperplasia:
-is an increased proliferation of the endometrial glands relative to the stroma, resulting in an increased glands-to-stroma ratio when compared to normal

• it is caused by anything that increases the exposure to estrogen (Obesity, Menopause, POS, functioning granulosa cell tumors of the ovary, prolonged administration of estrogen)
• inactivation of the tumor SUPPRESSOR gene PTEN

Question 4

Carcinoma:
Type 1: Endometrioid Carcinoma
-characteristics
-genetic component
-risk factors

Answer 4

Endometrioid Carcinoma (Type 1) usually occurs in younger women

• is slow growing and indolent. It generally spreads through the lymphatics or pelvic veins
• Mutation in the PTEN (tumor supressor) gene. Usually preceeded from endometrial hyperplasia
• risk factors: same as endometrial hyperplasia (anything that increases exposure to estrogen)

Question 5

Carcinoma
Type II- Serous Carcinoma
-Characteristics
-genetic component
-risk factors

Answer 5

Serous Carcinomas usually occur in older women (~10 years older than those that present with endometrioid carcinomas). The prognosis for a pt. with a Type II carcinoma is generally poorer than type 1 because of this tumors propensity to exfoliate and travel through fallopian tubes and implant on other perional surfaces.
-arises from endometrial atrophy
-by definition serous carcinoma tumors are poorly defferentiated
-Mutation in TP53 (use IHC to look for expression of TP53)
-

Question 6

Carcinoma definition

Answer 6

cancer arising on the epithelial tissue of skin or the lining of internal organs

Question 7

Leiomyoma
-location
-genetic component
-

Answer 7

Leiomyoma

• benign tumor of the myometrium
• associated with mutations in MED12

Question 8

Leiomyosarcomas

• morphology
• histology
• genetic component

Answer 8

Leiomyosarcomas

• larger with atypia compared to leiomyoma. They will be bulky, fleshy masses that invade the uterine wall or project into the uterine lumen
• distinguished from leiomyoma based on nuclear atypia, mitotic index and necrosis
• HAHA! Trick question! Leiomyosarcomas arise de novo (they don’t come from leiomyomas)

Question 9

Adenomyosis

• definition
• characteristics

Answer 9

Adenomyosis-
endometrial tissue WITHIN the uterine wall
-causes pain (not cyclical)
-irregular and heavy menses
-Thick uterine wall

Question 10

Endometriosis

• definition
• characteristics
• what can this lead to?

Answer 10

Endometriosis is the presence of ectopic endometrial tissue outside of the uterus

• cyclic bleeding
• Cysts (chocolate cysts in the ovaries)
• can lead to infertility, dysmenorrhea, and pelvic pain