Pathology of the Uterus Flashcards
A female pt comes to the ED with vaginal bleeding, pelvic pain, uterine tenderness, cervical motion tenderness.
- Is this Acute or Chronic Endometritis
- What microscopic changes would support this dx?
Chronic Endometritis
–spindly stroma with edema; focal early breakdown with surface neutrophils; plasma cells are characteristic, usually also histiocytes, lymphocytes and lymphoid follicles are present
–TX: Antibiotics, removal of IUD or curettage
–Clinical: fever, pelvic tenderness/pain, vaginal discharge or bleeding
Is this acute or chronic Endometritis?
What microscopic findings would you see?
What is this often caused by?
Acute
Micro: Must see microabscesses plus infiltration and destruction of glandular epithelium, as neutrophils are common in cycling endometrium
–Typically due to retained products of conception post-delivery or miscarriage or due to instrumentation
–Bacterial infection
•Group A strep, staph, polymicrobial (vaginal flora)
Risk factors for chronic endometritis (6)
(PID)
postpartum,
post-abortion (retained tissue),
IUD,
TB (miliary or TB salpingitis),
symptomatic bacterial vaginosis
Characteristic cells in chronic endometritis
Plasma cells
A female pt comes to the ED with vaginal bleeding, pelvic pain, uterine tenderness, cervical motion tenderness. based on the image what is the dx. What supports this dx?
Plasma cells= Chronic endometritis
•Benign outgrowths of endometrial stromal cells altered by chromosomal translocation with polyclonal glandular elements
What is the mechanism of action for the drug that places a pt at risk for developing this?
Treatment?
Endometrial Polyp
Tomoxifin:Selective estrogen receptor modulators (SERMs)—receptor antagonists in breast and agonists in bone. Also an agonist in endometrium
Block the binding of estrogen to ER ⊕ cells.
Treatment:
Asherman Syndrome:
Define
Etiology
- Adhesions and or fibrosis (Scarring) with destruction of basalis layer (stratum basalis) of endometrium
- Endometrial damage may follow vigorous curettage, usually in association with postpartum hemorrhage, miscarriage, or elective abortion complicated by infection.
88 percent followed postabortal or postpartum uterine curettage (Schenker, 1982).
•Damage may also result from other uterine surgery, including metroplasty, myomectomy, or cesarean delivery.
Destruction of the basalis layer can lead to ___
Amenorrhea
A pt that undergoes uterine surgery, including metroplasty, myomectomy, or cesarean delivery are at risk for what syndrom?
Asherman
What cancer is associated with endometriosis?
What features must you find to diagnos this?
Carcinoma
Must show 2/3 of the following:
- endometrial glands,
- endometrial stroma,
- hemorrhage
Powder burns and chocolate cysts
Endometriosis
dz?
Endometriosis
Endometriosis:
glands and stroma present
•Presence of endometrial glands and stroma tissue within the myometrium of the uterus
Sighns of this?
Adenomyosis
enlarged uterus
•Proliferation of endometrium due to estrogen excess with reduced progestational activity (“unopposed estrogen”)
This disorder is a predecessor of what?
Risk Factors
Endometrial Hyperplasia
Risk factors:
- anovulatory cycles,
- perimenopausal, obesity,
- estrogen-producing ovarian tumors,
- estrogen replacement therapy without progestational agent (HRT)
- tamoxifen therapy
- Polycystic ovarian syndrom
•May be simple or complex, may or may not have atypia
A postmenapausal woman presents to the ED with uterine bleeding.
Based on the image what is the diagnosis?
A postmenapausal woman presents to the ED with uterine bleeding.
Based on the image what is the diagnosis?
Complex Endometrial hyperplasia
Note the presence of nucleoili
A postmenapausal woman presents to the ED with uterine bleeding.
Based on the image what is the diagnosis?
Why is this patient especially at risk for cancer?
Endometrial hyperplasia with Atypia
•well-circumscribed, firm, round, white bulging mass, often multiple
Where is this usually located?
Leiomyoma
submucosal, intramural, subserosal
fascicular pattern of smooth muscle bundles separated by well vascularized connective tissue
What syptoms are associated with this?
Leiomyoma
•include menorrhagia, metrorrhagia, urinary frequency, pelvic pain, or infertility
–
•bulky, fleshy tumor invading into myometrial wall or polypoid tumor projecting into lumen, hemorrhagic or necrotic; grossly appear invasive / infiltrative; usually 5 cm or more in size but NOT MULTIPLE
Leiomyosarcoma
•hypercellular tumors composed of spindle cells somewhat resembling smooth muscle cells but with moderate to severe pleomorphism; 10+ mitotic figures per 10 high power fields (HPF) in most mitotically active area, abundant abnormal mitotic figures
How are these tumors derived?
Leiomyosarcoma
De-novo or leiomyoma
Leiomyosarcoma
