Repro - Pathology (Cervical & Endometrial Pathology) Flashcards
Pg. 579-581 in First Aid 2014 Pg. 528-529 in First Aid 2013 Sections include: -Endometritis -Endometriosis -Adenomyosis -Adenomyoma (polyp) -Endometrial proliferation -Leiomyoma (fibroid) -Gynecologic tumor epidemiology
What is endometritis? What characterizes it on histology?
Inflammation of the endometrium (with plasma cells and lymphocytes)
What typically causes endometritis?
Associated with retained products of conception following delivery (vaginal/C-section)/miscarriage/abortion or foreign body such as IUD.
Why do retained products of conception cause endometritis?
Retained material in uterus promotes infection by bacterial flora from vagina or intestinal tract.
What is the treatment for endometritis?
Treatment: gentamicin + clindamycin with or without ampicillin
What is endometriosis?
Non-neoplastic endometrial glands/stroma outside of the endometrial cavity.
Where can endometriosis be found? Which sites are most common?
Can be found anywhere; most common sites are ovary, pelvis, and peritoneum
How does endometriosis appear in the ovary?
In the ovary, appears as an endometrioma (blood-filled “chocolate cyst”)
What are 3 potential reasons for endometriosis?
Can be due to (1) retrograde flow, (2) metaplastic transformation of multipotent cells, or (3) transportation of endometrial tissue via the lymphatic system.
What 7 symptoms/signs characterize endometriosis?
Characterized by cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia (pain with defacation), infertility; NORMAL-SIZED uterus
What are 5 treatments for endometriosis?
Treatment: NSAIDs, OCPs, progestin, GnRH agonists, surgery
What characterizes cervical dysplasia/carcinoma in situ on histology?
Disordered epithelial growth; begins at basal layer of squamocolumnar junction (transition zone) and extends outward
What are the classifications of cervical dysplasia/carcinoma in situ? On what are these classifications based?
Classified as CIN 1, CIN 2, CIN 3 (severe dysplasia or carcinoma in situ), depending on extent of dysplasia
With what pathogenic strains is cervical dysplasia/carcinoma in situ associated? Why do these strains cause cancer?
Associated with HPV 16 and HPV 18, which product both the E6 gene product (inhibits p53 suppressor gene) and E7 gene product (inhibits RB suppressor gene).
What can happen with cervical dysplasia/carcinoma in situ if left untreated?
May progress slowly to invasive carcinoma if left untreated
How does cervical dysplasia/carcinoma in situ typically present? How is it diagnosed?
Typically asymptomatic (detected with Pap smear) or presents as abnormal vaginal bleeding (often postcoital)
What are the risk factors for cervical dysplasia/carcinoma in situ?
Risk factors: multiple sexual partners (#1), smoking, early sexual intercourse, HIV infection.
What kind of cells are often involved in invasive cervical carcinoma?
Often squamous cell carcinoma
Why is Pap smear such a useful test? What histological finding does it detect?
Pap smear can catch cervical dysplasia (koilocytes - wrinkled, “raisinoid” nuclei”, some of which have clearing or a perinuclear halo) before it progresses to invasive carcinoma
What is a possible medical complication with regard to invasive cervical carcinoma progression, and what causes this?
Lateral invasion can block ureters, causing renal failure
What is adenomyosis? What causes it?
Extension of endometrial tissue (glandular) into the uterine myometrium; Caused by hyperplasia of the basalis layer of the endometrium
What symptoms/signs are associated with adenomyosis?
Dysmenorrhea, menorrhagia. Uniformly ENLARGED, SOFT, globular uterus
What is the uterus like in endometriosis? How does that compare to the uterus in adenomyosis?
Endometriosis - Normal-sized uterus; Adenomyosis - Enlarged, soft, globular uterus
What is the treatment for adenomyosis?
Treatment: Hysterectomy
What is an adenomyoma (polyp)? What might it contain?
Well-circumscribed collection of endometrial tissue within the uterine wall; May contain smooth muscle cells
Where can an adenomyoma extend, and how?
Can extend into the endometrial cavity in the form of a polyp
What are 2 types of endometrial proliferation?
(1) Endometrial hyperplasia (2) Endometrial carcinoma
What is endometrial hyperplasia, and what usually causes it?
Abnormal endometrial gland proliferation usually caused by excess estrogen stimulation
How does endometrial hyperplasia relate to endometrial carcinoma?
Increased risk for endometrial carcinoma
How does endometrial hyperplasia manifest clinically?
Clinically manifests as postmenopausal vaginal bleeding.
What are 4 risk factors of endometrial hyperplasia?
Risk factors include anovulatory cycles, hormone replacement therapy, polcystic ovarian syndrome, and granulosa cell tumor.
What is the most common gynecologic malignancy?
Endometrial carcinoma
At what age range is the peak occurrence of endometrial carcinoma?
Peak occurrence at 55-65 years old
How does endometrial carcinoma present clinically? What is typically in the patient’s history?
Clinically presents with vaginal bleeding. Typically preceded by endometrial hyperplasia.
What are 6 risk factors for endometrial carcinoma?
Risk factors include (1) prolonged use of estrogen without progestins, (2) obesity, (3) diabetes, (4) hypertension, (5) nulliparity, and (6) late menopause.
What feature worsens prognosis for endometrial carcinoma?
Increased myometrial invasion –> decreased prognosis
What is the most common tumor in females?
Leiomyoma (fibroid)
Which patient population has an increased incidence of leiomyoma (fibroid)?
Increased incidence in blacks.
What is the a leiomyoma (fibroid)? Can it be malignant?
Benign smooth muscle tumor; malignant transformation is rare; Does not progress to leiomyosarcoma
What is important to know about the nature of leiomyoma in the context of hormones? What are implications of this?
Estrogen sensitive - tumor size increases with pregnancy and decreases with menopause.
What age range is the peak occurrence for leiomyoma (fibroid)?
Peak occurrence at 20-40 years old.
How does leiomyoma (fibroid) typically present clinically? What are potential complications?
May be asyptomatic, cause abnormal uterine bleeding, or result in miscarriage. Severe bleeding may lead to iron deficiency anemia.
How does leiomyoma (fibroid) typically appear on imaging/histology?
Often presents with multiple discrete tumors; Whorled pattern of smooth muscle bundles with well-demarcated boarders
List gynecologic tumors in order of decreasing incidence in the US. How does this differ worldwide?
Endometrial > Ovarian > Cervical (data pertain to the United States; cervical cancer is most common worldwide)
List gynecologic tumors in order of decreasingly worse prognosis.
Worst prognosis - Ovarian > Cervical > Endometrial
