Reproduction II Flashcards
What is defined as the abnormal presence of neutrophils in the endometrium?
Acute Endometritis
What are 3 causes of Acute Endometritis?
Ascending Infection due to Abortion
Delivery
Medical Instrumentation
**specific cause rare
What must Acute Endometritis be distinguished from?
Normal PMN’s due to menstruation
The presence of plasma cells, lymphocytes, and the occasional lymph nodule within normal Endometrium indicates what?
Chronic Endometritis
What is Chronic Endometritis often associated with?
3 things
IUD’s
PID
Abortion/Delivery substances (that have been retained)
Bleeding, Pelvic pain, IUD…
Chronic Endometritis
Pus in the Endometrial Cavity is defined as…
Pyometria
Anything that causes cervical stenosis (narrowing) will be associated with what condition?
*due to tumor, scarring, etc
Pyometria
Long standing pyometria may be associated with what?
How often does this occur?
Endometrial Squamous Cell Carcinoma
**Rare
Endometrial tissue that forms tumor-like nodules outside the uterus is known as…
Endometriosis
What are 3 places Endometriosis is often found?
Ovary
Fallopian tube
Pelvic peritoneum
Endometrial foci are composed of what?
Endometrial glands and stroma
***responds to estrogenic stimulation/cycle
Why can’t the blood be cyclically discharged in endometriosis?
Foci encased in CT/Peritoneum
Endometriosis primarily happens in the 3rd to 4th decade of life, and has a higher incidence in….
Higher socio-economic groups
*marry later
T/F
The most popular theory of Endometriosis pathogenesis is the Regurgitation Theory, but is not clearly understood
True
What color are the nodules/plaques in Endometriosis?
Red-Brown
Where are most foci in Endometriosis found?
Orifice of Fallopian Tubes
What percentage of women of reproductive age have Endometrial foci?
15-20%
T/F
Endometriosis does not progress to cancer
True
Where are Chocolate Cysts found?
How big are they?
Ovarian endometriosis
1-5 cms
*filled with brown red viscous fluid
If endometrial glands and stroma enter the myometrium, it can cause what?
Adenomyosis
T/F
The deeper the Adenomyosis penetration, the more likely symptomatic with dysmenorrhea (painful menstruation) or menorrhagia (heavy bleeding menstruation)
True
Adenomyosis is most often seen in what demographic?
Parous - have had children
Small, soft, tan, partially cystic masses in the myometrium is what?
*also mildly proliferative endometrial glands surrounded by stroma of varying fibrotic states
Adenomyosis
Adenomyosis is often asymptomatic, what percentage of removed uteri have some degree of this?
1/5
Benign tumors of the Myometrial smooth muscle are called what?
Leiomyomas
*Fibroids
Leiomyomas are ____ % benign and _____ % malignant and are then called ______
98%
1-2%
Leiomyosarcomas
What is the most common uterine tumor?
What % of reproductive-aged women have them?
Leiomyoma
20%
In connective tissue, ….oma is ______ and …sarcoma is ______.
Benign
Malignant
T/F
Leiomyomas aren’t seen before puberty or after menopause
True
Leiomyomas are more commonly seen in what ethnic group?
Blacks
Describe the histology of Leiomyoma:
Smooth muscle cells in fascicles
*unencapsulated, white-tan whorled masses
What are the 3 types of Leiomyoma fibroids?
Intramural - within myometrium
Subserosal - beneath uterine serosa
Submucosal - in endometrial cavity
**size and location determine symptoms
What type of Leiomyoma often compresses the rectum, and can cause abdominal heaviness, urinary urgency, and constipation?
Subserosal
What type of Leiomyoma can cause menstrual irregularities, bleeding, and Infertility?
Submucosal
*interfere with embryonic implantation
Submucosal fibroid (Leiomyoma) are treated how?
Surgically
small, myomectomy
large, hysterectomy
Excessive estrogen can cause what in the endometrium?
Endometrial Hyperplasia
Endometrial hyperplasia is mostly what type of tissue?
Glandular
*not much stroma
What are the 3 types of Endometrial Hyperplasia?
Simple - minimal glandular complexity, no cell atypia
Complex - multi-layered glandular complexity, no atypia
Atypical Hyperplasia - glandular complexity, cell atypia
What are the chances of progression to carcinoma/adenocarcinoma in the 3 types of Endometrial Hyperplasia?
Simple - 1% - carcinoma
Complex - 3% - adenocarcinoma
Atypical - 25% - adenocarcinoma
Estrogen -producing tumors, Polycystic Ovarian Syndrome, exogenous estrogen, an Obesity can all cause what?
Endometrial Hyperplasia
What is the treatment for Endometrial Hyperplasia?
Progestins (high dose)
*synthetic progesterone
What are the benign projections of the endometrial surface called?
Endometrial Polyps
What 2 things may cause endometrial foci to produce polyps?
Do polyps slough during menstruation?
Hypersensitive to Estrogen
Unresponsive to Progesterone
NO
Where are Endometrial Polyps usually found?
Fundus
What bleeds inter-menstually and has a high degree of endomentrial glands and stroma?
Endometrial Polyps
Endometrial Polyps aren’t considered neo-plastic, but _____ harbor Adenocarcinomas.
0.5%
What is the most common malignant tumor of the female genital tract?
It accounts for what % of GYN malignancies?
Endometrial Adenocarcinoma
50%
Endometrial Adenocarcinoma arises from what cells?
Associated with?
Epithelial cells lining endometrial glands
More estrogen exposure
What are 4 risk factors for Endometrial Adenocarcinoma?
Exogenous estrogen
Estrogen producing tumors
Obesity
Nulliparous (or early menarche/late menopause)
What gives the endometrium breaks from proliferation?
Progesterone
*Estrogens stimulate endometrium
What is the most important benefit to estrogen supplements?
Prevents bone loss
*but increases carcinoma
T/F
The risks outweigh the rewards for estrogen supplements
True
*bone loss more important to address, cancer can be detected early
**15,000 deaths/yr related to osteoporotic bone fractures
What is it about endometrial cancers (adenocarcinoma) that justifies estrogen supplementation?
80% confined to uterus.
Excellent prognosis
What 2 cancers, other than Endometrial Adenocarcinoma, are also estrogen dependent and have an increased risk for upon diagnosis?
Breast
Ovarian
How do most endometrial adenocarcinomas grow?
Exophytic - grow into endometrium
Describe the 4 Stages of Endometrial Carcinoma
I - Endometrium only
II - Endometrium, cervix, myometrium
III - Breaches uterus (but not outside pelvis)
IV - Bladder, rectum (outside pelvis)
T/F
Endometrial cancer is rare before 35, presents with inter-menstrual bleeding.
True
*mostly diagnosed through irregular bleeding
What is the treatment for Endometrial Cancer?
If advanced (or incomplete resection/undetected)?
If inoperable?
Hysterectomy
(with or without ovaries)
Radiation
Chemo
What are the most common primary lesions of the Fallopian Tubes?
Benign Paratubal Cysts
Describe Benign Paratubal Cysts?
0.1-2.0 cm
Translucent
Clear, serous fluid
Where are the largest Benign Paratubal Cysts found?
Fimbrae
Broad Ligament
*little clinical significance
Where do Ectopic Pregnancies most often implant?
3 places
Ovary
Abdominal cavity
Fallopian tubes (95%)
Ectopic Pregnancy incidence?
1/150
What is the greatest risk factor for Ectopic Pregnancy?
3 additional factors?
Chronic Salpingitis
Endometrial peritubular adhesions, Previous surgery, Leiomyoma
What usually happens in Ectopic Pregnancy 2-6 weeks after fertilization?
Rupture/Intraperitoneal hemorrhage
T/F
Decidual reaction of endometrium and no chorionic villi are indicative of Ectopic Pregnancy
True
PID ascends due to a variety of microorganisms
True
The ascent of PID can result in what 3 acute conditions?
Salpingitis
Pyosalpinx
Tuboovarian abscess
List 5 species that cause PID starting with the most common.
Gonorrhea
Chlamydia
Staph, Strept, Mycoplasma
What procedure/conditions may cause PID?
2 things
Septic Abortion
Postpartum endometritis
Cervicitis is usually due to what 2 bugs and has what symptoms?
Chlamydia/Gonococcus
Cervix red/swollen - yellow mucopurulent discharge
What is the most common symptom in Cervicitis/PID?
Lower abdominal pain