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Repro / GU > SM_216b: Pathology of the Endometrium and Uterus > Flashcards

SM_216b: Pathology of the Endometrium and Uterus Flashcards

1
Q

Uterus consists of ____ and ____

A

Uterus consists of endometrium and myometrium

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2
Q

Describe myometrium histology

A

Myometrium histology

  • Mostly smooth muscle (pink solid areas)
  • Spindled cells arranged in fascicles at various angles to each other
  • Fusiform, blunt-ended nuclei
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3
Q

Endometrium has two regions of mucosa: ____ and ____

A

Endometrium has two regions of mucosa

  • Lower uterine segment / ishmus: not as responsive to hormones
  • Uterine corpus: fully responsive to hormones
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4
Q

Two layers of endometrium in the corpus are ____ and ____

A

Two layers of endometrium in the corpus are basalis and functionalis

  • Basalis: lower layer, does not cycle, regenerates endometrium after menses
  • Functionalis: top layer, cycles and sheds at menses
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5
Q

Describe the proliferative endometrium

A

Proliferative endometrium

  • Corresponds to ovarian follicular phase
  • Response of endometrium to rising estrogen levels
  • Glands are simple straight tubules
  • Pseudostratified columnar cells
  • Mitoses in glands and stromas
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6
Q

Describe the secretory endometrium

A

Secretory endometrium

  • Corresponds to ovarian luteal phase
  • Response of endometrium to progesterone (produced by corpus luteum)
  • Variable appearance based on cycle day
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7
Q

Early secretory endometrium involves appearance of ____ and has a ____ appearance

A

Early secretory endometrium involves appearance of vacuoles (subnuclear then supranuclear) and has a piano keys appearance

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8
Q

Midsecretory endometrium involves ___

A

Midsecretory endometrium involves coiled glands

  • Intraluminal secretions
  • Stromal edema
  • No more vacuoles
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9
Q

Late secretory endometrium involves ____ and ____

A

Late secretory endometrium involves spiral arterioles and stromal decidualization (large pink stromal cells)

  • Sawthooth glands
  • Neutrophils and other inflammatory cells
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10
Q

Menstrual endometrium is caused by a ___ and involves ___

A

Menstrual endometrium is caused by a drop in progesterone and involves a breakdown of glands and stroma

  • No pregnancy -> corpus luteum involutes
  • Fibrin, necrotic debris, hemorrhage, and inflammatory cells
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11
Q

Atrophic / inactive endometrium results from ___

A

Atrophic / inactive endometrium results from decreased estrogen levels (usually following menopause)

  • Straight tubular glands
  • Simple columnar to cuboidal epithelium
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12
Q

____ of endometrium cycles in response to hormones

A

Functionalis of endometrium cycles in response to hormones

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13
Q

____ phase of endometrium is characterized by vacuoles

A

Early secretory phase of endometrium is characterized by vacuoles

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14
Q

Non-neoplastic / functional endometrial disorders frequently cause ____

A

Non-neoplastic / functional endometrial disorders frequently cause anovulatory cycles, chronic endometritis, endometrial polyps, and adenomyosis

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15
Q

Anovulatory cycles appear as ____ on histology

A

Anovulatory cycles appear as proliferative glands with stromal breakdown on histology (no progesterone to cause secretory differentiation)

  • Most frequent cause of dysfunctional uterine bleeding
  • Due to hormonal imbalances, endocrine disorders, ovarian lesions, and generalized metabolic disturbances
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16
Q

Chronic endometritis appears as ____ and ____ on histology

A

Chronic endometritis appears as stromal change (spindling) and plasma cells

  • Usually endometrium protected from infection by cervix
  • Causes: PID, retained POC, IUD, TB, or other infection
  • Acute endometritis is less common and due to infection
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17
Q

Endometrial polyps are ____ that appear as ____ on histology

A

Endometrial polyps are exophytic masses protruding into the endometrial cavity that appear as epihtelium on three sides with prominent blood vessels, fibrotic stroma, and dilated and irregularly shaped glands on histology

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18
Q

Adenomyosis is ___

A

Adenomyosis is endometrial glands and stroma within the myometrium

  • Similar to endometriosis but confined to myometrium
  • Can cause menometrorrhagia, dysmenorrhea, dyspareunia, and pelvic pain
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19
Q

Endometriosis appears as ___, ___, and ___ on histology

A

Endometriosis appears as endometrial glands, endometrial stroma, and evidence of hemorrhage on histology

  • Ectopic endometrial tissue outside the uterus
  • Most common sites of involvement: ovary, other pelvic sites, bowel
  • Symptoms: infertility, dysmenorrhea, pelvic pain
  • Can cause reactive fibrosis and adhesions between organs
  • Usually in reproductive age women
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20
Q

Ovarian chocolate cyst and hemosidern-laden macrophages are ____

A

Ovarian chocolate cyst and hemosidern-laden macrophages are endometriosis

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21
Q

Describe theories of pathogenesis of endometriosis

A

Theories of pathogenesis of endometriosis

  • Regurgitation theory: retrograde menstruation through tubes
  • Benign metastasis theory: lymph-vascular spread
  • Metaplastic theory: arises from metaplasia of peritoneum (mesothelium)
  • Extrauterine stem / progenitor cell theory: stem cells from bone marrow
22
Q

Top of the differential is ____

A

Top of the differential is chronic endometritis

23
Q

Describe endometrial hyperplasia

A

Endometrial hyperplasia

  • Precursor to most common type of endometrial carcinoma
  • Increased gland-to-stroma ratio (glands > stroma)
  • Associated with prolonged estrogen stimulation
  • Inactivation of PTEN tumor suppressor gene in > 20% of hyperplasias
24
Q

Endometrial hyperplasia classification involves ____ and ____

A

Endometrial hyperplasia classification involves

  • Hyperplasia without atypia / benign hyperplasia
  • Atypical hyperplasia / endometrial intraepithelial neoplasia
25
Q

Describe endometrial hyperplasia without atypia

A

Endometrial hyperplasia without atypia

  • Glandular crowding of varying degrees
  • Glands are irregular in size and shape, sometimes cystic
  • Glands can be back-to-back but still some intervening stroma
  • No nuclear atypia (nuclei similar to normal glands)
  • 1-3% progress to carcinoma
26
Q

Describe atypical endometrial hyperplasia

A

Atypical endometrial hyperplasia

  • Glandular crowding and irregularity
  • Nuclear atypia: appear different from those in normal glands
  • 23-48% have carcinoma at hysterectomy
  • Treatment: hysterectomy or progesterone therapy (sometimes with eventual hysterectomy after pregnancy)
27
Q

Endometrial carcinoma presents with ____

A

Endometrial carcinoma presents with abnormal bleeding

  • 7% of all invasive cancer in women
  • Diagnosis requires biopsy or curettage and subsequent histologic exam
  • Type I and II
28
Q

Compare type I and type II endometrial carcinoma

A

Type I and type II endometrial carcinoma

29
Q

Type I endometrial carcinoma is ____ that resembles ____

A

Type I endometrial carcinoma is an exophytic or endophytic mass with or without myometrial invasion that resembles proliferative endometrium

  • FIGO grade 1: mostly glandular, very little solid growth
  • FIGO grade 2: some solid growth (glands > solid)
  • FIGO grade 3: mostly solid growth
  • Squamous metaplasia common
30
Q

This is ____

A

This is endometrial carcinoma

  • Complex, fused glands replacing normal endometrium
  • Superficial invasion into myometrium
    Fused glands with no stroma in between (cribriforming): swiss cheese appearance
31
Q

Endometrial carcinoma that is mostly glandular growth (no solid growth) is ___

A

Endometrial carcinoma that is mostly glandular growth (no solid growth) is FIGO 1

32
Q

Endometrial carcinoma that is a solid non-squamous growth is ____

A

Endometrial carcinoma that is a solid non-squamous growth is FIGO grade 2 or 3

33
Q

____ is most common molecular alteration in type I endometrial carcinoma

A

PTEN mutation is most common molecular alteration in type I endometrial carcinoma

  • Cowden syndrome: germline PTEN mutation, prediposed to endometrial carcinoma
  • PIK3CA, KRAS, ARID1-alpha are also frequently mutation
  • Microsatellite instability (defects in mismatch repair proteins): Lynch syndrome (HNPCC) if germline
  • Poorly differentiated (FIGO grade 3) can have p53 mutations
34
Q

____ in the most common type II endometrial carcinoma and almost always has ____ mutations

A

Serous carcinoma in the most common type II endometrial carcinoma and almost always has p53 mutations

  • High-grade tumors by definition
  • Background atrophic endometrium
  • Often present with deep invasion and at higher stage
  • Tumor cells can detach, travel through fallopian tubes, and implant on peritoneal surfaces
35
Q

Describe uterine serous carcinoma (type II endometrial carcinoma) on histology

A

Uterine serous carcinoma (type II endometrial carcinoma) on histology

  • Papillary or glandular growth pattern
  • Marked nuclear atypia: high nuclear-cytoplasmic ratio, large darkly stained nuclei, prominent nucleoli, numerous and atypical mitoses
36
Q

Carcinosarcoma (type II endometrial carcinoma) is composed of ____ and ____

A

Carcinosarcoma (type II endometrial carcinoma) is composed of

  • Carcinoma: high-grade, often serous
  • Sarcoma: homologous (smooth muscle, endometrial stroma) or heterologous (cartilage, skeletal muscle, bone)

Also called malignant mixed Mullerian tumor

Shared mutations in both components: most likely carcinomas with sarcomatous transformation

Large polypoid tumors

37
Q

Carcinosarcoma histology involves ____ and ____

A

Carcinosarcoma histology involves malignant gland (carcinoma) and malignant stroma (sarcoma)

38
Q

Endometrial carcinoma treatment usually involves ___

A

Endometrial carcinoma treatment usually involves hysterectomy ± radiation and/or chemotherapy

39
Q

This is ____

A

This is endometrioid carcinoma

40
Q

Describe mesenchymal tumors

A

Mesenchymal tumors

  • Endometrial stroma -> endometrial stromal tumors (benign or sarcoma)
  • Smooth muscle (myometrium) -> smooth muscle tumors (leiomyoma, leiomyosarcoma)
41
Q

Describe endometrial stromal nodules

A

Endometrial stromal nodules

  • Benign neoplasm
  • Well-circumscribed
  • Tumor cells resemble normal endometrial stroma
  • JAZF1:JJAZ1 fusion due to chromosomal translocation t(7;17)(p15;q21)
42
Q

Describe endometrial stromal tumors

A

Endometrial stromal sarcoma

  • Infiltrative growth
  • Low-grade (most common): tumor cells resemble normal endometrial stroma, JAZF1:JJAZ1 fusion due to chromosomal translocation t(7;17)(p15;q21)
43
Q

Endometrial stroma sarcoma commonly involves ____ and ____ may occur

A

Endometrial stroma sarcoma commonly involves recurrence and late distant metastasis may occur

44
Q

Describe leiomyoma

A

Leiomyoma (fibroid)

  • Benign smooth muscle tumors
  • Frequently multiply
  • May be asymptomatic
  • May cause abnormal bleeding, urinary frequency, pelvic pain, and infertility
  • Common genetic abnormalities: rearrangements of 12q or 6p, MED12 mutations
  • Trransformation to malignancy is rare
45
Q

Describe appearance of leiomyoma

A

Leiomyoma (fibroid)

  • Well-circumscribed round nodules / masses
  • Variable size: subcentimeter to massive tumors filling pelvis
  • Firm / rubbery, tan / what, whorled cut surfaces
  • Location: submucosal (under endometrium), intramural (within myometrial wall), subserosal (under serosa)
46
Q

Leiomyoma appears as ____ and ____ on histology

A

Leiomyoma appears as well-circumscribed nodule within myometrium and smooth muscle bundles at various angles to each other on histology

47
Q

___, ___, and ___ are examined to differentiate leiomyoma (benign) from leiomyosarcoma (malignant)

A

Mitotic activity, tumor necrosis, and atypia are examined to differentiate leiomyoma (benign) from leiomyosarcoma (malignant)

  • ≥2 of 3 following features means leiomyosarcoma: ≥ 10 mitotic figures / 10 HPF, tumor necrosis present, moderate to severe atypia
48
Q

Describe leiomyosarcoma

A

Leiomyosarcoma

  • Invasive endophytic tumor or polypoid exophytic tumor
  • Most common in ages 40-60 but wide age range
  • Genetics: complex, variable karyotypes
49
Q

Leiomyosarcoma often ___, ___, and have ___ survival

A

Leiomyosarcoma often recur, can metastasize hematogenously, and have low survival

50
Q

This is ___

A

This is leiomyoma

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