THE BODY OF THE UTERUS AND ENDOMETRIUM Flashcards
The body of the uterus and endometrium
The uterus has two major components; the ________ and the __________.
myometrium; endometrium
The body of the uterus and endometrium
The myometrium is composed of __________ ———— ________ of smooth muscles that form the _____ of the uterus.
tightly interwoven bundles
walls
The body of the uterus and endometrium
The internal cavity of the uterus is lined by the _________ composed of _______ embedded in a _______________.
endometrium; glands
cellular stroma
The body of the uterus and endometrium
The uterus is subject to a variety of disorders, the most common of which result from _______________, complications of _______, and _________ proliferation.
These lesions with those of the _______ ______ account for most patients visits to gynaecologic practices.
endocrine imbalances
pregnancy; neoplastic
cervix uteri
Endometrial history in the menstrual cycle.
The endometrium is a dynamic tissue that undergoes physiologic and characteristic morphologic changes during the menstrual cycle as a result of the effect of _________ hormones coordinately produced in the _______.
sex steroid
ovary
Endometrial history in the menstrual cycle.
The ovary, in turn is influenced by ————-,———-,_________ factors and their interactions regulate ______ of_________, ________ and ________.
hypothalamic, pituitary, ovarian
maturation of ovarian follicles
ovulation and menstruation
Endometrial history in the menstrual cycle.
Dating the endometrium by its ________ appearance is often used clinically to assess ______ status, document ______, and determine causes of endometrial _________ and __________
histologic
hormonal; ovulation
bleeding and infertility.
Endometrial history in the menstrual cycle.
The cycle begins with ______________________________ of the endometrium, referred to as the ________ during menses under the influence of ______, produced by the ______ cells of the developing ______ in the ovary.
The remaining _____ (———-) of the endometrium undergoes extremely (slow or rapid?) growth of _______________________
During the proliferative phase the glands are ____,______ structures lined by regular, tall, ________,__________ cells.
Mitotic figures are ________ and there is no evidence of _______ or thickly compact spindle cells that have _____ cytoplasm but _________ mitotic activity.
shedding of the upper half to two thirds
functionalis; estrogen; granulosa; follicle
Third; basalis; rapid ; both glands and stroma.
straight, tubular; pseudostratified columnar
numerous; mucus secretion; scant; abundant
Endometrial history in the menstrual cycle.
At the time of ovulation the endometrium ____ in its growth, and it ceases ______ activity within days after ovulation, at which time the ______ is producing ______ in addition to _______.
The post ovulatory endometrium is initially marked by ________beneath the nuclei in the glandular epithelium.
The secretory activity is most prominent during the _____ week of the menstrual cycle , when the __________ progressively push past the nuclei.
By the _____ week, the secretions are discharged into the gland lumen, when secretion is maximal , between 18 and 24 days the glands are ______ .
By the fourth week the glands are ______, producing a _______ appearance when they are cut in their long axis . The serrated or saw-toothed appearance is accentuated by _____________ and _______ of the glands.
slows; mitotic
corpus luteum; progesterone; estrogen
secretory vacuoles ; third
basal vacuoles ; fourth; dilated
tortuous; serrated; secretory exhaustion
shrinking
The body of the uterus and endometrium
The stromal changes in late secretory phase, due predominantly to _______ are important for dating the endometrium and consist of the development of prominent _________ by days 21 to 22.
progesterone
spiral arterioles
The body of the uterus and endometrium
A considerable increase in ground substance and _____ between the ______ occurs and it is followed in days 23 to 24 by stromal cells with accumulation of _________ ———— ( ________ change) and resurgence of _________.
edema ; stroma cells
cytoplasmic eosinophilia
pre-decidual ; stromal mitoses
The body of the uterus and endometrium
Pre-decidual changes spread throughout the _________ during days 24 to 28 and are accompanied by scattered _______ and occasional _________, which in this context do not imply __________.
functionalis
neutrophils; lymphocytes
inflammation
The body of the uterus and endometrium
With the dissolution of the ————-, the functionalis shedding begins with the escape of ——— into the stroma , marking the beginning of ___________
corpus luteum
blood
menstrual shedding .
The body of the uterus and endometrium
Although the molecular mechanism by which the _____ and _______ causes the profound changes in the endometrium are not well understood , it is known that these hormones induce local production of molecules that act in an _____________________ fashion .
estrogen and progesterone
autocrine and paracrine
The body of the uterus and endometrium
The hormonal action occurs through their _____________ receptors (estrogen receptor ___, progesterone receptor ___ and progesterone receptor ___).
However, they may also act through alternate receptor perhaps even by receptor-independent pathways. In addition, there is considerable cross-talk between the _______ and _______
cognate nuclear
X; A ; B
glands and stroma.
The body of the uterus and endometrium
The effect of estrogen on glandular proliferation occurs via _______ cells which in response to estrogen produce ______ factors (e.g. ____________ and ___________) that bind receptors expressed on the epithelial cells .
stromal; growth
insulin-like growth factor-1 and epidermal growth factor
The body of the uterus and endometrium
In the secretory phase, progesterone initially ______________ in the glands and causes profound alterations of the ________ .
Interestingly, progesterone secretion leads to a decrease in _____ receptor expression in __________, making the endometrium relatively _________________ still being produced by the _______ .
inhibits proliferation ; stroma
estrogen; both the gland and stroma
unresponsive to estrogen; ovary
The body of the uterus and endometrium
.
To further elucidate the mechanisms responsible for the hormonal effects, global gene expressions studies are used.
It is thought that such information will aid the treatment of women with disorders of the endometrium that range from ________ to ______
infertility to cancer.
The uterine corpus is composed of _____________ and the underlying ____________ ————- . The more frequent and significant disorders of the uterus are considered here.
endometrial mucosa
smooth muscles myometrium
Endometritis
Inflammation of the ______ is classified as acute or chronic depending on whether, _______________ or _________________ predominates respectively.
endometrium
a neutrophilic or lymphoplasmacytic response
Endometritis
The diagnosis of chronic endometritis generally requires the presence of _______________ ,as _______ normally are seen in the endometrium.
plasmacells; lymphocytes
Endometritis
Endometritis often is a consequence of ____________ disease and is frequently due to __________ or __________.
pelvic inflammatory
N.gonorrhoeae or C.trachomatis
Endometritis
Histologic examination reveals a _________ infliltrate in the superficial endometrium and glands coexisting with _____________________ infiltrate.
Prominent ________________ are more commonly seen in chlamydial infection.
neutrophilic
stromal lympho-plasmacytic
lymphoid follicles
Endometritis
Tuberculosis causes ________ endometritis, frequently with associated tuberculosis ________ and ______.
Although seen in the United States mainly in ________ persons, Tuberculous endometritis is common in countries where __________ and should be included in the differential diagnosis for _____________ in women who have recently emigrated from endemic areas .
granulomatous
salpingitis and peritonitis
immunocompromised; tuberculosis is endemic
pelvic inflammatory disease
Endometritis
Endometritis also may be due to __________ of conception, secondary to _______ or delivery or to presence of foreign body such as an ___________
retained products; miscarriage
intrauterine device.
Endometritis
Retained tissues or foreign bodies act as a _______ for ____________ by vaginal or intestinal tract flora.
____________________________________ typically results in resolution.
nidus; ascending infection
Removal of the offending tissues or foreign body
Endometritis
Clinically, all forms of endometritis may manifest with ______,_________, and ______________ .
In addition , there is an increased risk of ———- and ______ as a consequence of damage and _______ of the __________.
fever, abdominal pain and menstrual abnormalities
infertility and ectopic pregnancy
scarring; fallopian tubes.
Endometritis
The stroma is _______ and may contain scattered ______ inflammatory cells.
Superimposed chronic inflammation may lead to _______ of the overlying epithelium and ulcerations.
These lesions may ______ , thereby arousing concern, but they have __________
edematous; mononuclear
squamous metaplasia
bleed; no malignant potential.
Adenomyosis
Refers to the growth of the ——- layer of the ———- down into the _________.
Nests of the endometrial ______,_______ or both are found deep into the ________ interposed between the __________.
basal; endometrium; myometrium
stroma, glands
myometrium; muscles bundles.
Adenomyosis
The aberrant presence of endometrial tissues induces __________ of the myometrium , resulting into an (enlarged or shrunken?) ______ uterus, often with a (thinned or thickened?) uterine wall.
reactive hypertrophy
Enlarged; globular
thickened
Adenomyosis
Because the glands in adenomyosis derive from the stratum _______ of the endometrium, they do not undergo ________, nevertheless, marked adenomyosis may produce __________,______________, and pelvic pain before the onset of menstruation.
basalis
cyclic bleeding
menorrhagia, dysmenorrhea
Endometriosis
Defined by the presence of endometrial glands and stroma in the location ______________ .
It occurs in as many as ——-% of women in their reproductive years and in nearly _____ of women with infertility.
outside the endo-myometrium
10; half
Endometriosis
It frequently is _______ and often involves _____ structures (ovaries, pouch of Douglas, uterine ligament, tubes and rectovaginal septum).
Less frequently, distant areas the _________ or ____________ are involved. Uncommonly, distant sites such as lymph nodes, lungs and even heart, skeletal muscles ,or bone are affected .
multifocal; pelvic
peritoneal cavity or periumbilical tissues
Endometriosis
Three hypotheses have been put forth to explain the origin of these dispersed lesion;
I. The regurgitation theory, which is currently ______, proposes that ______ through the _______ leads to implantation
favored; menstrual backflow
fallopian tubes
Endometriosis
Three hypotheses have been put forth to explain the origin of these dispersed lesion;
The __________ theory
The __________ theory
The __________ or ___________________ theory
The regurgitation theory
The metaplastic theory
The vascular or lymphatic dissemination theory
Endometriosis
Three hypotheses have been put forth to explain the origin of these dispersed lesion
The metaplastic theory, on the other hand, posits endometrial __________ of ___________ (from which endometrium originates) are the source.
differentiation; coelomic epithelium
Endometriosis
Three hypotheses have been put forth to explain the origin of these dispersed lesion
The vascular or lymphatic dissemination theory has been invoked to explain ________ or _______ implants .
extrapelvic or intranodal
__________ and ____ theories, cannot however explain lesions in the _________,__________, and _______
Regurgitation
Metaplastic
lymph nodes, skeletal muscles or lungs
________ and ________ of the endometriotic tissue within _______________ is a key feature in the pathogenesis of endometriosis
survival and persistence
a foreign location
Morphology of Endometriosis
In contrast with adenomyosis, endometriosis almost always contains __________, which undergoes ________, because __________________, they usually appear grossly as _______ nodules or implants.
They range in size from microscopic to 1cm - 2cm in diameter and lie on or just under the affected ______ surface.
functioning endometrium
cyclic bleeding
blood collects in these aberrant foci
red - brown; serosal
Morphology of Endometriosis
Often, individual lesions coalesce to form larger masses. When the ______ are involved, the lesions may form large, _________ that turn ______ (_______ cysts) as the blood ages.
ovaries; blood-filled cysts
brown; chocolate
Morphology of Endometriosis
With seepage and organization of the blood, widespread ______ occurs leading to ________ among pelvic structures , leading to ______ of the ____________________ ends and distortion of the _________ as well as ovaries.
fibrosis; adhesions
sealing; tubal fimbriated
oviducts
Morphology of Endometriosis
The histologic diagnosis at all sites depends on finding two of the following three features within the lesion: Endometrial ______
Endometrial _____
___________ pigment.
Endometrial glands
Endometrial stroma
hemosiderin pigment.
Clinical features of Endometriosis
The clinical manifestation of endometriosis depend on the _____________.
Extensive scarring of the _______ and _______ often produce discomfort in the lower abdominal quadrants and eventual _______
distribution of the lesion
oviducts and ovaries; sterility