THE BODY OF THE UTERUS AND ENDOMETRIUM Flashcards

1
Q

The body of the uterus and endometrium

The uterus has two major components; the ________ and the __________.

A

myometrium; endometrium

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2
Q

The body of the uterus and endometrium

The myometrium is composed of __________ ———— ________ of smooth muscles that form the _____ of the uterus.

A

tightly interwoven bundles

walls

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3
Q

The body of the uterus and endometrium

The internal cavity of the uterus is lined by the _________ composed of _______ embedded in a _______________.

A

endometrium; glands

cellular stroma

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4
Q

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.

A

endocrine imbalances

pregnancy; neoplastic

cervix uteri

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5
Q

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 _______.

A

sex steroid

ovary

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6
Q

Endometrial history in the menstrual cycle.

The ovary, in turn is influenced by ————-,———-,_________ factors and their interactions regulate ______ of_________, ________ and ________.

A

hypothalamic, pituitary, ovarian

maturation of ovarian follicles

ovulation and menstruation

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7
Q

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 __________

A

histologic

hormonal; ovulation

bleeding and infertility.

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8
Q

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.

A

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

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9
Q

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.

A

slows; mitotic

corpus luteum; progesterone; estrogen

secretory vacuoles ; third

basal vacuoles ; fourth; dilated

tortuous; serrated; secretory exhaustion

shrinking

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10
Q

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.

A

progesterone

spiral arterioles

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11
Q

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 _________.

A

edema ; stroma cells

cytoplasmic eosinophilia

pre-decidual ; stromal mitoses

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12
Q

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 __________.

A

functionalis

neutrophils; lymphocytes

inflammation

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13
Q

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 ___________

A

corpus luteum

blood

menstrual shedding .

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14
Q

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 .

A

estrogen and progesterone

autocrine and paracrine

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15
Q

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 _______

A

cognate nuclear

X; A ; B

glands and stroma.

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16
Q

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 .

A

stromal; growth

insulin-like growth factor-1 and epidermal growth factor

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17
Q

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 _______ .

A

inhibits proliferation ; stroma

estrogen; both the gland and stroma

unresponsive to estrogen; ovary

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18
Q

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 ______

A

infertility to cancer.

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19
Q

The uterine corpus is composed of _____________ and the underlying ____________ ————- . The more frequent and significant disorders of the uterus are considered here.

A

endometrial mucosa

smooth muscles myometrium

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20
Q

Endometritis

Inflammation of the ______ is classified as acute or chronic depending on whether, _______________ or _________________ predominates respectively.

A

endometrium

a neutrophilic or lymphoplasmacytic response

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21
Q

Endometritis

The diagnosis of chronic endometritis generally requires the presence of _______________ ,as _______ normally are seen in the endometrium.

A

plasmacells; lymphocytes

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22
Q

Endometritis

Endometritis often is a consequence of ____________ disease and is frequently due to __________ or __________.

A

pelvic inflammatory

N.gonorrhoeae or C.trachomatis

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23
Q

Endometritis

Histologic examination reveals a _________ infliltrate in the superficial endometrium and glands coexisting with _____________________ infiltrate.

Prominent ________________ are more commonly seen in chlamydial infection.

A

neutrophilic

stromal lympho-plasmacytic

lymphoid follicles

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24
Q

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 .

A

granulomatous

salpingitis and peritonitis

immunocompromised; tuberculosis is endemic

pelvic inflammatory disease

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25
Q

Endometritis

Endometritis also may be due to __________ of conception, secondary to _______ or delivery or to presence of foreign body such as an ___________

A

retained products; miscarriage

intrauterine device.

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26
Q

Endometritis

Retained tissues or foreign bodies act as a _______ for ____________ by vaginal or intestinal tract flora.

____________________________________ typically results in resolution.

A

nidus; ascending infection

Removal of the offending tissues or foreign body

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27
Q

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 __________.

A

fever, abdominal pain and menstrual abnormalities

infertility and ectopic pregnancy

scarring; fallopian tubes.

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28
Q

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 __________

A

edematous; mononuclear

squamous metaplasia

bleed; no malignant potential.

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29
Q

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 __________.

A

basal; endometrium; myometrium

stroma, glands

myometrium; muscles bundles.

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30
Q

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.

A

reactive hypertrophy

Enlarged; globular

thickened

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31
Q

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.

A

basalis

cyclic bleeding

menorrhagia, dysmenorrhea

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32
Q

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.

A

outside the endo-myometrium

10; half

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33
Q

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 .

A

multifocal; pelvic

peritoneal cavity or periumbilical tissues

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34
Q

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

A

favored; menstrual backflow

fallopian tubes

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35
Q

Endometriosis

Three hypotheses have been put forth to explain the origin of these dispersed lesion;
The __________ theory
The __________ theory
The __________ or ___________________ theory

A

The regurgitation theory
The metaplastic theory
The vascular or lymphatic dissemination theory

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36
Q

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.

A

differentiation; coelomic epithelium

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37
Q

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 .

A

extrapelvic or intranodal

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38
Q

__________ and ____ theories, cannot however explain lesions in the _________,__________, and _______

A

Regurgitation

Metaplastic

lymph nodes, skeletal muscles or lungs

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39
Q

________ and ________ of the endometriotic tissue within _______________ is a key feature in the pathogenesis of endometriosis

A

survival and persistence

a foreign location

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40
Q

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.

A

functioning endometrium

cyclic bleeding

blood collects in these aberrant foci

red - brown; serosal

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41
Q

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.

A

ovaries; blood-filled cysts

brown; chocolate

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42
Q

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.

A

fibrosis; adhesions

sealing; tubal fimbriated

oviducts

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43
Q

Morphology of Endometriosis

The histologic diagnosis at all sites depends on finding two of the following three features within the lesion: Endometrial ______
Endometrial _____
___________ pigment.

A

Endometrial glands
Endometrial stroma
hemosiderin pigment.

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44
Q

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 _______

A

distribution of the lesion

oviducts and ovaries; sterility

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45
Q

Clinical features of Endometriosis
The clinical manifestation of endometriosis depend on the distribution of the lesion.

_______ involvement may produce pain on defecation, while involvement of the _______ or ________ can cause dyspareunia (painful intercourse) and dysuria, respectively.

A

Rectal wall

uterine or bladder serosa

46
Q

Clinical features of Endometriosis
The clinical manifestation of endometriosis depend on the distribution of the lesion.

Almost all cases feature severe _________ and _______ pain resulting from intrapelvic ______ and peri-uterine _______

A

dysmenorrhea and pelvic

bleeding

adhesions.

47
Q

Abnormal uterine bleeding

Women commonly seek medical attention for some type of abnormal uterine bleeding such as menorrhagia (______________ bleeding at the time of the period) . Metrorrhagia (______ bleeding between periods, or __________ bleeding, common causes include endometrial _______, leiomyoma, endometrial _________, endometrial _______ and endome______.
:

A

profuse or prolonged

irregular; postmenopausal

endometrial polyps, leiomyoma, endometrial hyperplasia, endometrial carcinoma and endometritis.

48
Q

Abnormal uterine bleeding

The probable cause of uterine bleeding in any given case depends somewhat on the _______ of the patient.

Abnormal bleeding from the uterus in the absence of any organic uterine lesion is called __________________________.

A

age

Dysfunctional Uterine Bleeding.

49
Q

Abnormal uterine bleeding

The various causes of abnormal uterine bleeding, both dysfunctional and that which is secondary to an organic lesion can be segregated into four groups:

Failure of ________
Inadequate _____ phase
_________ induced bleeding
_______________ disorders

A

ovulation

luteal
Contraceptive
Endo-myometrial

50
Q

Abnormal uterine bleeding

Failure of ovulation: anovulatory cycles are very common at both ends of reproductive life, due to;
hypothalamic pituitary axis, adrenal or thyroid dysfunction functional ovarian lesions producing excess estrogen malnutrition, obesity or debilitating disease
severe physical or emotional stress
Regardless of the cause, ovulatory failure results in an excess of estrogen relative to progesterone.
Thus, the endometrium goes through a proliferative phase that is not followed by the normal secretory phase. The endometrial glands may develop mild cystic changes or appear disorderly while the endometrial stroma, which requires progesterone for growth may be scarce.
These combination of abnormalities makes the endometrium prone to breakdown and abnormal bleeding.

A
51
Q

Abnormal uterine bleeding

Failure of ovulation: anovulatory cycles are very (common or rare?) at both ends of reproductive life, due to:

________,_________, or _______ dysfunction

functional _________ producing excess ———

______,________ or debilitating disease

severe ________ or _________ ———

A

Common

hypothalamic pituitary axis, adrenal or thyroid

ovarian lesions; estrogen

malnutrition, obesity

physical or emotional stress

52
Q

Abnormal uterine bleeding

Failure of ovulation

Regardless of the cause, ovulatory failure results in an excess of ——— relative to _________.

Thus, the endometrium goes through a phase that is not followed by the normal ______ phase.

The endometrial glands may develop ________ changes or appear disorderly while the endometrial stroma, which requires ________ for growth may be ______.

These combination of abnormalities makes the endometrium prone to breakdown and abnormal bleeding.

A

estrogen; progesterone

proliferative; secretory

mild cystic; progesterone; scarce

53
Q

Abnormal uterine bleeding

Inadequate luteal phase: The corpus luteum may __________ normally or may ______ prematurely leading to a relative lack of _________.

The endometrium under these circumstance fails to show the expected ________ changes.

A

fail to mature; regress

progesterone

secretory

54
Q

Abnormal uterine bleeding

Contraceptive induced bleeding: older oral contraceptive containing __________ and __________ induced a variety of endometrial responses, including a ____,________-like stroma and _______,____________ glands.

The pills in current use no longer cause these abnormalities.

A

synthetic estrogen and progestin

lush, decidua

inactive, non-secretory

55
Q

Abnormal uterine bleeding

Endo-myometrial disorders including ______ endometritis, endometrial ______, and submucosal leiomyoma

A

chronic

polyps

56
Q

Summary
Endometriosis refers to a (neoplastic or non-neoplastic?) disorder of endometrial __________ located (inside or outside?) the uterus and may involve the pelvic or abdominal peritoneum.

Rarely, distant sites like the _______ and _________ are involved.

A

non-neoplastic

glands and stroma ; outside

lymph nodes and lungs

57
Q

Summary

The ectopic endometrium in endometriosis undergoes _______, and the condition is a common cause of ______ and _________

A

cyclic bleeding

dysmenorrhea and pelvic pain.

58
Q

Summary

Adenomyosis refers to growth of __________________________________ with uterine _______ . Unlike with endometriosis, there is __________ .

A

Endometrium into the myometrium

enlargement

no cyclic bleeding

59
Q

Proliferative Lesion of the Endometrium and Myometrium

The most common proliferative lesions of the uterine corpus are _________,________,___________ ,___________.

All tend to produce ___________________ as their earliest manifestation

A

endometrial hyperplasia, endometrial polyps, endometrial carcinomas, smooth muscle tumor

abnormal uterine bleeding

60
Q

Endometrial Hyperplasia

An excess of ______ relative to __________, if sufficiently prolonged or marked, can induce an exaggerated ______________________(______) which is an important precursor of ——————-

A

estrogen ; progestin

endometrial proliferation (hyperplasia)

endometrial carcinoma.

61
Q

Endometrial Hyperplasia

Potential cause of estrogen excess include:

Failure of _____ (such as is seen in ______________)

Prolonged administration of _______ without ______________________.

________ producing ovarian lesions (such as _____________________ or _____________________ tumor of the ovary).

A

ovulation; pre-menopause

estrogenic steroids

counterbalancing progestin.

Estrogen

Polycystic ovary disease and Granulosa - theca cell

62
Q

Endometrial Hyperplasia

A common cause of estrogen excess is _______, as ___________converts steroid precursor into ______

A

obesity

adipose tissue

estrogens

63
Q

Endometrial Hyperplasia

The severity of hyperplasia is correlated with the level and duration of __________, and is classified based on;

________(———- complex)

The presence or absence of _______.

When hyperplasia with atypia is discovered, it must be monitored by ____________.

A

estrogen excess

Crowding; simple verse

cytologic atypia

Complex; cellular atypia

64
Q

Endometrial Hyperplasia

Complex hyperplasia without cellular atypia carries a (low or high?) risk (____________%) for progression to endometrial carcinoma,while Complex hyperplasia with cellular atypia is associated with much higher risk (___% to ___%).

A

Low ; less then 5

20;50

65
Q

The risk of developing carcinoma is related to the presence of cellular atypia.

T/F

A

T

66
Q

Endometrial hyperplasia

In time, the hyperplasia may proliferate ________, no longer requiring ______, and eventually may give rise to __________.

A

autonomously

estrogen

carcinoma.

67
Q

Endometrial hyperplasia

In a significant number of cases, the hyperplasia is associated with inactivating mutations in the _____ tumor suppressor gene, an important brake on signaling through the ________/_______ signaling pathway.

A

PTEN

PI-3-kinase /AKT

68
Q

Endometrial hyperplasia

Acquisition of _____ mutations is believed to be one of several key steps in the transformation of hyperplasia to _______________ , which also often harbor _____ mutations.

A

PTEN

endometrial carcinomas

PTEN

69
Q

Endometrial Carcinoma
In the United states and many western countries, endometrial carcinoma is the most frequent cancer occurring in the female genital tract .

It generally appears between the age of ____ and _____ years and is uncommon before age ____ .

Endometrial carcinoma comprise two distinct kinds of cancer: _________ and ———- of the endometrium.
These two types are histologically and pathogenetically (similar or distinct?).

A

55 and 65

40

Endometrioid and Serous carcinoma

Distinct

70
Q

Endometrial Carcinoma

Endometrioid cancers arise in association with ________ and _________ in ____menopausal women, whereas

Serous cancer arise in the setting of __________ in older _____menopausal women.

A

estrogen excess; endometrial hyperplasia; peri

endometrial atrophy; post

71
Q

Pathogenesis Of endometrial carcinoma

The Endometrioid type account for ___% of cases of Endometrial carcinomas.

These tumors are designated endometrioid because of their histologic similarity to ——————————- .

A

80

normal endometrial glands

72
Q

Pathogenesis Of endometrial type of endometrial carcinoma

Risk factors of this type of carcinoma include:
_______
________
Hypertension
________
Exposure to ______________

A

Obesity
Diabetes
Hypertension
Infertility
Exposure to unopposed estrogen

73
Q

Pathogenesis Of the Endometrioid type of Endometrial carcinomas.

Many of these risk factors result in increased _______ stimulation of the endometrium and are associated with endometrial hyperplasia .

A

Estrogen

74
Q

It is well recognized that prolonged __________ therapy and __________ tumors increase the risk of endometrioid type of endometrial carcinoma.

A

estrogen replacement

estrogen- secreting ovarian

75
Q

breast carcinoma occurs in women with endometrial cancer and vice versa more frequently than by chance alone

T/F

A

T

76
Q

breast carcinoma is also Estrogen dependent

T/F

A

T

77
Q

Mutations in ________ gene and the tumor suppressor gene ______ are (early or late?) events in the stepwise development of endometrioid carcinoma.

A

mismatch repair; PTEN

Early

78
Q

Women with germ line mutation in PTEN (_______ syndrome ) are at high risk for this endometroid cancer.

_____ mutations occur but are relatively uncommon and believed to be (early or late?) events in the genesis of this type.

A

Cowden

TP53
Late

79
Q

The serous type of endometrial carcinoma is much (more or less?) common. accounting for roughly ____% of tumors.

Nearly all cases have mutations in the ______ tumor suppressor gene, whereas mutations in _________ genes and ——— are rare

A

Less; 15

TP53

DNA mismatch repair

PTEN

80
Q

Morphology of Endometrial carcinoma

Endometrioid carcinomas closely resemble ________ and may be _________ or __________.

They include a range of histologic types , including those showing __________, __________ (ciliated) and __________ (occasionally adeno- squamous differentiation) .

A

normal endometrium

exophytic or infiltrative.

mucinous, tubal (ciliated) and squamous (occasionally adeno- squamous differentiation) .

81
Q

Morphology of Endometrial carcinoma

Tumors originates in the _____ and may _____________ and enter ______ spaces.

They may also metastasize to _________________.

A

mucosa

infiltrate the myometrium

vascular; regional lymph nodes .

82
Q

Morphology of Endometrial carcinoma

Endometrioid carcinomas are graded ____ to ____ based on the degree of differentiation.

A

1 to 3

83
Q

Morphology of Endometrial carcinoma

Serous carcinomas on the other hand, form ________ and ______, rather than the ______ seen in endometrioid carcinoma, and exhibit much greater _________. They behave ________ and thus are by definition ___-grade .

A

small tufts and papillae

glands; cytologic atypia

aggressively; High

84
Q

Immunohistochemistry often reveals high levels of _____ in serous carcinoma, a finding that correlates with the presence of _____ mutations

A

p53; TP53

85
Q

Clinical cause of Endometrial Carcinoma

Endometrial carcinomas usually manifest with ________ and _____ bleeding, often in ____menopausal women with progression, the uterus ______ and may become ______________________________ as the cancer _______ surrounding tissues.

A

leukorrhea; irregular

post; enlarges

affixed to surrounding structures

infiltrates

86
Q

Clinical cause of Endometrial Carcinoma

These tumors usually are (slow or rapid?) to metastasize, but if left untreated eventually disseminate to ________ and more distant sites.

With therapy, the ____-years survival rate for early-stage carcinoma is ____% but survival drops precipitously in higher-stage tumors.

A

Slow

regional nodes

5; 90

87
Q

Clinical cause of Endometrial Carcinoma

The prognosis with serous carcinomas is strongly dependent on operative staging and cytologic screening of ________ is imperative, because very small or superficial serous tumors may nonetheless spread by way of the ________ to the ____________.

A

peritoneal washings

fallopian tube; peritoneal cavity

88
Q

Endometroid VS serous carcinoma

Behavior
Spread

Clinical setting
Precursor

Mutated gene
Age

A

Indolent ; Aggressive

lymphatics; Intraperitoneal and lymphatic

Unopposed Estrogen, obesity; atrophy, thin physique

Hyperplasia; serous endometrial, intraepithilial carcinoma

PTEN; TP53
55-65; 65- 75

89
Q

Summary
Endometrial Hyperplasia and Endometrial Carcinoma

Endometrial hyperplasia results from ___________________________

Risk factors for developing endometrial hyperplasia include _____ cycles,———- syndrome, ___________ tumor, obesity, and _____ therapy without _______

A

excess endogenous or exogenous estrogen.

anovulatory; polycystic ovary; estrogen-producing ovarian ; estrogen; counterbalancing progestin.

90
Q

Summary
Endometrial Hyperplasia and Endometrial Carcinoma

The severity of hyperplasia is graded on the basis of architectural (______ versus ______ ) and cytologic (_______ versus _____) criteria.

The risk of developing carcinoma is predominantly related to ______

A

simple; complex

normal; atypical

cytologic atypia.

91
Q

Endometrial Polyps

These _____, usually _______ lesions range from 0.5 to 3 cm in diameter.

Larger polyps may project from the ________ into the __________

A

sessile; hemispheric

endometrial mucosa ; uterine cavity.

92
Q

Endometrial Polyps

On histologic examination, they are composed of endometrium resembling the ______, frequently with (small or large?) muscular arteries.

Some glands have a _____ endometrial architecture, but more often they are _____________ .

The stromal cells are _______, often with a rearrangement of chromosomal region ______ and thus constitutes the neoplastic component of the polyp.

A

basalis; small

normal; cystically dilated

monoclonal ; 6p21

93
Q

Endometrial Polyps

Although endometrial polyps may occur at any age, they are most commonly detected around the time of ________.

Their clinical significance lies in the abnormal _________ and more important in the risk (however rare) of __________

A

menopause

uterine bleeding

giving rise to a cancer.

94
Q

Leiomyoma

(Benign Or Malignant ?) tumors that arise from the _________ cells in the ________ are properly termed leiomyomas, because of their _______ however they often are referred to clinically as __________

A

Benign ; smooth muscle

myometrium ; firmness

fibroids

95
Q

___________ are the most common benign tumor in females affecting 30% to 50% of women of reproductive age and considerably more frequent in (black or white?) than in (blacks or whites?) .

A

Leiomyomas

black ; whites.

96
Q

Leiomyoma

These tumors are monoclonal and are associated with several different recurrent chromosomal abnormalities, including rearrangement of chromosomes ____ and ——- that also are found in a variety of other benign neoplasms, such as _______ and _________

A

6 and 12

endometrial polyps and lipomas.

97
Q

Leiomyoma

______ and possibly ________ stimulates the growth of leiomyomas

conversely; these tumors shrink _________________

A

Estrogen

oral contraceptives

post- menopausally.

98
Q

Morphology of Leiomyomas

Leiomyomas are typically (sharply or irregularly?) circumscribed, (loose or firm?) , ________ masses with a characteristic _______ cut surface .

They may occur ______, but more often ______ tumors are scattered within the uterus, ranging from small nodules to large tumors that large tumors that may dwarf the uterus.

A

sharply; firm

gray-white; whorled

singly; multiple

99
Q

Morphology of Leiomyomas

Some are embedded _________________ (intramural ), whereas others may ________________( submucosal) or directly _________ (subserosal).

In the latter location , tumors may extend out on ___________ and even become attached to surrounding organs, from which they may develop a blood supply (———- leiomyomas).

A

within the myometruim

lie directly beneath the endometrium

beneath the serosa

attenuated stalks; parasitic

100
Q

Morphology of leiomyomas

On histologic examination, the tumor are characterized by _______________ mimicking the appearance of normal myometrium, foci of __________, ________ and ___________ may be present.

A

bundles of smooth muscles cells

fibrosis; calcification

degenerative softening

101
Q

Morphology of Leimyomas

Leiomyomas of the uterus often are (asymptomatic of symptomatic?) , being discovered incidentally on routine pelvic examination .

The most frequent presenting sign is _________, with or without ————.

A

asymptomatic

menorrhagia

metrorrhagia

102
Q

Rarely leiomyomas may be _______ by the affected woman or may produce a _______ sensation.

A

palpated; dragging

103
Q

Leiomyomas almost never transform into sarcomas

T/F.

A

T

104
Q

In Leiomyomas,
the presence of multiple lesions increases the risk of malignancy.

T/F

A

F

Does not

105
Q

Leiomyosarcoma

Leiomyosarcoma arise _______ from the ———— cells of the myometruim, not from _______________.

They are almost always _____ and most often occur in _________ women in contradistinction to leiomyomas, which frequently are _______ and usually arise _____________.

A

de novo; mesenchymal

preexisting leiomyomas

solitary; postmenopausal

multiple; premenopausally

106
Q

Leiomyosarcoma

Morphology

Leiomyosarcoma typically take the form of (soft or hard?) , _______,_______ masses.

The histologic appearance varies widely, form tumors that ———— to _____________

A

Soft ; hemorrhagic, necrotic

closely resemble leiomyoma

widely anaplastic neoplasm.

107
Q

Leiomyosarcoma

Morphology

Those well- differentiated tumors that lie at the interface between leiomyoma and leiomyosarcoma are sometimes designated _______ tumors of ______ malignant potential; in such cases, only ______ will tell if the tumor’s behavior is benign or malignant .

A

smooth muscles; uncertain

time

108
Q

Leiomyosarcoma

Morphology

The diagnostic features of overt leiomyosaroma include tumor ______, cytologic _____, and ______ activity.

Since increased _________ is sometimes seen in benign smooth muscle tumors particularly in (young or old?) women, an assessment of all three features is necessary to make a diagnosis of malignancy.

A

necrosis; atypia ; mitotic

mitotic activity

Young

109
Q

Recurrence after removal is (common or rare?) with Leiomyosarcoma and many metastasize, typically to the ____ yielding ___-years survival rate of about ___%.

The outlook with anaplastic tumors is less favorable than with well- differentiated tumors.

A

Common

lungs

5; 40

110
Q

Summary
Uterine Smooth Muscle Neoplasms

____________ tumors, called leiomyomas are (common or rare?) and frequently (single or multiple?)

they may manifest with ______ or as a pelvic mass or may be detected as cause of ______.

A

Benign smooth muscles

Common; multiple

menorrhagia; infertility

111
Q

Summary
Uterine Smooth Muscle Neoplasms

_______________ tumors, called leiomyosarcoma arise ______ not from _________.

Criteria of malignancy include _______,________, and ________

A

Malignant smooth muscles

de novo; leiomyomas

necrosis, cytologic atypia and mitotic activity.