THE BODY OF THE UTERUS AND ENDOMETRIUM

Question 1

The body of the uterus and endometrium

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

Answer 1

myometrium; endometrium

Question 2

The body of the uterus and endometrium

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

Answer 2

tightly interwoven bundles

walls

Question 3

The body of the uterus and endometrium

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

Answer 3

endometrium; glands

cellular stroma

Question 4

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.

Answer 4

endocrine imbalances

pregnancy; neoplastic

cervix uteri

Question 5

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 _______.

Answer 5

sex steroid

ovary

Question 6

Endometrial history in the menstrual cycle.

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

Answer 6

hypothalamic, pituitary, ovarian

maturation of ovarian follicles

ovulation and menstruation

Question 7

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 __________

Answer 7

histologic

hormonal; ovulation

bleeding and infertility.

Question 8

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.

Answer 8

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

Question 9

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.

Answer 9

slows; mitotic

corpus luteum; progesterone; estrogen

secretory vacuoles ; third

basal vacuoles ; fourth; dilated

tortuous; serrated; secretory exhaustion

shrinking

Question 10

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.

Answer 10

progesterone

spiral arterioles

Question 11

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 _________.

Answer 11

edema ; stroma cells

cytoplasmic eosinophilia

pre-decidual ; stromal mitoses

Question 12

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 __________.

Answer 12

functionalis

neutrophils; lymphocytes

inflammation

Question 13

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 ___________

Answer 13

corpus luteum

blood

menstrual shedding .

Question 14

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 .

Answer 14

estrogen and progesterone

autocrine and paracrine

Question 15

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 _______

Answer 15

cognate nuclear

X; A ; B

glands and stroma.

Question 16

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 .

Answer 16

stromal; growth

insulin-like growth factor-1 and epidermal growth factor

Question 17

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 _______ .

Answer 17

inhibits proliferation ; stroma

estrogen; both the gland and stroma

unresponsive to estrogen; ovary

Question 18

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 ______

Answer 18

infertility to cancer.

Question 19

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

Answer 19

endometrial mucosa

smooth muscles myometrium

Question 20

Endometritis

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

Answer 20

endometrium

a neutrophilic or lymphoplasmacytic response

Question 21

Endometritis

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

Answer 21

plasmacells; lymphocytes

Question 22

Endometritis

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

Answer 22

pelvic inflammatory

N.gonorrhoeae or C.trachomatis

Question 23

Endometritis

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

Prominent ________________ are more commonly seen in chlamydial infection.

Answer 23

neutrophilic

stromal lympho-plasmacytic

lymphoid follicles

Question 24

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 .

Answer 24

granulomatous

salpingitis and peritonitis

immunocompromised; tuberculosis is endemic

pelvic inflammatory disease

Question 25

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

Answer 25

retained products; miscarriage intrauterine device.

Question 26

Endometritis Retained tissues or foreign bodies act as a _______ for ____________ by vaginal or intestinal tract flora. ____________________________________ typically results in resolution.

Answer 26

nidus; ascending infection Removal of the offending tissues or foreign body

Question 27

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 __________.

Answer 27

fever, abdominal pain and menstrual abnormalities infertility and ectopic pregnancy scarring; fallopian tubes.

Question 28

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 __________

Answer 28

edematous; mononuclear squamous metaplasia bleed; no malignant potential.

Question 29

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 __________.

Answer 29

basal; endometrium; myometrium stroma, glands myometrium; muscles bundles.

Question 30

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.

Answer 30

reactive hypertrophy Enlarged; globular thickened

Question 31

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.

Answer 31

basalis cyclic bleeding menorrhagia, dysmenorrhea

Question 32

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.

Answer 32

outside the endo-myometrium 10; half

Question 33

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 .

Answer 33

multifocal; pelvic peritoneal cavity or periumbilical tissues

Question 34

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

Answer 34

favored; menstrual backflow fallopian tubes

Question 35

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

Answer 35

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

Question 36

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.

Answer 36

differentiation; coelomic epithelium

Question 37

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 .

Answer 37

extrapelvic or intranodal

Question 38

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

Answer 38

Regurgitation Metaplastic lymph nodes, skeletal muscles or lungs

Question 39

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

Answer 39

survival and persistence a foreign location

Question 40

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.

Answer 40

functioning endometrium cyclic bleeding blood collects in these aberrant foci red - brown; serosal

Question 41

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.

Answer 41

ovaries; blood-filled cysts brown; chocolate

Question 42

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.

Answer 42

fibrosis; adhesions sealing; tubal fimbriated oviducts

Question 43

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

Answer 43

Endometrial glands Endometrial stroma hemosiderin pigment.

Question 44

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 _______

Answer 44

distribution of the lesion oviducts and ovaries; sterility

Question 45

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.

Answer 45

Rectal wall uterine or bladder serosa

Question 46

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 _______

Answer 46

dysmenorrhea and pelvic bleeding adhesions.

Question 47

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______. :

Answer 47

profuse or prolonged irregular; postmenopausal endometrial polyps, leiomyoma, endometrial hyperplasia, endometrial carcinoma and endometritis.

Question 48

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 __________________________.

Answer 48

age Dysfunctional Uterine Bleeding.

Question 49

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

Answer 49

ovulation luteal Contraceptive Endo-myometrial

Question 50

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.

Question 51

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 _________ ———

Answer 51

Common hypothalamic pituitary axis, adrenal or thyroid ovarian lesions; estrogen malnutrition, obesity physical or emotional stress

Question 52

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.

Answer 52

estrogen; progesterone proliferative; secretory mild cystic; progesterone; scarce

Question 53

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.

Answer 53

fail to mature; regress progesterone secretory

Question 54

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.

Answer 54

synthetic estrogen and progestin lush, decidua inactive, non-secretory

Question 55

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

Answer 55

chronic polyps

Question 56

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.

Answer 56

non-neoplastic glands and stroma ; outside lymph nodes and lungs

Question 57

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

Answer 57

cyclic bleeding dysmenorrhea and pelvic pain.

Question 58

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

Answer 58

Endometrium into the myometrium enlargement no cyclic bleeding

Question 59

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

Answer 59

endometrial hyperplasia, endometrial polyps, endometrial carcinomas, smooth muscle tumor abnormal uterine bleeding

Question 60

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

Answer 60

estrogen ; progestin endometrial proliferation (hyperplasia) endometrial carcinoma.

Question 61

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).

Answer 61

ovulation; pre-menopause estrogenic steroids counterbalancing progestin. Estrogen Polycystic ovary disease and Granulosa - theca cell

Question 62

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

Answer 62

obesity adipose tissue estrogens

Question 63

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 ____________.

Answer 63

estrogen excess Crowding; simple verse cytologic atypia Complex; cellular atypia

Question 64

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 ___%).

Answer 64

Low ; less then 5 20;50

Question 65

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

Answer 65

T

Question 66

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

Answer 66

autonomously estrogen carcinoma.

Question 67

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.

Answer 67

PTEN PI-3-kinase /AKT

Question 68

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.

Answer 68

PTEN endometrial carcinomas PTEN

Question 69

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?).

Answer 69

55 and 65 40 Endometrioid and Serous carcinoma Distinct

Question 70

Endometrial Carcinoma Endometrioid cancers arise in association with ________ and _________ in ____menopausal women, whereas Serous cancer arise in the setting of __________ in older _____menopausal women.

Answer 70

estrogen excess; endometrial hyperplasia; peri endometrial atrophy; post

Question 71

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 ——————————- .

Answer 71

80 normal endometrial glands

Question 72

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

Answer 72

Obesity Diabetes Hypertension Infertility Exposure to unopposed estrogen

Question 73

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 .

Answer 73

Estrogen

Question 74

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

Answer 74

estrogen replacement estrogen- secreting ovarian

Question 75

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

Answer 75

T

Question 76

breast carcinoma is also Estrogen dependent T/F

Answer 76

T

Question 77

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

Answer 77

mismatch repair; PTEN Early

Question 78

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.

Answer 78

Cowden TP53 Late

Question 79

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

Answer 79

Less; 15 TP53 DNA mismatch repair PTEN

Question 80

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) .

Answer 80

normal endometrium exophytic or infiltrative. mucinous, tubal (ciliated) and squamous (occasionally adeno- squamous differentiation) .

Question 81

Morphology of Endometrial carcinoma Tumors originates in the _____ and may _____________ and enter ______ spaces. They may also metastasize to _________________.

Answer 81

mucosa infiltrate the myometrium vascular; regional lymph nodes .

Question 82

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

Answer 82

1 to 3

Question 83

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 .

Answer 83

small tufts and papillae glands; cytologic atypia aggressively; High

Question 84

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

Answer 84

p53; TP53

Question 85

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.

Answer 85

leukorrhea; irregular post; enlarges affixed to surrounding structures infiltrates

Question 86

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.

Answer 86

Slow regional nodes 5; 90

Question 87

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 ____________.

Answer 87

peritoneal washings fallopian tube; peritoneal cavity

Question 88

Endometroid VS serous carcinoma Behavior Spread Clinical setting Precursor Mutated gene Age

Answer 88

Indolent ; Aggressive lymphatics; Intraperitoneal and lymphatic Unopposed Estrogen, obesity; atrophy, thin physique Hyperplasia; serous endometrial, intraepithilial carcinoma PTEN; TP53 55-65; 65- 75

Question 89

Summary Endometrial Hyperplasia and Endometrial Carcinoma Endometrial hyperplasia results from ___________________________ Risk factors for developing endometrial hyperplasia include _____ cycles,———- syndrome, ___________ tumor, obesity, and _____ therapy without _______

Answer 89

excess endogenous or exogenous estrogen. anovulatory; polycystic ovary; estrogen-producing ovarian ; estrogen; counterbalancing progestin.

Question 90

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 ______

Answer 90

simple; complex normal; atypical cytologic atypia.

Question 91

Endometrial Polyps These _____, usually _______ lesions range from 0.5 to 3 cm in diameter. Larger polyps may project from the ________ into the __________

Answer 91

sessile; hemispheric endometrial mucosa ; uterine cavity.

Question 92

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.

Answer 92

basalis; small normal; cystically dilated monoclonal ; 6p21

Question 93

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 __________

Answer 93

menopause uterine bleeding giving rise to a cancer.

Question 94

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 __________

Answer 94

Benign ; smooth muscle myometrium ; firmness fibroids

Question 95

___________ 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?) .

Answer 95

Leiomyomas black ; whites.

Question 96

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 _________

Answer 96

6 and 12 endometrial polyps and lipomas.

Question 97

Leiomyoma ______ and possibly ________ stimulates the growth of leiomyomas conversely; these tumors shrink _________________

Answer 97

Estrogen oral contraceptives post- menopausally.

Question 98

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.

Answer 98

sharply; firm gray-white; whorled singly; multiple

Question 99

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).

Answer 99

within the myometruim lie directly beneath the endometrium beneath the serosa attenuated stalks; parasitic

Question 100

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

Answer 100

bundles of smooth muscles cells fibrosis; calcification degenerative softening

Question 101

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 ————.

Answer 101

asymptomatic menorrhagia metrorrhagia

Question 102

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

Answer 102

palpated; dragging

Question 103

Leiomyomas almost never transform into sarcomas T/F.

Answer 103

T

Question 104

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

Answer 104

F Does not

Question 105

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 _____________.

Answer 105

de novo; mesenchymal preexisting leiomyomas solitary; postmenopausal multiple; premenopausally

Question 106

Leiomyosarcoma Morphology Leiomyosarcoma typically take the form of (soft or hard?) , _______,_______ masses. The histologic appearance varies widely, form tumors that ———— to _____________

Answer 106

Soft ; hemorrhagic, necrotic closely resemble leiomyoma widely anaplastic neoplasm.

Question 107

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 .

Answer 107

smooth muscles; uncertain time

Question 108

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.

Answer 108

necrosis; atypia ; mitotic mitotic activity Young

Question 109

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.

Answer 109

Common lungs 5; 40

Question 110

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 ______.

Answer 110

Benign smooth muscles Common; multiple menorrhagia; infertility

Question 111

Summary Uterine Smooth Muscle Neoplasms _______________ tumors, called leiomyosarcoma arise ______ not from _________. Criteria of malignancy include _______,________, and ________

Answer 111

Malignant smooth muscles de novo; leiomyomas necrosis, cytologic atypia and mitotic activity.