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Emma Repro > The Uterus > Flashcards

The Uterus Flashcards

1
Q

endometrial hyperplasia subtype with highest risk of cancer progression

A

complex hyperplasia with atypia

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2
Q

endometrial hyperplasia

A
  • older age
  • genetics (Lynch)
  • xs estrogens
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3
Q

causes of xs estrogen stimulation

A
  • PCOS/chronic anovulation
  • obesity
  • unopposed ERT
  • estrogen secreting tumor
  • tamoxifen therapy
  • nulliparity/no breast-feeding
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4
Q

low risk endometrial hyperplasia tx

A

progestin therapy (thins endometrium)

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5
Q

high risk endometrial hyperplasia tx

A

hysterectomy

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6
Q

endometrial hyperplasia histo

A

atypical glands sep by stroma

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7
Q

endometrial cancer

A

atypical glands fused together without stroma

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8
Q

most comm gynecologic cancer in US

A

endometrial cancer

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9
Q

endometrial cancer tx

A

surgery (hysterectomy and bilateral salpingo-oophorectomy)

-poss pelvic and para-aortic lymph node sampling

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10
Q

staging of uterine CA

A

FIGO

  1. confined to uterus/invades myometrium
  2. cervix
  3. serosa/vagina/nodes
  4. bladder or bowel mucosa/ distant mets
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11
Q

endometrial polyps tx

A

-resection if irregular or post-menopausal bleeding

post-menopausal women have a higher risk of malignancy

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12
Q

endometriosis vs adenomyosis

A

both cause dysmenorrhea

adenomyosis is also assoc w/ menorrhagia

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13
Q

outside uterus and unlikely to cause AUB

A

endometriosis

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14
Q

inside uterine wall and more likely to cause AUB

A

adenomyosis

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15
Q

adenomyosis tx

A

hormonal

  • LNG-IUD
  • depo

hysterectomy if highly symp and completed child bearing

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16
Q

diffusely enlarged, globular uterus - feels soft

A

adenomyosis

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17
Q

leiomyomas

A
  • benign tumor of myometrium
  • usu multiple tumors
  • premenopaousal women
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18
Q

leiomyomas tx if submucosal

A

tx for AUB

hysteroscopic resection

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19
Q

leiomyomas tx if large/intramural

A
  • myomectomy
  • hysterectomy (use GnRH agonist to shrink size before surgery)
  • UAE, UFE (embolization)
20
Q

GnRH agonist used to shrink leiomyoma before surgery

A

leuprolide

21
Q

adenomyosis

A
  • benign endometrial glands and stroma deeply within myometrium
  • diffusely enlarged uterus (vs nodular enlargement of leiomyomas)
  • pt present w abnml bleeding/dysmenorrhea/enlarged uterus
22
Q

pathologic dx of endometriosis

A
  • endometrial glands
  • endometrial stroma
  • hemosiderin
23
Q

theories of endometriosis pathogenesis

A

Regurgitation theory**
Metaplastic theory
Metastatic theory
Stem cell differentiation

24
Q

accepted theory of endometriosis

A

movement of mestrual tissue thru Fallopian tubes –> ovaries, peritoneum

25
Q

most common tumor in female genital tract

A

leiomyoma
(fibroid)
benign tumor of smc

26
Q

leiomyomas arise most commonly in the

A

myometrium

27
Q

most common location of leiomyomas

A

intramural

28
Q

cigar-shaped nuclei and abundant eos cytoplasm

A

leiomyoma

29
Q

leiomyosarcoma

A
  • rare
  • DE NOVO
  • peak at older age, post-menopausal
  • abnml bleeding/pain/mass
  • prognosis dec on stage
  • spread is intraperitoneal to nodes and hematogenously to lungs, liver, or brain
30
Q

features of leiomyosarcoma

A
  • necrosis
  • mitotic count inc
  • cytological atypia
31
Q

STUMP

A

smooth-muscle tumor of undetermined malignant potential

if hard to distinguish leiomyoma vs leiomyosarcoma

32
Q

leiomyosarcoma histo

A 
hypercellular
pleomorphic nuclei
hyperchromatic nuclei
increased mitoses
atypical mitoses
(necrosis)
(hemorrhage)

sm actin, desmin +

33
Q

endometrial polyp malignant potential

A

CA may rarely be found within a polyp, but no evidence to suggest that polyps are premalignant

34
Q

3 histological features of endometrial polyps

A
  • dilated endometrial glands
  • fibrotic stroma
  • thick walled blood vessels
35
Q

endometrial hypERplasia

A

via influence of high levels of unopposed estrogen

36
Q

How would obesity lead to endometrial hypERplasia?

A

estrogens are formed in peripheral adipose tissue from androstenedione

xs estrogen –> endometrial hyperplasia

37
Q

normal proliferative phase endometrium

A

gland:stoma ratio

<1:1

38
Q

enlarged, crowded, poorly oriented nuclei

A

atypia

39
Q

endometrial carcinoma risk fx

A
  • age
  • estrogen
  • diabetes
  • smoking
  • genetic (LYNCH)
40
Q

Mutations in type II endometrial cancer

A

K-ras, p53, HER2neu

41
Q

2 types of ovarian carcinoma

A
  1. endometrioid

2. serous

42
Q

type I endometrial carcinoma (endometrioid type)

A
  • endometrial type epithelium
  • estrogen-driven
  • hypERplasia
  • lower grade
  • superficially invasive
  • better prognosis
43
Q

type II endometrial carcinoma (serous type)

A
  • Fallopian tube type endothelium
  • estrogen-INDEPENDENT
  • driven by p53
  • no hyperplasia
  • deep invasion
  • POOR PROGNOSIS, AGGRESSIVE
44
Q

carcinosarcoma

A 
malignant glands
malignant stroma (homologous or heterologous)
45
Q

carcinosarcoma, heterologous type

A

rhabdomyosarcoma

chondrosarcoma

Emma Repro (23 decks)

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