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Pathology/ICM-GYN Module > Uterine Disease > Flashcards

Uterine Disease Flashcards

1
Q

Endometrium undergoes changes due to _________hormones made by the _______.

A

sex steroid hormones

ovary

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2
Q

What is menses?

A

superficial portion of endometrium(EM) is shed

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3
Q

what occurs during the proliferation stage?

A

rapid growth of glands and stoma in the EM

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4
Q

what are the glands in the EM lined by?

A

columnar cells
mitosis
(NO MUCOUS NO VACUOLATION)

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5
Q

describe ovulation

A

proliferation ceases and differentiation begins

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6
Q

what occurs post ovulation

A

secretory EM

will see vacuoles(they will move to surface due to progesterone)

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7
Q

what ar causes of abnormal uterine bleeding?

A
  • hormonal disturbances
  • chronic endometritis
  • endometrial polyps
  • submucuosal leiomyosmas
  • endometrial tumors
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8
Q

what is dysfunctional uterine bleeding?

A

uterine bleeding without any structural abnormality

-hypothalamic pituitary ovary axis must be intact

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9
Q

what is the most frequent cause of dysfunctional uterine bleeding?

A

anovulation

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10
Q

what can cause anovulation?

A

endocrine (thyroid,adrenal or pituitary)

  • ovary (tumors or PCOS)
  • metabolic (obestiy, malnutrition)
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11
Q

what is the pathology behind dysfunctional uterine bleeding??

A

endometrium stimulation unopposed by progesterone (won’t see secretory phase because lacking progesterone)

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12
Q

what is a consequence of lack of progesterone during post ovulation

A

inadequate luteal phase

-infertility associated with increase bleeding or amenorrhea

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13
Q

What is the cause of acute endometritis?

A

usually bacterial
usually seen after delivery of mimscharge
can be due to retained products of conception

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14
Q

how do you treat acute endometritis?

A

removed retained products of contraception

give antibiotics

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15
Q

how often is chronic endometritis?

A

very common

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16
Q

what are the causes of chronic

A 
chronic PID
retained gestational tissue
IUDs
TB
Chlamydia
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17
Q

how often is acute endometritis?

A

very rare

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18
Q

how do you diagnose chronic endometritis?

A

plasma cells int he stroma

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19
Q

what is the appearance of chronic endometritis?

A

abnormal bleeding
pain
discharge
and infertility

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20
Q

how do you treat chronic endometritis?

A

with prophylactic antibiotics to prevent salpinitigitis

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21
Q

what is endometriosis?

A

ectopic endometrial tissue at a site outside the uterus

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22
Q

What is the type of etopic endometrial tissue seen in endometriosis?

A

can be both EM glands and stoma or only stroma

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23
Q

where are the sites of topic endometrial tissue in endometriosis?

A 
#1 ovaries -chocolate cyst
uterine ligaments
rectovaginal septum
pelvic peritoneum
intestine
cervix vagina fallopian tubes
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24
Q

what are the clinical signs and symptoms of endometriosis?

A

dysmenorrhea
pelvic pain
infertility

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25
Q

what age group is endometriosis seen in?

A

20s and 30s

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26
Q

what is a complication of endometriosis?

A

can invade and spread through wall of bowel….leads to pain on deification

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27
Q

what are the four theories of endometriosis?

A

regurgitation theory
metaplastic theory
benign metastasis theory
extra uterine stem/progenitor theory

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28
Q

explain the regurgitation theory

A

retrograde menstruation thru fallopian tube

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29
Q

explain the metaplastic theory

A

endometrium comes from the mesothelium of the pelvis/abdomen

mesonephric remnants can differentiate into EM

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30
Q

explain benign metastasis theory

A

endometrium issue can spread thru the blood and lymphatics to distant site

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31
Q

explain the extra uterine stem/progenitor cell theory

A

bone marrow cells differentiate into endometrium tissue

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32
Q

Can men treated with high dose estrogens get endometriosis?

A

yes

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33
Q

What is the new molecular theory of endometriosis?

A
  1. please of pro inflammatory factors (PGE2!!,IL1-B, TNF-alpha)
  2. these pro inflammatory factors increase the # of estrogen receptors
  3. Estrogen increases the survival of EM tissue
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34
Q

how do you treat endometriosis?

A

treat with aromatase inhibitors

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35
Q

what factors into the progression of endometriosis?

A

increased vascular networks
decreased immune clearance
increased response to ER
and decreased response to PR

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36
Q

what is the association of endometriosis and cancer?

A

endometriorid and clear cell have high associations with cancer

37
Q

what mutations are seen with endometriosis?

A

mutations in PTEN

AND ARID1A

38
Q

Whats a DD of endometriosis?

A

endosalpingosis (fallopian tube tissues are seen outside of the fallopian tube)
only if glands are seen

39
Q

What is the precursor to EM carcinoma in the uterus?

A

EM hyperplasia atypical

40
Q

what are the clinical signs and symptoms of endometriosis?

A 
sever dysmenorrhea
dyspareunia
pelvic pain
menstrual irregularities
infertility
41
Q

What is adenomyosis?

A

endometrial tissue with the myometrium

42
Q

what is the clinical presentation of adenomyosis?

A

menometrorrhagia (irregular and heavy periods)
colicky pain
dyspareunia
and pelvic pain

43
Q

what is the micro view of adenomyosis?

A

next of endometrium separated from the basalts by 2-3 mm

44
Q

what can cause endometrium polyps?

A

tamoxifen

45
Q

where do you see atrophic EM polyps?

A

post menopausal women

46
Q

what is EM hyperplasia

A

increased proliferation of glands vs stroma

47
Q

how is EM hyperplasia caused?

A

-by prolonged estrogenic stimulation of EM unopposed by progesterone
-anovulation
-obesity
-incr estrogen production
-menopause
-granulosa cell tumors of the ovary
ovarian cortical stromal hyperplasia

48
Q

What is the molecular basis behind EM hyperplasia?

A

inactivation of PTEN

49
Q

what does PTEN do?

A

encodes lipid phosphatase and neg regulator of PI3K-AKT pathway

50
Q

what is cowed syndrome

A

gremline mutation in PTEN

which causes increased EM carcinoma and great cancer

51
Q

what is another name for atypical hyperplasia of the endometrium?

A

Endometrial intraepithelial neoplasia EIN

52
Q

does non atypical EM hyperplasia progress to adenocarcinoma?

A

no

but can evolve into cystic atrophy when ER is withdrawn

53
Q

what pattern of proflierating glands does atypical EM hyperplasia (EIN) have

A

complex pattern of proliferating glands
with nuclear atypic
and back to back glands

54
Q

how to treat atypical hyperplasia?

A

hysterectomy
if it is a young women-trial of progestin therapy with close follow up…if it doesn’t regress after having a child..remove uterus

55
Q

what is the most common carcinoma of the female genital tract

A

cancer of the endometrium

56
Q

when do you see endometrial cancer?

A

post menopausal

57
Q

what is a sign of endometrial cancer?

A

post menopausal bleeding or irregular bleeding with leukorrhea

58
Q

whats the difference between normal EM cancer and serous EM cancer?

A

serous EM cancer spread through tube and lymphatics…

extrauterine spread

59
Q

what population is serous EM usually seen?

A

african american women

60
Q

what are the new treatment hopes for EM cancer?

A

Inhibiting PI3K/AKT pathway

61
Q

what is the most common type of EM carcinoma?

A

type 1-well differentiated

62
Q

what are the risk factors for EM carcinoma?

A

obesity
diabetes
infertility
unopposed estrogens

63
Q

grade 3 EM carcinoma is ______ differentiated?

A

poorly

64
Q

what is the age group of type 1 versus type 2 serous EM carcinoma?

A

type 2 EM carcinoma is usually seen in people ten years older

65
Q

what are the subtypes of type 2 serous carcinoma?

A

clear cell carcinoma

MMMT

66
Q

what are the mutations in type 2 serous carcinoma?

A

TP53 mutations

67
Q

what is the precursor lesion for type 2 serous carcinoma?

A

serous endometrial intraepithelial carcinoma

68
Q

what type of growth is seen in type 2 serous carcinoma?

A

papillary growth

69
Q

what is Malignant Mixed Mullrian Tumors (MMMT) AKA carcinosarcoma?

A

EM carcinoma with mesenchymal component

can protrude thru os

70
Q

what mutations cause MMMt?

A

PTEN, TP53 PIK3CA

71
Q

what age group is MMMT usually seen?

A

post menopausal women with bleeding

72
Q

what age group is Adenosarcoma

A

premenopausal

73
Q

what is a Adenosarcoma?

A

tumors of EM stroma

74
Q

how often do you see Adenosarcoma?

A

rarely

75
Q

how do you treat Adenosarcoma?

A

block ER and remove ovaries

76
Q

what is endometrial storm sarcoma?

A

tumor of EM Stroma

77
Q

what is the gene mutation for endometrial stromal sarcoma

A

JAZF1

78
Q

what is Leiomyoma/fibroids

A

benign tumor of myometrium

79
Q

what is the gene mutation seen in leiomyomas?

A

MED12

80
Q

What are some symptoms of leiomyoma?

A 
abnormal bleeding
urinary frequency
pain (from fibroids compressing organs)
impaired fertility
if pregnant spontaneous abortions
81
Q

what is the gross appearance of a leiomyoma?

A

ground circumscribed round form

multiple nodules

82
Q

Leiomyosarcoma is seen in what age group

A

pre and post menopausal women

83
Q

where do Leiomyosarcoma arise from/

A

myometrium or EM stroma

84
Q

what is the treatment of leiomyoma

A
  • depends on patients child bearing plans
  • NSAIDS-pain
  • Oral contraceptives-for bleeding
  • GRH(leuprolide)-reduction of fibroid size and amenorrhea
  • uterine artery embolization
  • myomectomy
  • hysterectomy
85
Q

what is the clinical presentation of adenomyosis?

A

heavy bleeding
dysmenorrhea
chronic pelvic pain
diffuse uterine enlargment

86
Q

In what age group do you see endometriosis?

A

reproduite age women

87
Q

what is endometriosis in the ovary called?

A

chocolate cyst

88
Q

how do you treat endometrial hyperplasia with no atypia and if patient wishes to preserve fertility?

A

treat with progesterone

89
Q

how do you treat endometrial hyperplasia with atypia and if completed child bearing?

A

hysterectomy

Pathology/ICM-GYN Module (11 decks)

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