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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
what age group is endometriosis seen in?
20s and 30s
26
what is a complication of endometriosis?
can invade and spread through wall of bowel....leads to pain on deification
27
what are the four theories of endometriosis?
regurgitation theory metaplastic theory benign metastasis theory extra uterine stem/progenitor theory
28
explain the regurgitation theory
retrograde menstruation thru fallopian tube
29
explain the metaplastic theory
endometrium comes from the mesothelium of the pelvis/abdomen | mesonephric remnants can differentiate into EM
30
explain benign metastasis theory
endometrium issue can spread thru the blood and lymphatics to distant site
31
explain the extra uterine stem/progenitor cell theory
bone marrow cells differentiate into endometrium tissue
32
Can men treated with high dose estrogens get endometriosis?
yes
33
What is the new molecular theory of endometriosis?
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
34
how do you treat endometriosis?
treat with aromatase inhibitors
35
what factors into the progression of endometriosis?
increased vascular networks decreased immune clearance increased response to ER and decreased response to PR
36
what is the association of endometriosis and cancer?
endometriorid and clear cell have high associations with cancer
37
what mutations are seen with endometriosis?
mutations in PTEN | AND ARID1A
38
Whats a DD of endometriosis?
endosalpingosis (fallopian tube tissues are seen outside of the fallopian tube) only if glands are seen
39
What is the precursor to EM carcinoma in the uterus?
EM hyperplasia atypical
40
what are the clinical signs and symptoms of endometriosis?
``` sever dysmenorrhea dyspareunia pelvic pain menstrual irregularities infertility ```
41
What is adenomyosis?
endometrial tissue with the myometrium
42
what is the clinical presentation of adenomyosis?
menometrorrhagia (irregular and heavy periods) colicky pain dyspareunia and pelvic pain
43
what is the micro view of adenomyosis?
next of endometrium separated from the basalts by 2-3 mm
44
what can cause endometrium polyps?
tamoxifen
45
where do you see atrophic EM polyps?
post menopausal women
46
what is EM hyperplasia
increased proliferation of glands vs stroma
47
how is EM hyperplasia caused?
-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
What is the molecular basis behind EM hyperplasia?
inactivation of PTEN
49
what does PTEN do?
encodes lipid phosphatase and neg regulator of PI3K-AKT pathway
50
what is cowed syndrome
gremline mutation in PTEN | which causes increased EM carcinoma and great cancer
51
what is another name for atypical hyperplasia of the endometrium?
Endometrial intraepithelial neoplasia EIN
52
does non atypical EM hyperplasia progress to adenocarcinoma?
no | but can evolve into cystic atrophy when ER is withdrawn
53
what pattern of proflierating glands does atypical EM hyperplasia (EIN) have
complex pattern of proliferating glands with nuclear atypic and back to back glands
54
how to treat atypical hyperplasia?
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
what is the most common carcinoma of the female genital tract
cancer of the endometrium
56
when do you see endometrial cancer?
post menopausal
57
what is a sign of endometrial cancer?
post menopausal bleeding or irregular bleeding with leukorrhea
58
whats the difference between normal EM cancer and serous EM cancer?
serous EM cancer spread through tube and lymphatics... | extrauterine spread
59
what population is serous EM usually seen?
african american women
60
what are the new treatment hopes for EM cancer?
Inhibiting PI3K/AKT pathway
61
what is the most common type of EM carcinoma?
type 1-well differentiated
62
what are the risk factors for EM carcinoma?
obesity diabetes infertility unopposed estrogens
63
grade 3 EM carcinoma is ______ differentiated?
poorly
64
what is the age group of type 1 versus type 2 serous EM carcinoma?
type 2 EM carcinoma is usually seen in people ten years older
65
what are the subtypes of type 2 serous carcinoma?
clear cell carcinoma | MMMT
66
what are the mutations in type 2 serous carcinoma?
TP53 mutations
67
what is the precursor lesion for type 2 serous carcinoma?
serous endometrial intraepithelial carcinoma
68
what type of growth is seen in type 2 serous carcinoma?
papillary growth
69
what is Malignant Mixed Mullrian Tumors (MMMT) AKA carcinosarcoma?
EM carcinoma with mesenchymal component | can protrude thru os
70
what mutations cause MMMt?
PTEN, TP53 PIK3CA
71
what age group is MMMT usually seen?
post menopausal women with bleeding
72
what age group is Adenosarcoma
premenopausal
73
what is a Adenosarcoma?
tumors of EM stroma
74
how often do you see Adenosarcoma?
rarely
75
how do you treat Adenosarcoma?
block ER and remove ovaries
76
what is endometrial storm sarcoma?
tumor of EM Stroma
77
what is the gene mutation for endometrial stromal sarcoma
JAZF1
78
what is Leiomyoma/fibroids
benign tumor of myometrium
79
what is the gene mutation seen in leiomyomas?
MED12
80
What are some symptoms of leiomyoma?
``` abnormal bleeding urinary frequency pain (from fibroids compressing organs) impaired fertility if pregnant spontaneous abortions ```
81
what is the gross appearance of a leiomyoma?
ground circumscribed round form | multiple nodules
82
Leiomyosarcoma is seen in what age group
pre and post menopausal women
83
where do Leiomyosarcoma arise from/
myometrium or EM stroma
84
what is the treatment of leiomyoma
- 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
what is the clinical presentation of adenomyosis?
heavy bleeding dysmenorrhea chronic pelvic pain diffuse uterine enlargment
86
In what age group do you see endometriosis?
reproduite age women
87
what is endometriosis in the ovary called?
chocolate cyst
88
how do you treat endometrial hyperplasia with no atypia and if patient wishes to preserve fertility?
treat with progesterone
89
how do you treat endometrial hyperplasia with atypia and if completed child bearing?
hysterectomy

Pathology/ICM-GYN Module (11 decks)

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