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patho II > Uterine Pathology > Flashcards

Uterine Pathology Flashcards

1
Q

Cause of Acute Endometritis

A
  • Staphylococci and Streptococci (after delivery or miscarriage)
  • Neisseria gonorrhoeae, Chlamydia trachomatis
  • Retained products of conception
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2
Q

What type of Endometritis shows plasma cells (lympho-plasmacytic infiltrates) on histology?

A

Chronic Endometritis

Acute -> Neutophilic infiltrates

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3
Q

Histology of Acute vs Chronic Endometritis

A

Chronic –> Plasma cells
Acute –> Neutophilic infiltrates

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4
Q

Causes of Chronic Endometritis

A
  • Chlamydia trachomatis, Mycobacterium tuberculosis → Granulomatous Endometritis + Salpingitis + Peritonitis
  • Retained gestational tissue (post-partum or post
    abortion patients)
  • Intra-uterine contraceptive device (IUD)
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5
Q

Clinical presentations of Endometritis

A

Fever, abdominal pain, and menstrual abnormalities

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6
Q

Complications of Endometritis

A

Increased risk of infertility and ectopic pregnancy
(consequence of scarring of the fallopian tubes)

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7
Q

———-: Growth of the basal layer of the endometrium down into the myometrium

A

Adenomyosis

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8
Q

Macroscopic features:
– Enlarged globular uterus
– Thickened uterine wall

Microscopic findings:
– Nests of endometrial stroma, glands, or both, deep in the myometrium interposed between the muscle bundles
– Reactive hypertrophy of the myometrium

features of?

A

Adenomyosis

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9
Q

Clinical presentation of Adenomyosis

A

1) AUB/HMB (abnormal uterine bleeding/ heavy menstural bleeding)
2) pelvic pain and Dymernorrhea (pain ass. w/ mensturation)

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10
Q

———— : Presence of endometrial glands and stroma
in a location outside the endo-myometrium

A

Endometriosis

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11
Q

Endometriosis is commonly found in?

A

ovaries (frequently bilateral), pelvis, peritoneum, recto-vaginal septum, tubes, uterine ligaments
(can spread to distant sites such as the lymphs, heart and lungs)

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12
Q

Cause of Endometriosis

A

May be due:
1) Retrograde (backflow) menstrual flow
2) Metaplastic transformation; Endometrail diffrentiation of coleomic epithelium
3) transportation of endometrial tissue via lymphatic system

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13
Q

What udergoes cycling bleeding, Endometriosis or Adenomyosis?

A

Endometriosis

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14
Q

Clinical presentation of Endometriosis

A

1) Cyclic pelvic pain and Dysmenorrhoea
2) Pain on defecation (Dyschezia)
3) Dyspareunia (painful intercourse)
4) Dysuria
5) Infertility

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15
Q

Microscopic findings:
1. Endometrial glands
2. Endometrial stroma
3. Haemosiderin pigment
4. blood filled, Chocolate cysts

features of?

A

Endometriosis

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16
Q

The 3 Types of Abnormal uterine bleeding

A

1. Menorrhagia: Profuse or prolonged bleeding at the time of the period
2. Metrorrhagia: Irregular bleeding between the periods
3. Post-menopausal bleeding

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17
Q

Causes of Abnormal Uterine Bleeding
(4 groups)

A

1. Failure of Ovulation
2. Inadequate Luteal Phase
3. Contraceptive-induced Bleeding
4. Endo-Myometrial Disorders

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18
Q

What group of AUB is caused by failure of the corpus luteum to mature normally or regresses prematurely → relative lack of progesterone?

A

Inadequate Luteal Phase

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19
Q

Patho of Ovulatory faliure

A

excess of oestrogen relative to progesterone; Thus, the endometrium goes through a proliferative phase that is not followed by the normal secretory phase –> breakdown and abnormal bleeding

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20
Q

Microscopic findings:
– Disordered or mild dilated endometrial glands
– Scarce endometrial stroma (due to lack of
progesterone)

features of?

A

Abnoraml Uterine Bleeding caused by Ovulatory failure

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21
Q

patho of AUB caused by Contraceptive-induced bleeding

A

The use of Older oral contraceptives –> induces a variety of endometrial responses, resulting in abnormal bleeding

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22
Q

State 3 Endo-Myometrial Disorders

A

✓Endometritis
✓Endometrial Polyps
✓Submucosal Leiomyomas

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23
Q

Proliferative lesions/Neoplasms of the Endometrium

A
  1. Endometrial Hyperplasia
  2. Endometrial Carcinomas
  3. Endometrial Polyps
  4. Endometrial Stromal Sarcoma
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24
Q

Proliferative lesions/Neoplasms of the Myometrium

A
  1. Leiomyomas
  2. Leiomyosarcomas, de novo
25
Q

Epi of Endometrial Hyperplasia

A

Excess of oestrogen relative to progesterone

26
Q

Causes of Endometrial Hyperplasia

A

Failure of ovulation, oestrogen producing ovarian
lesions (polycystic ovary disease), obesity

27
Q

Clinical presentation of Endometrial Hyperplasia

A

Abnormal uterine bleeding

28
Q

Endometrial Hyperplasia is asso. w?

A

Increased risk for Endometrial Carcinoma,
(esp. w/ cytologic atypia)

29
Q

what type of Endometrial Hyperplasia is this?

A

Simple Hyperplasia
without Atypia

30
Q

what type of Endometrial Hyperplasia is this?

A

Complex Hyperplasia
with Atypia

31
Q

what type of Endometrial Hyperplasia is this?

A

Complex Hyperplasia
without Atypia

32
Q

Epi of Endometrial CA

A
  • Most frequent cancer in the female genital tract
  • btw 55-65 yrs
33
Q

The 2 distinct types of Endometrial CA?

A
  1. Endometrioid Carcinoma (80% of cases)
  2. Serous Carcinoma (15% of cases)
34
Q

Endometrioid CA is ass. w?

A

Association with Oestrogen excess and Endometrial Hyperplasia in peri-menopausal women

35
Q

Risk factors of Endometrioid CA

A
  1. Obesity
  2. Diabetes mellitus
  3. Hypertension
  4. Infertility
  5. Exposure to unopposed Oestrogen
36
Q

Endomterioid CA are caused by what type of mutations?

A

mismatch repair genes and the tumour
suppressor gene PTEN

37
Q

Serous type CA are caused by what type of mutations?

A

Mutations in TP53 gene

38
Q

Microscopic findings:
– Similarity to normal endometrial glands
– Various histologic types: i. Mucinous, ii. Tubal, &
iii. Squamous differentiation
- Tall columnar cells w/ bland nuclei

features of?

A

Endometrioid type Carcinoma

39
Q

what Grade of Endometrioid Adeno-Ca is this?

A

Grade 1 Endometrioid Adeno-Ca
(myo-invasion)

40
Q

what Grade of Endometrioid Adeno-Ca is this?

A

Endometrioid type Ca (Grade 3)

41
Q

what Grade of Endometrioid Adeno-Ca is this?

A

Endometrioid type Ca (Grade 2)

42
Q

Prognosis of serous Type CA

A

Aggressive behaviour; By definition high-grade

43
Q

Microscopic findings:
– Small tufts and papillae (chracteristic)
– High degree of cytologic atypia
- Immunohistochemistry: Marked positivity for TP53

features of ?

A

Serous type Carcinoma

44
Q

Clinical presentation of Endometrial CA?

A

1) Leukorrhoea and irregular bleeding (post-menopausal women)
2) Uterus enlargement

45
Q

Complications of Endometerial CA

A

Dissemination to regional lymph nodes and distant sites

46
Q

———— : Polypoid projection of the endometrial mucosa into the uterine cavity

A

Endometrial Polyps

47
Q

Epi of Endometrial Polyps

A

At any age, but most frequently around the time of menopause

48
Q

Clinical presentation of Endometrial Polyps

A

Abnormal uterine bleeding

49
Q

Microscopic findings:
– Endometrium resembling stratum basalis
– Frequently, Presence of small muscular arteries (thick-walled)
– Most commonly, cystically dilated glands

Features of?

A

Endometrial Polyps

50
Q

———–: Benign tumours that arise from the smooth muscle cells in the myometrium

A

Leiomyomas

51
Q

Epi of Leiomyomas

A
  • The most common benign tumour in females
    – increased incidence in Black pateints
52
Q

patho of Leiomymoas

A

Oestrogen sensitive–> Oestrogens stimulate the growth of Leiomyomas

53
Q

Clinical presentation of leiomyomas

A

1) Abnormal uterine bleeding
2) Large leiomyomas –> Palpable lesions
3) Dragging sensation

54
Q

Macroscopic features:
– More often multiple discrete tumours [D]
– Sharply circumscribed
– Firm gray-white mass
– Characteristic whorled pattern of smooth muscle bundles w/ well-demarcated borders
– Localisation: intramural, submucosal, subserosal

Features of?

A

Leiomyomas

55
Q

Malignant tumours that arise, de novo from
the mesenchymal cells of the myometrium . W/ soft, haemorrhagic, necrotic masses microscopically.

A

Leiomyosarcomas

56
Q

Diagnostic features of malignancy

A
  1. Necrosis
  2. Cytologic atypia
  3. Mitotic activity
57
Q

Microscopic features:
* Cytologic atypia with hyperchromatic pleomorphic nuclei
* Prominent cellular pleomorphism
* spindle-shapped smooth muscle cells with varying degree of Atypia and mitotic figures
* Round or polygonal cells with eosinophilic to clear cytoplasm
* widely variable histologic appearance; ranging from tumours closely resembling Leiomyomas to wildly anaplastic neoplasms

features of?

A

Leiomyosarcomas

58
Q

Epi of Leiomyosarcomas

A

Post-menopausal women

patho II (29 decks)

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