uterine pathology Flashcards
what layer is shed during menses
functionalis
mucosa of uterus
made up of glandular and stromal cells which both respond to hormonal activity
tumors can originate in either cell type
proliferative phase
mitotic figures in cells with small tubular glands
secretory phase
day 14-16 progesterone surge
first change is subnuclear vaculization
can be certain pt has ovulated
late secretory phase
clear spaces move above nuceli and secretions dumped into lumen
if implantation takes place
secretory changes even more apparent and get arias stella reaction -> can determine pregnancy
menstrual phase
balls of stromal cells, fragments of glands, and blood
dysfunctional uterine bleeding
unscheduled bleeding, presumed to be hormonal dysfnx
Dx of exclusion
oligomenorrhea
intervals of greater then 35 days
polymenorrhea
intervals less then 24 days
menorrhagia
excessive bleeding with normal intervals
metorrhagia
excessive flow and duration at normal intervals
menometorrhagia
irregular menses
withdrawal bleeding
bleeding following the withdrawal of hormones
anovulatory cycles
results in increases prolonged unopposed E stim
resulting endometrium is unstable and breaks down -> bleeding
Bx shows irregular dialted glands, no P effect, and stromal breakdown
very common around menarche and perimenopausal period
inadequate luteal phase
abnormal corpus luteum fnx -> low p in secretory phase
typically presents as infertility with menorrhagia or amenorrhea
acute endometritis
Bx shows neutrophils
limited to infections that arise after delivery or miscarriage
infection is usually polymicrobial
Tx0 with endometrial cavity curetting and abx
chronic endometritis
Bx shows plasma cells
usually d/t chronic PID, retained products of conception, IUDs, TB
endometriosis
presence of endometrial tissue (glands and stroma) outside of uterus can occur anywhere there is peritoneal lining
3x increase in ovarian CA
adenomyosis
presence of endometrial tissue in myometrium
forms a discrete mass called adenomyoma
can coexist with endometriosis
most common presentation of endometriosis
infertility
cyclic dysmenorrhea
cyclic pelvic pain
endometriomas
tumors of endometriosis on ovary
can cause chocolate cyst
endometriosis of cervix
powder burn appearance
endometrial polyps
benign endometrial polyp, not polypoid endometrial mass
may be peduculated or sessile
benign, but may have foci of neoplastic cells
surgery
endometrial hyperplasia
important cause of abnormal bleeding
increased proliferation of endometrial glands relative to stroma
strong relationship with endometrial carcinoma
hyperplasia and carcinoma share specific mutations
endometrial hyperplasia is associated with what?
prolonged E stimulation which can be d/t anovulaton, endogenous or exogenous source
risk factors for endometrial hyperplasia
obesity DM II menopause PCOD granulosa cell tumors or ovary prolonged E replacement therapy
progression of hyperplasia
Benign (simple and complex patterns) -> EIN (complex clonal hyperplasia with atypia) -> Carcinoma (invasion)
genetic alterations in endometrial hyperplasia and CA
inactivation of PTEN tumor suppressor gene on chrom 10
Cowden syndrome
cowden
AD disorder with PTEN mutation and high rate of endometrial CA
loss of PTEN
activation of PI3K-AKT -> mTOR -> cell growth
leads to warburg effect and can detect with PET scans
if you see the word atypia what must you do
hysterectomy
if invasive check lymph nodes
endometrioid adenocarcinoma type I
peak age 45-55, uncommon <40
associated with conditions of increased E
mutations in endometrioid adenocarcinoma type I
PTEN
microsatellite instability in KRAD associated with HNPCC (lynch syndrome)
typical presentation of endometrioid adenocarcinoma type I
abnormal bleeding, amenorrhea >6 months
spread by direct extension with late spread to nodes and mets
risk factors for endometrial CA
age E therapy tamoxifen therapy early menarche late menopause nullparity PCOS obesity DM E secreting tumor lynch syndrome cowden syndrome
PTEN staining
stains brown in normal cells, however ABSENT in endometrioid adenocarcinoma type I cells
non-endometrioids adenocarcinoma (type II)
serous carcinoma
post menopausal disease 55-65
mutations in p53
p53 stain
CA cells stain +, normal cells stain -
are ALL high grade lesions 3/3 with aggressive course
spread early thru lymph and retrograde along fallopian tubes
MMMT
malignant mixed mullerian tumors
carcinosarcomas
often present with bulky polypoid mass
has both epi and mesenchymal components
non-endometrioids adenocarcinoma (type II)
stains + for p53
papilla have stromal and vessels inside covered with malignant epi outside
endometrial stromal neoplasms
adenosarcomas
endometrial stromal nodule
endometrial stromal sarcoma
adenosarcomas
present as large sessile polyps that may protrude thru os
malignant stroma with benign glands
must differentiate from benign polyps
endometrial stromal nodule
benign mass w/o clinical significance, except must be differentiated from sarcoma
endometrial stromal sarcoma
spindle cell neoplasm
confirmed stain for CD10
differentiate from stromal nodule by diffuse infiltration of myometrium
lymph invasion, 5 yr survival 50%
leiomyoma
aka fibroids
benign smooth mm neoplam
mutation in MED12 (unique to smooth m tumors of uterus)
symptoms of leiomyoma
bleeding pain/sense of pelvic fullness urinary frequency infertility miscarriage (2nd trimester)
leiomyosarcoma
do not appear to arise in leiomyomas
malignant smooth m neoplams
subset also have MED12 mutation
differentiating leiomyosarcoma from leiomyoma
can invade into or out of wall
HIGH mitotic rate (>10) differentiates from fibroids
cytological atypia, tumoral necrosis and hemorrhage
peak 40-60
mets by blood vessels
40% 5 yr
types of leiomyomatas
submucosal- most likely to bleed
intramural- may or may not bleed
subserosal- may cause urinary frequency
salpingitis
part of PID spectrum
acute bacterial salpingitis is suppurative (60:40 G:C)
if ends of tube scar shut -> hydrosalpinx or pyosalpinx
can also cause tubo-ovarian abscesses
complications include adhesions, infertility, and ectopics
paratubal cysts
arise in mullerian remnant at the fimbriated end of tube or in broad lig
translucent thin-walled unicameral
endometrial Bx with ectopic
arias stella effect, but no chorionic villi of placenta
adenocarcinoma of fallopian tube
increasing believed to be source of high grade serous carcinomas of ovary/peritoneum
