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Repro II > uterine pathology > Flashcards

uterine pathology Flashcards

1
Q

what layer is shed during menses

A

functionalis

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2
Q

mucosa of uterus

A

made up of glandular and stromal cells which both respond to hormonal activity
tumors can originate in either cell type

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3
Q

proliferative phase

A

mitotic figures in cells with small tubular glands

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4
Q

secretory phase

A

day 14-16 progesterone surge
first change is subnuclear vaculization
can be certain pt has ovulated

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5
Q

late secretory phase

A

clear spaces move above nuceli and secretions dumped into lumen

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6
Q

if implantation takes place

A

secretory changes even more apparent and get arias stella reaction -> can determine pregnancy

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7
Q

menstrual phase

A

balls of stromal cells, fragments of glands, and blood

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8
Q

dysfunctional uterine bleeding

A

unscheduled bleeding, presumed to be hormonal dysfnx

Dx of exclusion

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9
Q

oligomenorrhea

A

intervals of greater then 35 days

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10
Q

polymenorrhea

A

intervals less then 24 days

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11
Q

menorrhagia

A

excessive bleeding with normal intervals

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12
Q

metorrhagia

A

excessive flow and duration at normal intervals

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13
Q

menometorrhagia

A

irregular menses

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14
Q

withdrawal bleeding

A

bleeding following the withdrawal of hormones

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15
Q

anovulatory cycles

A

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

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16
Q

inadequate luteal phase

A

abnormal corpus luteum fnx -> low p in secretory phase

typically presents as infertility with menorrhagia or amenorrhea

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17
Q

acute endometritis

A

Bx shows neutrophils
limited to infections that arise after delivery or miscarriage
infection is usually polymicrobial
Tx0 with endometrial cavity curetting and abx

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18
Q

chronic endometritis

A

Bx shows plasma cells

usually d/t chronic PID, retained products of conception, IUDs, TB

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19
Q

endometriosis

A

presence of endometrial tissue (glands and stroma) outside of uterus can occur anywhere there is peritoneal lining
3x increase in ovarian CA

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20
Q

adenomyosis

A

presence of endometrial tissue in myometrium
forms a discrete mass called adenomyoma
can coexist with endometriosis

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21
Q

most common presentation of endometriosis

A

infertility
cyclic dysmenorrhea
cyclic pelvic pain

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22
Q

endometriomas

A

tumors of endometriosis on ovary

can cause chocolate cyst

23
Q

endometriosis of cervix

A

powder burn appearance

24
Q

endometrial polyps

A

benign endometrial polyp, not polypoid endometrial mass
may be peduculated or sessile
benign, but may have foci of neoplastic cells
surgery

25
Q

endometrial hyperplasia

A

important cause of abnormal bleeding
increased proliferation of endometrial glands relative to stroma
strong relationship with endometrial carcinoma
hyperplasia and carcinoma share specific mutations

26
Q

endometrial hyperplasia is associated with what?

A

prolonged E stimulation which can be d/t anovulaton, endogenous or exogenous source

27
Q

risk factors for endometrial hyperplasia

A 
obesity
DM II
menopause
PCOD
granulosa cell tumors or ovary
prolonged E replacement therapy
28
Q

progression of hyperplasia

A

Benign (simple and complex patterns) -> EIN (complex clonal hyperplasia with atypia) -> Carcinoma (invasion)

29
Q

genetic alterations in endometrial hyperplasia and CA

A

inactivation of PTEN tumor suppressor gene on chrom 10

Cowden syndrome

30
Q

cowden

A

AD disorder with PTEN mutation and high rate of endometrial CA

31
Q

loss of PTEN

A

activation of PI3K-AKT -> mTOR -> cell growth

leads to warburg effect and can detect with PET scans

32
Q

if you see the word atypia what must you do

A

hysterectomy

if invasive check lymph nodes

33
Q

endometrioid adenocarcinoma type I

A

peak age 45-55, uncommon <40

associated with conditions of increased E

34
Q

mutations in endometrioid adenocarcinoma type I

A

PTEN

microsatellite instability in KRAD associated with HNPCC (lynch syndrome)

35
Q

typical presentation of endometrioid adenocarcinoma type I

A

abnormal bleeding, amenorrhea >6 months

spread by direct extension with late spread to nodes and mets

36
Q

risk factors for endometrial CA

A 
age
E therapy
tamoxifen therapy
early menarche
late menopause
nullparity
PCOS
obesity
DM
E secreting tumor
lynch syndrome
cowden syndrome
37
Q

PTEN staining

A

stains brown in normal cells, however ABSENT in endometrioid adenocarcinoma type I cells

38
Q

non-endometrioids adenocarcinoma (type II)

A

serous carcinoma
post menopausal disease 55-65
mutations in p53

39
Q

p53 stain

A

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

40
Q

MMMT

A

malignant mixed mullerian tumors
carcinosarcomas
often present with bulky polypoid mass
has both epi and mesenchymal components

41
Q

non-endometrioids adenocarcinoma (type II)

A

stains + for p53

papilla have stromal and vessels inside covered with malignant epi outside

42
Q

endometrial stromal neoplasms

A

adenosarcomas
endometrial stromal nodule
endometrial stromal sarcoma

43
Q

adenosarcomas

A

present as large sessile polyps that may protrude thru os
malignant stroma with benign glands
must differentiate from benign polyps

44
Q

endometrial stromal nodule

A

benign mass w/o clinical significance, except must be differentiated from sarcoma

45
Q

endometrial stromal sarcoma

A

spindle cell neoplasm
confirmed stain for CD10
differentiate from stromal nodule by diffuse infiltration of myometrium
lymph invasion, 5 yr survival 50%

46
Q

leiomyoma

A

aka fibroids
benign smooth mm neoplam
mutation in MED12 (unique to smooth m tumors of uterus)

47
Q

symptoms of leiomyoma

A 
bleeding
pain/sense of pelvic fullness
urinary frequency
infertility
miscarriage (2nd trimester)
48
Q

leiomyosarcoma

A

do not appear to arise in leiomyomas
malignant smooth m neoplams
subset also have MED12 mutation

49
Q

differentiating leiomyosarcoma from leiomyoma

A

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

50
Q

types of leiomyomatas

A

submucosal- most likely to bleed
intramural- may or may not bleed
subserosal- may cause urinary frequency

51
Q

salpingitis

A

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

52
Q

paratubal cysts

A

arise in mullerian remnant at the fimbriated end of tube or in broad lig
translucent thin-walled unicameral

53
Q

endometrial Bx with ectopic

A

arias stella effect, but no chorionic villi of placenta

54
Q

adenocarcinoma of fallopian tube

A

increasing believed to be source of high grade serous carcinomas of ovary/peritoneum

Repro II (20 decks)

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