Uterine Pathology 5 Flashcards
Benign and Malignant Uterine Disease
1
Q
What are the gross histologic features of leiomyomas?
A
- Well circumscribed benign masses
- Single or multiple masses
- Whirled, shiny, white, bulging, rubbery cut surface
- Vary in size → up to 100 lbs
- Composed of irregular bundles of cells in an extensive connective tissue matrix
- Grow in response to sex steroids
2
Q
What kinds of people get uterine fibroids?
A
- Cumulative Incidence of 65-70%
-
Risk Factors:
- Race: increased in AAW
- Obesity
- Hypertension
- Pelvic infections
- Alcohol incrases risk in women who drink > 7 beers/week
- Parity and smoking decreases risk
3
Q
What is the clinical presentation of fibroids?
A
- Clinically symptoms in 25-50% of women with fibroids
- Symptoms vary with location and size of the fibroid
- 62% of women with symptoms present with multiple symptoms:
- abnormal uterine bleeding
- pelvic mass
- pelvic pain
- pelvic pressure symptoms
- infertility
- pregnancy loss
4
Q
What are the hormonal effects on leiomyomas?
A
-
No estrogen and progesterone
- no tumors
-
Increased estrogen and progesterone
- intrauterine and extrauterine tumors
-
Decreased estrogen and progesterone
- extrauterine tumors
5
Q
Describe the major histologic findings of leiomyomas.
A
- Gross and histologic evidence of increased ECM relative to myometrium
- Overexpression of TGFb in leiomyoma
- Increased production of collagens in leiomyoma
- Limit in the clinical response to sex steroid antagonists
6
Q
What is the pathophysiology for leiomyomas?
A
- Single cell undergoes neoplastic transformation
- Monoclonal expansion due to a number of growth factors (i.e. estrogens, progesterone, TGF-b, etc.)
- Excessive Production of extracellular matrix
7
Q
How are leiomyomas evaluated?
A
- Will vary depending on symptoms and physical exam, but MAY include:
- Ultrasound
- MRI
- Sonohysterogram
- Hysterosalpingogram
- Complete Blood Count
- Endometrial biopsy
8
Q
What are the medical and surgical interventions for leiomyomas?
A
-
Multiple short term options with specific risk/benefit profiles (medical)
- GnRH Agonists/Antagonists
- Levonorgestrel Releasing IUS
- Aromatase Inhibitors
- SPRMs
-
Hysterectomy
- only definitive treatment
- multiple types
- recovery times ranging from 2-8 weeks depending on method
- loss of childbearing ability
9
Q
What are the major uses of uterine artery embolization? What are the major risk factors?
A
- Decrease blood flow through uterine arteries
- Within 2-4 months à 40-60% reduction in uterine volume
- 83% pts reported symptomatic improvement in menorrhagia
- ~8 day recovery time
-
Absolute contraindications:
- pregnancy, active infection, suspected pelvic cancer
-
Relative contraindications:
- coagulopathy, desire to maintain childbearing, immunocompromise
- Risks: Major complications in 1-5% of cases
10
Q
Describe the MRI-guided focused ultrasound approach.
A
- FDA approved in 2004
- Uses focused sound waves to create thermal energy and destroy tissue
- 13.5% mean reduction in fibroid size at 6 months
- No serious side effects reported
- Recovery time of 1-2 days
11
Q
What is endometriosis and what are some of the risk factors?
A
- Estrogen dependent benign disease characterized by endometrial glands and stroma outside of the uterus
- Ectopic tissue typically located in the pelvis
-
Overall prevalence of 3-10%; higher in :
- infertile women
- teens with dysmenorrhea
- women with CPP/dysmenorrhea
-
Risk Factors:
- vaginal obstruction of menstrual flow
- DES exposure
- prolonged exposure to endogenous estrogen
12
Q
What is the clinical presentation of endometriosis?
A
- Chronic Pelvic Pain
- Dysmenorrhea
- Dyspareunia
- Cyclic bowel or bladder symptoms
- Infertility/Subfertility
13
Q
What are the treatment options for endometriosis?
A
-
Medical
- NSAIDs
- OCPs
- cyclic vs. continuous
- Progestins
- Medroxyprogesterone acetate
- Levonorgestrel IUS
- GnRH Agonist
- Aromatase Inhibitors
- Danazol
- Surgical – conservative vs definitive
14
Q
Define adenomyosis and the risk factors for this disease.
A
- Extension of endometrial glands and stroma into the myometrium
- Can result in diffuse enlargement of the uterus - “globular uterus” or focal lesions
- Pathogenesis unknown
-
“Risk Factors”:
- increasing parity
- uterine surgery
- early menarche
- shorter menstrual cycles
15
Q
What is the diagnosis and treatment of adenomyosis?
A
-
Diagnosed by :
- clinical symptoms
- imaging - MRI
- pathology
-
Treatment
- medical
- radiological - UAE
- surgical - conservative vs definitive
16
Q
What is uterine sarcoma and what are the major risk factors?
A
- Arise from the connective tissue elements of the endometrium or from the myometrium
-
Include:
- endometrial stromal sarcomas
- leiyomeiosarcoma
- undifferentiated endometrial sarcoma
- RARE → 3-7 cases/100,000
- 9.1% of all uterine cancers
-
Risk Factors:
- age
- race
- long term Tamoxifen use
- pelvic radiation
- retinoblastoma
18
Q
What are endometrial polyps and the major risk factors of this disease?
A
- Hyperplastic growths of the endometrium
- 95% Benign
-
Clinical Manifestations:
- asymptomatic
- abnormal uterine bleeding
-
Risk Factors
- premenopausal
- age
- obesity
- SERMs
-
Treatment
- hysteroscopic polypectomy
21
Q
What is endometrial cancer and what are the major histological classifications?
A
-
Most common GYN malignancy in the United States
- >46,000 cases annually
- >8,000 deaths annually
- Most common uterine cancer
-
Histologies:
- Endometrioid**
- Serous
- Mucinous
- Clear cell
