Uterine Pathology I Flashcards
internal and external os
opening of cervix
- to uterus- internal
- to vagina - external
layers of uterus
myometrium
basalis
functionalis - this shed at menses
has glands and stroma - make up mucosa layer
day 1 of menstrual cycle
1st day of menses
phases of menstrual cycle
follicular - day 1 to day before LH surge
luteal - day of LH surge to onset of menses
length of menstrual cycle
14-21 days in follicular
14 days luteal
little variability age 20-40
significant variability first 5-7 years and last 10 years of menstruation
proliferative phase
estrogen
secretory phase
progesterone
POD2-3
ovulation
-subnuclear vacuoles
POD9
mid-secretory phase
-periarteriolar decidual change
POD12
late-secretory phase
-predecidua, inflammatory cells
menometrorrhagia
irregular menses
metrorrhagia
excessive flow and duration at irregular intervals
menorrhagia
excessive bleeding - normal intervals
withdrawal bleeding
bleeding follows withdrawal of hormones
oligomenorrhea
intervals greater than 35 days
polymenorrhea
intervals less than 24 days
dysfunctional uterine bleeding
dx of exclusion
-unschedule bleeding, presumed to be consequence of hormonal/functional abnormality
subnuclea vacuolizations
early secretory phase
abnormal uterine bleeding in perimenopause and menopause women
if have lesion - need biopsy
-carcinoma, hyperplasia, polyps
most common cause of anovulatory cycle in repro age
unopposed estrogen
anovulatory cycle
prolonged and unopposed estrogen stimulation
endometrium unstable with breakdown
inadequate luteal phase
abnormal corpus luteum
-low progesterone
infertility
bx - histo date is >2 days behind clinical date of menstrual cycle**
bx - histo date is >2 days behind clinical date of menstrual cycle**
inadequate luteal phase
neutrophils in endometrium
acute endometritis
infections that areise after delivery or miscarriage
vaginal bacteria
strep group A and staph - polymicro
tx - broad spectrum antibiotics
plasma cells in endometrium
chronic endometritis
chronic endometritis
chronic PID
retained products of conception
IUD
TB
presence of endometrium tissue outside endometrium
endometriosis
presences of endometrium tissue inside myometrium
adenomyosis
forms discrete mass - adenomyoma
locations of endometriosis
ovary uterine ligament rectovaginal septum cul de sac pelvic peritoneum bowel genitalia bladder mucosa
cyclic pelvic pain
endometriosis
infertility
40% of endometriosis
fallopian tubes or ovary
metastatic theory
endometriosis from implantation of menstrual tissue
metaplastic theory
endometriosis arises from mesothelium - bc mullerian origin
extrauterine stem cell theory
endometriosis from bone marrow cells that differentiate to endometrial tissue
endometriosis
see glands and stroma**
cyclic pain pattern
COX-2 inhibitors - control inflammation
endometriosis tissue
cycles with menstrual cycle - including bleeding
risks with endometriosis
2x increase in ovarian cancer of endometroid and clear cell types
PTEN and ARID1A mutations
endometroid and clear cell ovarian cancer
chocolate cyst
endometrioma
endometriosis tissue in ovary - fills with lbood
powder burn
endometriosis of cervix
endometrial polyps
benign - but may contain neoplastic foci
tx - surgery
present with bleeding
increased gland to stroma ratio
endometrial hyperplasia
proliferation of endometrial glands relative to stroma
endometrial hyperplasia
obesity, menopause, PCOS (stein leventhal syndrome), granulosa cell tumor of ovary, prolonged estrogen therapy
relationship to endometrial carcinoma
obese women
prolonged estrogen stimulation
-endometrial hyperplasia
stein-leventhal syndrome
PCOS
EIN
endometrial intraepithelial neoplasia - atypia
tx - hysterectomy
increased estrogen**
PTEN
inactivation of this tumor suppressor gene
-endometrial hyperplasia
chromosome 10q23.3
cowden syndrome
mutation of PTEN
-high incidence of endometrial cancer
warburg effect
increased glucose uptake by tumor cells
loss of PTEN
activation of PI3K-AKT
-promoting cell growth
atypia
EIN
