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S3B3 Pathology > Uterus > Flashcards

Uterus Flashcards

1
Q

The provided images are examples of the proliferative, secretory, or menstrual phase?

What features helped you draw this conclusion?

A

Proliferative

  • straight tubular glands
    • evenly spaced
    • lined by mitotic figures
    • no mucin vacoules
  • stromal cells
    • monotonous nuclei
    • oval/spindle shaped cells
    • mitotic figures
  • endometrium will get thicker
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2
Q

Each endometrial phase is driven by which hormones?

A

Proliferative: estrogen

Secretory: progesterone

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3
Q

What day in the 28-day menstrual cycle does ovulation take place?

A

14

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4
Q

The provided images are examples of the proliferative, secretory, or menstrual phase?

What features helped you draw this conclusion?

A

Secretory phase

  • no mitotic figures in stroma or epithelium
  • nuclear vacoules present – headed for lumen
  • glands look “saw-tooth” in appearance
  • secretory material may be present in the lumen of the glands
  • start getting prominent spiral arterioles
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5
Q

The provided image is an example of the proliferative, secretory, or menstrual phase?

What features helped you draw this conclusion?

A

Proliferative

arrow points to mitosis

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6
Q

The provided image is an example of the proliferative, secretory, or menstrual phase?

What features helped you draw this conclusion?

A

Early secretory

subnuclear vacoules

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7
Q

The provided image is an example of the proliferative, secretory, or menstrual phase?

What features helped you draw this conclusion?

A

Late secretory (predecidual)

  • have about reached secretory exhaustion
  • stromal cells develop more cytoplasm (hypertrophy) - more “plate-like” morphology
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8
Q

The provided image is an example of the proliferative, secretory, or menstrual phase?

What features helped you draw this conclusion?

A

Menstrual endometrium

  • Stromal break down (confluence btw stromal cells)
    • big/swollen cells
    • stromal collect into clusters
    • neutrophils & lots of blood
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9
Q

The provided image is an example of what part of the uterus?

A

myometrium

smooth muscle fasicles

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10
Q

What are the possible causes of abnormal uterine bleeding in pre-pubertal individuals?

A
  • precocious puberty
    • hypothalamic
    • pituitary
    • ovarian
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11
Q

What are the possible causes of abnormal uterine bleeding in adolescents?

A

anovulatory cycle

coagulation disorders

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12
Q

What are the possible causes of abnormal uterine bleeding in individuals of reproductive age?

A
  • complications of pregnancy
  • anatomic lesions
  • dysfunctional uterine bleeding
  • anovulatory cycle
  • ovulatory dysfunctional bleeding (inadequate luteal phase)
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13
Q

What is the most common tumor in females?

A

leiomyoma

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14
Q

What are the possible causes of abnormal uterine bleeding in perimenopausal individuals?

A

dysfunctional uterine bleeding

anatomic lesions

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15
Q

What are the possible causes of abnormal uterine bleeding in postmenopausal individuals?

A

endometrial atrophy

anatomic lesions

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16
Q

What is dysfunctional uterine bleeding?

A

Uterine bleeding in the absensce of an identifiable cause in the uterus – typically due to hormonal abnormalities

glandular & stromal breakdown during the proliferative phase

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17
Q

The provided image is an example of what uterine pathology? It is most common in what demographics?

A

Dysfunctional Uterine Bleeding - difficult to distinguish from menstrual phase endometrium, except you should be able to find some mitotic figures & don’t have saw-tooth appearance of secretory phase glands, nor stromal changes

menarche (beginning of menstruation) & perimenopausal periods

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18
Q

What is the name for infection/inflammation of the endometrium?

A

acute endometritis

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19
Q

The provided images are an example of what pathology?

A

Acute endometritis

  • glands cysticaly dilated
    • filled with neotrophils
  • neotrophils in surface epithelium & scattered throughout stroma
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20
Q

The provided stain is indicative of what pathology?

A

IUD associated endometritis

dark blue-staining sulfur (actinomycotic) granule surrounded by inflammatory cells (neutrophils)

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21
Q

When differentiating between chronic & acute endometritis, what are you looking for?

A

Chronic: presence of plasma cells

Acute: presence nuetrophils

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22
Q

What pathology is shown in the provided histological slides of the uterus?

A

Chronic Endometritis

  • Numerous stromal plasma cells (white arrows)
    • cytoplasm slightly different color (pale/medium purple) w/ lighter color around the nucleus
    • fair amount of cytoplasm
    • nucleus on edge of cell
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23
Q

What is the clinical presentation of chronic endometritis?

A

abdominal pain

+/- fever

+/- bleeding

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24
Q

The following symptoms indicate what diagnosis?

  • abnormal bleeding
  • dysmenorrhea, pelvic pain
  • dyspareunia
  • dysuria
  • pain on defecation
  • infertility
A

Endometriosis - ectopic endometrial tissue

(can also be asymptomatic)

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25
Q

What is the most common location of endometrial tissue causing endometriosis?

A

ovary

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26
Q

How is the ectopic endometrial tissue in endometriosis different from regular endometrial tissue?

A

produces more inflammatory mediators

& b/c it is bleeding into abdominal cavity will also elicit inflammatory response from adjacent organs

Results in pain & scarring

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27
Q

What is currently the most favored hypothesis for the pathogenesis of endometriosis? Explain it.

A

Regurgitation theory

backflow of the endometrial tissue shed during menses is (instead of going out of the vagina) going up into the fallopian tube and out into the pelvic cavity

this explains the most common sites where endometrial tissue is found

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28
Q

The provided gross sample is an example of what pathology?

A

Endometriosis

left - “chocolate” cyst

right - lots of fibrosis & will usually have dark brown speckles

29
Q

What features need to be present in a sample to make the diagnosis of endometriosis?

A

endometrial glands and/or stroma

30
Q

What is Adenomyosis?

A

Endometrial tissue present within the myometrium

31
Q

The provided image is a histological sample of what pathology?

A

Adenomyosis

the glands/stroma surrounging the gland is a lighter color that the surrounding myometrium

32
Q

What condition is depicted by the provided image of the gross sample of a uterus?

A

Adenomyosis

Wall is irregularly thickened (upper portion) with dark spots indicating areas of hemorrhage

33
Q

The two bottom arrows shown in the provided image point to what type of pathology?

A

Endometrial Polyp

34
Q

The provided histological slide is an example of what pathology?

A

Endometrial Polyp

  1. cystically dilated glands
  2. thick-walled blood vessels
  3. fibrous stroma (usually a more pink color)
35
Q

What components are you looking for on a histological slide to diagnose an endometrial polyp?

A
  1. cystically dilated glands
  2. thick-walled blood vessels
  3. fibrous stroma (usually a more pink color)
36
Q

Endometrial hyperplasia is driven by what hormone?

A

estrogen

1- benign endometrium

2- cystic changes

3- increased glands (less stroma)

37
Q

What is the difference between endometrial hyperplasia & endometrial intraepithelial neoplasia (EIN)?

A

EIN has dysplasia (morphological manifestation of underlying molecular changes)

1-3 are hyperplasia

4-5 are EIN

38
Q

Is the provided image an example of anovulatory endometrium, hyperplasia without atypia or hyperplasia with atypia?

A

Anovulatory endometrium

  • focal disorder proliferative phase endometrium
  • cystically dilated glands
  • still quite a bit of stroma
38
Q

Is the provided image an example of anovulatory endometrium, hyperplasia without atypia or hyperplasia with atypia?

A

Hyperplasia without atypia

  • too many glands for the amount of stroma
  • can start to see a little irregularity to the shape of the glands
  • not atypical at the cellular level
39
Q

Is the provided image an example of anovulatory endometrium, hyperplasia without atypia or hyperplasia with atypia?

A

Hyperplasia with atypia

  • crowded glands with saw-tooth appearance
  • nuclear atypia (larger & dark blue)
  • cells may be pseudostratified (not as much as with proliferative phase endometrium) with mitotic figures
39
Q

Is the provided image an example of anovulatory endometrium, hyperplasia without atypia or hyperplasia with atypia?

A

Hyperplasia with atypia

  • nuclei are large, darker & close to the lumen with irregular outlines
  • crowded glands with saw-tooth appearance
  • cells may be pseudostratified (not as much as with proliferative phase endometrium) with mitotic figures
40
Q

What condition is shown in the provided image?

A

Endometrial intrepithelial neoplasia

  • usually localized (left half of photo)
  • gland crowding
  • cytology distinct from the background normal endometrial glands (black arrows)
  • ** bordering on carcinoma, but probably has not invaded yet
41
Q

Fill out the provided table for Type I Endometrial Carcinoma

**don’t worry about gene mutations

42
Q

Fill out the provided table for Type II Endometrial Carcinoma

**don’t worry about gene mutations

43
Q

What gene mutation is found in most Type II Endometrial carcinomas & high grade Type I?

44
Q

What is the most common type of endometrial carcinoma?

A

Endometrioid Adenoma

45
Q

What are the risk factors associated with endometrioid carcinoma?

A

obesity

diabetes

hypertension

infertility

exogenous unopposed estrogen stimulation

46
Q

Endometrioid adenocarcinoma most commonly arises in the setting of what conditions?

A

excess estrogenic stimulation

endometrial hyperplasia

47
Q

What condition is shown within the sample in the provided image?

A

Endometrioid Adenocarcinoma

Left: polyploid

Right: infiltrative

48
Q

What criteria are used to grade endometrial adenocarcinoma?

A
  • Architectural features
    • is it forming glands? - more glands = lower grade
      • grade I = 95%+ glandular
      • _grade I_I = 50-95% glandular
      • grade III = 50%+ solid (nonglandular)
  • Nuclear morphology
    • ugly nuclei = higher grade
    • if have very atypical & huge nuclei, will shift it up a grade from the architectural features
49
Q

What are the two most important Type II carcinomas? Which is most common?

A

serous carcinoma- most common

carcinosarcoma

50
Q

Type II carcinomas most commonly arise in what demographic of people?

A

postmenopausal women

51
Q

What is the precursor lesion to Type II carcinomas?

A

endometrial intraepithelial carcinoma

52
Q

What pathology is depicted in the provided image?

A

Serous Carcinoma

  • tumor fills the endometrial cavity
  • may be deeply invasive or superficial
  • notice striking papillary growth in image provided on answer slide
53
Q

What are cellular difference that can help you differentiate Type I carcinoma from Type II carcinoma?

A

Type I: cell tend to be cohesive

Type II (serous carcinoma) - cells easily separate; like leaves falling off a tree in the fall

54
Q

What condition is depicted by the provided histological sample?

A

Serous Carcinoma

  • papillary configuration & marked nuclear hyperchromasia (bizarre)
  • “hobnail” formation
55
Q

What do the brown-staining aspects indicate about the provided samples?

A

strong expression of p53 (tumor suppressor protein)

tumor/malignancy - helps make diagnosis of serous carcinoma

56
Q

What is a carcinosarcoma? How do they present?

A

Type II carcinoma with mesenchymal component

molecular genetics of type II carcinoma - poor prognosis

bulky mass

57
Q

Carcinosarcoma typically arise in what demographics of persons?

A

post-menopausal

African American

58
Q

What condition is shown via the gross & microscopic samples provided?

A

Carcinosarcoma

gross: huge polypoid mass in uterine wall (atrophy of endometrium)

microscopic: glandular tissues (left) & mesenchymal components (ie. cartilage on right)

59
Q

What condition is characteristic of the provided histological slide?

A

Carcinosarcoma

  • malignant stroma (spindle shaped, large, bizarre)
  • glandular component
  • mitoses (atypical)
60
Q

How will carcinosarcoma lymph node metastasis look? How do they metastasize?

A

typically only show the carcinomatous component

can metastasize via vascular or lymph

61
Q

What is the name of benign smooth muscle tumor of the uterus?

A

leiomyoma

well-circumscribed tan-white mass

62
Q

What condition is depicted in the provided image?

63
Q

The provided histological slide is an example of what pathology?

A

leiomyoma

(benign smooth muscle tumor)

  • typically no cellular atypia
    • cigar-shaped nuclei characteristic of smooth muscle
64
Q

How could you differentiate leioomyosarcoma from a leiomyoma?

A
  • leiomyosarcoma
    • areas of hemorrage & necrosis
    • atypical mitotic figures
    • hypercellularity
    • pleomorphism
65
Q

What pathology is depicted by the provided gross & microscopic sample?

A

leiomyosarcoma

  • Gross
    • large mass with areas of hemorrhage/necrosis
  • microscopic
    • hypercellularity
    • pleomorphism
    • atypical mitoses
    • necrosis
66
Q

What is the prognosis of a leiomyosarcoma pathology?

A

variable

low grade / stage – good prognosis

high grade / stage – poor prognosis

S3B3 Pathology (6 decks)

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