Uterus Flashcards
What is the normal endometrial cycle in reproducting age?
Menstruating phase (0-5 days)
Proliferative Phase (6-14 days)
Secretory phase (15-28 days)
What hormones decrease in the absence of implantation of a fertilizing egg in the menstruating phase?
Estrogen
Progesterone
LH
What are the histological features in the menstruating phase?
Disintegration of functional layer => menstrual bleeding => stromal hemorrhage
What phase of of the endometrial cycle has INC Estrogen levels, stratum functionalis is regenerated from the stratum basalis?
Proliferative phase (6-14days)
What are the physiologic events of Proliferative phase?
- endometrial thickness
- CT, arteries, granular structures
What are the histological features during the Proliferative phase?
Straight, tubular glands
Pseudostratified columnar, non-vacuolated lining epithelia
Presence of mitotic figures
Compact, spindly stroma
What happens to the glands in the Secretery phase?
Convoluted & endometrial cells INC glycogen stores
What hormone primarily drives the Secretory phase of the endometrial cycle?
Progesterone
What are the histo features of the Secretory phase of the endometrial cycle?
Early secretory (day 17-19)
- secretory vacuoles filled with glycogen
- supranuclear vacuoles (“piano keys”)
Mild secretory (day 20-22)
- Intraluminal secretions
- Maximal stromal edema
Late secretory (day 23-28)
- Tortuous, serrated, saw-tooth appearance of endometrial glands
What is endometrial activity during pregnancy & menopause?
Pregnancy
- retains secretory phenotype & stroma
- myometrium undergoes mechano-adaptation
Menopause
- endometrium becomes inactive & may undergo atrophy
How much is the ave blood loss/cycle?
20-60mL
What are the causes of abnormal uternine bleeding in Prepuberty & Adolescence?
Prepuberty = precocious puberty
Adolescence = anovulatory cycle, coagulation disorders
What are the uterine causes of bleeding in reproductive age?
Complicaitons of pregnancy
Anatomic lesions
Dysfunctional uterine bleeding
What are the causes of uterine bleeding in Perimenopausal, Postmenopausal women?
Perimenopausal
- Dysfunctional uterine bleeding
- anatomic lesions (carcinoma, hyperplasia, polyps
Postmenopausal
- Endometrial atrophy
- anatomic lesions (carcinoma, hyperplasia, polyps
What condition has an abnormal uterine bleeding that is not associated with organic disease of the uterus but with endocrine disturbances?
Dysfunctional uterine bleeding
What are the categories of Dysfunctional uterine bleeding?
Anovulatory bleeding
Lutral phase abnormalities
What are the diff conditions seen in anovulatory bleeding & luteal phase abnormalities?
Anovulatory bleeding
- disordered proliferative
- glandulo-stromal breakdown
Luteal phase abnormalities
- inadequate luteal pahse
- irregular shedding
What are the 2 hormones responsible for dysfunctional uterine bleeding and which one is more common?
Estrogen - more common
Progesterone
What is the most common form of dysfunctional uterine bleeding where there is a excessive estrogenic stimulation w/o ovulation
ANovulatory bleeding
What is the predisposing condition of Anvoulatory bleeding?
Endometrial hyperplasia
What is the pathologic findings of anovulatory bleeding?
Dependent on unpposed estrogen stimulation
What are the 2 patterns of ANovulatory bleeding?
Disordered proliferativeGandulo-stromal breakdown
What are the morphologic features of DUB?
Glandulo-stromal breakdown -> Stromal condensation
No secretory activity
Endometrial hyperplasia & metaplasia
What are the histo features of Disordered Proliferative?
- Proliferative glands w/o secretory devt -> glandula rarchitecctural variation is the most important finding
- stroma: spindled
What are the histo changes seen in abnormal endometrial bleeding?
- Proliferative, non-secretory, and focal bg
- not uniformed abnormal glandular & stromal breakdown
- heterogenous pattern with fragments of intact, non-shedding endometrium
What causes Luteal phase defect in reproductive age & perimenopausal women?
abnormal secretory phase patterns w/ assoc non-menstrual breakdown and bleeding
What is the pathogenesis of luteal phase defects?
failure of corpus luteum to develop normally after ovulation
underdeveloped corpus luteum that produce def in progesterone secretion
What are the clin features of Inadequate luteal phase?
Premenstrual bleeding
Hypermenorrhea
Habitual 1st trimester abortion
Infertility
Failure of basal body temp to exhibit normal post-ovulatory elevation
What are the histo features seen in Inadequate luteal phase?
Secretory endometrium that lags behind in development
= glands show secretory changes yet lack marked tortuosity & secretory excretion
What causes inadequate luteal phase?
deficient progesterone secretion, inadequate secretory development
What are the diff requirements for dx of Inadequate Luteal Phase?
- Secretory lag & underdeveloped secretory changes
- clinical correlatin
- atleast 2 biopsies showing lag in devt
What is the cause of irregular shedding of luteal phase defects?
failure of the CL to involute or regress normally –> persistent function w/ secretion of Progesterone
What are the morphologic features seen in irregular shedding?
stellate shapes as they involute
What are the microscopic findings?
- admixture of predominantly secretory (star-shaped) and some proliferative glands
- irregular maturation pattern from fragment to fragment stromal predecidualization
- Glandular & stromal breakdown
What are the clinical features of inadequate luteal phase?
Premenstrual bleeding
Hypermenorrhea
Habitual 1st trimester abortion
Infertility
Failure of basal body temperature to exhibit normal post-ovulatory elevation
What are the causes of inadequate Luteal phase?
- deficient Progesterone secretion, inadeqaute secretory development
- ovulation occurs, but secretory changes are inadequate
What are the requirements for diagnosis of inadequate luteal phase?
- clinical correlation to the cndition
- atleast 2 biopsies showing lag in devt
- secretory lag & underdeveloped secretory changes must be demonstrated in atleast 2 consecutive cycles
What is the cause of irregular shedding during the luteal pahse?
failure of the corpus lutem to involute or regress normally
What are the morphological features of irregular shedding?
- Stellate shapes as they involute
Histo
- admixture of secretory (star-shaped) & some proliferative glands
- glandular and stromal breakdwon
What is the medical term for blood within the uterine cavity?
Hematometra
Give 3 out of 6 conditions that we see with acute endometriosis?
Pregnancy
Postdeliver/abortion
Retianed products of conception
Puerperium
Perineal/cervical lacerations
Trauma to genitals & instrumentation
What are the microscopic findings in acute endometriosis?
Microabscesses in the lumen of the endometrial glands & storma
Destruciton of glandular epithelium
Abundant neutrophilic infiltration
What can happen if acute endometriosis progresess in to a severe condition?
Pyometra - exudates accumulate as a bag of pus in the uterine cavity
What are the clinical features of Chronic endometriosis?
On-and-off low grade fever
Abdominal pain
Foul-smelling purulent lochia
Uterine or pelvic tenderness
What are other causes of Chronic endometriosis?
Actinomyces
Granulomatous inflam in TB
Fungi
Parasites
What gram positive anaerobe can cause chronic endometriosis?
Actinomyces israelli
What disorders are assoc to chronic endometriosis?
Chronic PID
Retained gestational/placental tissues ff abortion & postpartum
IUD
Milary TB
Idipathic
What condition has exophytic masses of var size that project sinto the endometrial cavity?
Endometrial polyp
What drug induces the formation of Endometrial polyp?
Tamoxifen
What are the gross & histo features of endometrial polyp?
Gross:
- pedunculated, sessile, polypoid mass filling up the endometrial cavity
- attached by a stalk
Histo
- surface (columnar) epithelium on 3 sides
- cystic dilation (SWISS CHEESE APPEARANCE)
Where can Adenomyosis /Endometriosis reside in? Give 3
Ovaries
Myometrium
Fallopian tube
Uterine ligaments
Rectovaginal septum
Pelvic peritoneum
What are the clinical consequences of Adenomyosis & Endometriosis?
Infertility
Dysmenorrhea
Pelvic pain
Ovarian cyst transformation (CHOCOLATE CYST)
What are the causes of Adenomyosis/Endometriosis?
Regurgitation theory
Benign metastasis theory
Metaplastic theory
Extrauterine stem/Progenator cell theory
What theory states that endometrial tissue implants at ectopic site via retrograde flow of menstrual endometrium?
Regurgitation theory
What theory states that endometrial tissue from uterus can spread to distant sides via hematogenous spread or through lymphatic channels?
Benign metastasis theory
What theory states that endometrium arise directly from coelemic epithelium or the mesothelium of pelvis and abdomen?
Metaplastic theory
What theory states that stem or progenitor cells from BM differnetiates into the endometrial tissue?
Extrauterine stem or Progenator cell theory
What hormone is used to treat Endometriosis?
Estrogen
What are the gross findings in Endometriosis?
Small black red nodules on uterine serosa
What condition has endometriotic implants found in the uterine corpus?
Adenomyosis
What condition has implants appearing tumoral or resembles leiomyoma?
Adenomyoma
What are the gross findings of Adenomyosis?
- Globular and enlarged corpus luteum
- thickened, fibrous, firm with fasciculated and WHORLED appearance
- Cigarette burn lesiosn scattered within the wall
What are the microscopic features of Adenomyosis?
- Ectopic endometrial glands and the stroma
(Embedded in myometrium) - Myometrial fibrosis and hypertrophy
What are the clin features of Adenomyosis? Give 4
Infertility
Dysmenorrhea
Bleeding
Menstrual irreg
Cyst transformation of ovary
Uterine enlargement
Low risk for malignant transformation
What disorder has proliferation of endometrial glands relative to the stroma resulting from unpposed Estrogenic stimulation of the endometrial tissue?
Endometrial hyperplaia
What are the 2 types of endometrial hyperplasia?
Non-atypical endometrial hyperplasia
Atypical endometrial hyperplasia
What are the gross and histo features of Endometrial hyperplasia?
Gross:
- lush and thickened, with the edematou glistening, creamy, yellow, white appearance
Histo:
- INC number of endometrial glands relative to the stroma
What are the 3 main categories of hyperplasia?
Simple hyperplasia
Complex hyperplasia without atypia
COmplex hyperplasia with atypia
What is a distinct characterisitc of Non-atypical endometrial hyperplasia?
Closely packed glands with gland to stroma ratio of >3:1
What are distinct characteristics of Complex Hyperplaia (non-atypical endometrial hyperplasia)?
Crowded, back to back glands
Stratified epithelium
Clelular stroma
Increased glands, less stroma
What condition is aka Corpus Cancer syndrome?
Endometrial carcinoma
What are the 2 categories of endometrial cacrcinoma?
- Hyperestrinism + Backgound of endometrial hyperplasia (TYPE 1)
- Less Hyperestrinism background (TYPE 2)
What is a more common tyoe of Endometrial carcinoma that is assoc w/ obesity, DM, HPN, infetility?
Type 1 endometrial carcinoma
What type of endometrial carcinoma has less hypertenism but is poorly-diff and aggressive type?
Type 2 endometrial carcinoma
What are the gross and histo features of endometrial carcinoma?
Gross:
- bivalve, showing fleshy, white, nodular masses that carpet the endometrial surface
Histo
- Papillary, tubular, clear, and serous or w/ squamous differentiation
What are the 2 histological types of Endometrial carcinoma? How do you differentiate them?
Type 1 = Endometrioid carcinoma & Adenocarcinoma with squamous differentiation
Type 2 = adenosquamous carcinoma, serous papillary carcinoma, clear cell carcinoma
What are imporant histo feature sof Clear cell ccarcinoma?
- polyglonal cells with clear eosinophilic cytoplasm
- HObnail cells
- High nuclear grade
What are the histlogic features of Serous endometrial carcinoma?
- papillary/micropapillary pattern
- Psamomma bodies
- high nuclear grade
What are the degenerative changes in Leiomyoma?
Hyaline degeneration
Edema
Cystic degeneration
Calcification
Myxomatou
What are the histologic features of Leiomyoma?
Cigar-shaped bipolar nuclei
Spindle cell proliferation
Scarce mitotic figures
What are the gross & histo features of Malignant Mixed Mullerian tumor?
Gross:
- Bulky & polypoid may protrude through the cervical os
Histo:
- area of adenocarcinoma present as Endometrioid, serous, or clear cell mixed with malignant mesenchymal elements
What are the common CA of inflammation in the fallopian tubes?
N gonorrheae
Chlamydia
Mycoplasma homonis
Staph, Strep
What causes SUppurative sapingitis in fallopian tubes?
N gonorrhorae
What are the 2 types of fallopian tubes inflammation?
Suppurative salpangitis
Tuuberculous salpingiti
What are the diff tumors and cysts of the fallopian tubes?
Paratubal cysts
Hydatids of Morgagni
Adenomatoid tumors (Mesethelioma)
Adenocarcinoma
What is the most common primary lesion of the fallopian tube?
Paratubal cysts
What lesion of the fallopian tubes is found near the fimbriated end of the tube or in the broad ligaments?
Hydatids of Morgagni
What lesion of the fallopian tubes is located at the suberosa of the tube or int he mesosalpinx?
Adenomatoid tumors (Mesothelioma)
What lesion of the fallopian tube presents as dominant tubal mass discovered during pelvic exam? What are assoc symptoms of this?
Adenocarcinoma
Assoc symptoms:
- abdominal discharge
- bleeding
- abnormal pap smear cells
