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Pathology > Uterus > Flashcards

Uterus Flashcards

1
Q

What is the normal endometrial cycle in reproducting age?

A

Menstruating phase (0-5 days)
Proliferative Phase (6-14 days)
Secretory phase (15-28 days)

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2
Q

What hormones decrease in the absence of implantation of a fertilizing egg in the menstruating phase?

A

Estrogen
Progesterone
LH

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3
Q

What are the histological features in the menstruating phase?

A

Disintegration of functional layer => menstrual bleeding => stromal hemorrhage

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4
Q

What phase of of the endometrial cycle has INC Estrogen levels, stratum functionalis is regenerated from the stratum basalis?

A

Proliferative phase (6-14days)

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5
Q

What are the physiologic events of Proliferative phase?

A
  • endometrial thickness
  • CT, arteries, granular structures
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6
Q

What are the histological features during the Proliferative phase?

A

Straight, tubular glands
Pseudostratified columnar, non-vacuolated lining epithelia
Presence of mitotic figures
Compact, spindly stroma

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7
Q

What happens to the glands in the Secretery phase?

A

Convoluted & endometrial cells INC glycogen stores

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8
Q

What hormone primarily drives the Secretory phase of the endometrial cycle?

A

Progesterone

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9
Q

What are the histo features of the Secretory phase of the endometrial cycle?

A

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

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10
Q

What is endometrial activity during pregnancy & menopause?

A

Pregnancy
- retains secretory phenotype & stroma
- myometrium undergoes mechano-adaptation

Menopause
- endometrium becomes inactive & may undergo atrophy

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11
Q

How much is the ave blood loss/cycle?

A

20-60mL

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12
Q

What are the causes of abnormal uternine bleeding in Prepuberty & Adolescence?

A

Prepuberty = precocious puberty
Adolescence = anovulatory cycle, coagulation disorders

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13
Q

What are the uterine causes of bleeding in reproductive age?

A

Complicaitons of pregnancy
Anatomic lesions
Dysfunctional uterine bleeding

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14
Q

What are the causes of uterine bleeding in Perimenopausal, Postmenopausal women?

A

Perimenopausal
- Dysfunctional uterine bleeding
- anatomic lesions (carcinoma, hyperplasia, polyps

Postmenopausal
- Endometrial atrophy
- anatomic lesions (carcinoma, hyperplasia, polyps

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15
Q

What condition has an abnormal uterine bleeding that is not associated with organic disease of the uterus but with endocrine disturbances?

A

Dysfunctional uterine bleeding

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16
Q

What are the categories of Dysfunctional uterine bleeding?

A

Anovulatory bleeding
Lutral phase abnormalities

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17
Q

What are the diff conditions seen in anovulatory bleeding & luteal phase abnormalities?

A

Anovulatory bleeding
- disordered proliferative
- glandulo-stromal breakdown

Luteal phase abnormalities
- inadequate luteal pahse
- irregular shedding

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18
Q

What are the 2 hormones responsible for dysfunctional uterine bleeding and which one is more common?

A

Estrogen - more common
Progesterone

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19
Q

What is the most common form of dysfunctional uterine bleeding where there is a excessive estrogenic stimulation w/o ovulation

A

ANovulatory bleeding

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20
Q

What is the predisposing condition of Anvoulatory bleeding?

A

Endometrial hyperplasia

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21
Q

What is the pathologic findings of anovulatory bleeding?

A

Dependent on unpposed estrogen stimulation

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22
Q

What are the 2 patterns of ANovulatory bleeding?

A

Disordered proliferativeGandulo-stromal breakdown

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23
Q

What are the morphologic features of DUB?

A

Glandulo-stromal breakdown -> Stromal condensation
No secretory activity
Endometrial hyperplasia & metaplasia

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24
Q

What are the histo features of Disordered Proliferative?

A
  • Proliferative glands w/o secretory devt -> glandula rarchitecctural variation is the most important finding
  • stroma: spindled
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25
Q

What are the histo changes seen in abnormal endometrial bleeding?

A
  • Proliferative, non-secretory, and focal bg
  • not uniformed abnormal glandular & stromal breakdown
  • heterogenous pattern with fragments of intact, non-shedding endometrium
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26
Q

What causes Luteal phase defect in reproductive age & perimenopausal women?

A

abnormal secretory phase patterns w/ assoc non-menstrual breakdown and bleeding

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27
Q

What is the pathogenesis of luteal phase defects?

A

failure of corpus luteum to develop normally after ovulation

underdeveloped corpus luteum that produce def in progesterone secretion

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28
Q

What are the clin features of Inadequate luteal phase?

A

Premenstrual bleeding
Hypermenorrhea
Habitual 1st trimester abortion
Infertility
Failure of basal body temp to exhibit normal post-ovulatory elevation

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29
Q

What are the histo features seen in Inadequate luteal phase?

A

Secretory endometrium that lags behind in development
= glands show secretory changes yet lack marked tortuosity & secretory excretion

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30
Q

What causes inadequate luteal phase?

A

deficient progesterone secretion, inadequate secretory development

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31
Q

What are the diff requirements for dx of Inadequate Luteal Phase?

A
  • Secretory lag & underdeveloped secretory changes
  • clinical correlatin
  • atleast 2 biopsies showing lag in devt
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32
Q

What is the cause of irregular shedding of luteal phase defects?

A

failure of the CL to involute or regress normally –> persistent function w/ secretion of Progesterone

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33
Q

What are the morphologic features seen in irregular shedding?

A

stellate shapes as they involute

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34
Q

What are the microscopic findings?

A
  1. admixture of predominantly secretory (star-shaped) and some proliferative glands
  2. irregular maturation pattern from fragment to fragment stromal predecidualization
  3. Glandular & stromal breakdown
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35
Q

What are the clinical features of inadequate luteal phase?

A

Premenstrual bleeding
Hypermenorrhea
Habitual 1st trimester abortion
Infertility
Failure of basal body temperature to exhibit normal post-ovulatory elevation

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36
Q

What are the causes of inadequate Luteal phase?

A
  • deficient Progesterone secretion, inadeqaute secretory development
  • ovulation occurs, but secretory changes are inadequate
37
Q

What are the requirements for diagnosis of inadequate luteal phase?

A
  • 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
38
Q

What is the cause of irregular shedding during the luteal pahse?

A

failure of the corpus lutem to involute or regress normally

39
Q

What are the morphological features of irregular shedding?

A
  • Stellate shapes as they involute

Histo
- admixture of secretory (star-shaped) & some proliferative glands
- glandular and stromal breakdwon

40
Q

What is the medical term for blood within the uterine cavity?

A

Hematometra

41
Q

Give 3 out of 6 conditions that we see with acute endometriosis?

A

Pregnancy
Postdeliver/abortion
Retianed products of conception
Puerperium
Perineal/cervical lacerations
Trauma to genitals & instrumentation

42
Q

What are the microscopic findings in acute endometriosis?

A

Microabscesses in the lumen of the endometrial glands & storma

Destruciton of glandular epithelium

Abundant neutrophilic infiltration

43
Q

What can happen if acute endometriosis progresess in to a severe condition?

A

Pyometra - exudates accumulate as a bag of pus in the uterine cavity

44
Q

What are the clinical features of Chronic endometriosis?

A

On-and-off low grade fever
Abdominal pain
Foul-smelling purulent lochia
Uterine or pelvic tenderness

45
Q

What are other causes of Chronic endometriosis?

A

Actinomyces
Granulomatous inflam in TB
Fungi
Parasites

46
Q

What gram positive anaerobe can cause chronic endometriosis?

A

Actinomyces israelli

47
Q

What disorders are assoc to chronic endometriosis?

A

Chronic PID
Retained gestational/placental tissues ff abortion & postpartum
IUD
Milary TB
Idipathic

48
Q

What condition has exophytic masses of var size that project sinto the endometrial cavity?

A

Endometrial polyp

49
Q

What drug induces the formation of Endometrial polyp?

A

Tamoxifen

50
Q

What are the gross & histo features of endometrial polyp?

A

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)

51
Q

Where can Adenomyosis /Endometriosis reside in? Give 3

A

Ovaries
Myometrium
Fallopian tube
Uterine ligaments
Rectovaginal septum
Pelvic peritoneum

52
Q

What are the clinical consequences of Adenomyosis & Endometriosis?

A

Infertility
Dysmenorrhea
Pelvic pain
Ovarian cyst transformation (CHOCOLATE CYST)

53
Q

What are the causes of Adenomyosis/Endometriosis?

A

Regurgitation theory
Benign metastasis theory
Metaplastic theory
Extrauterine stem/Progenator cell theory

54
Q

What theory states that endometrial tissue implants at ectopic site via retrograde flow of menstrual endometrium?

A

Regurgitation theory

55
Q

What theory states that endometrial tissue from uterus can spread to distant sides via hematogenous spread or through lymphatic channels?

A

Benign metastasis theory

56
Q

What theory states that endometrium arise directly from coelemic epithelium or the mesothelium of pelvis and abdomen?

A

Metaplastic theory

57
Q

What theory states that stem or progenitor cells from BM differnetiates into the endometrial tissue?

A

Extrauterine stem or Progenator cell theory

58
Q

What hormone is used to treat Endometriosis?

A

Estrogen

59
Q

What are the gross findings in Endometriosis?

A

Small black red nodules on uterine serosa

60
Q

What condition has endometriotic implants found in the uterine corpus?

A

Adenomyosis

61
Q

What condition has implants appearing tumoral or resembles leiomyoma?

A

Adenomyoma

62
Q

What are the gross findings of Adenomyosis?

A
  • Globular and enlarged corpus luteum
  • thickened, fibrous, firm with fasciculated and WHORLED appearance
  • Cigarette burn lesiosn scattered within the wall
63
Q

What are the microscopic features of Adenomyosis?

A
  • Ectopic endometrial glands and the stroma
    (Embedded in myometrium)
  • Myometrial fibrosis and hypertrophy
64
Q

What are the clin features of Adenomyosis? Give 4

A

Infertility
Dysmenorrhea
Bleeding
Menstrual irreg
Cyst transformation of ovary
Uterine enlargement
Low risk for malignant transformation

65
Q

What disorder has proliferation of endometrial glands relative to the stroma resulting from unpposed Estrogenic stimulation of the endometrial tissue?

A

Endometrial hyperplaia

66
Q

What are the 2 types of endometrial hyperplasia?

A

Non-atypical endometrial hyperplasia
Atypical endometrial hyperplasia

67
Q

What are the gross and histo features of Endometrial hyperplasia?

A

Gross:
- lush and thickened, with the edematou glistening, creamy, yellow, white appearance

Histo:
- INC number of endometrial glands relative to the stroma

68
Q

What are the 3 main categories of hyperplasia?

A

Simple hyperplasia
Complex hyperplasia without atypia
COmplex hyperplasia with atypia

69
Q

What is a distinct characterisitc of Non-atypical endometrial hyperplasia?

A

Closely packed glands with gland to stroma ratio of >3:1

70
Q

What are distinct characteristics of Complex Hyperplaia (non-atypical endometrial hyperplasia)?

A

Crowded, back to back glands
Stratified epithelium
Clelular stroma
Increased glands, less stroma

71
Q

What condition is aka Corpus Cancer syndrome?

A

Endometrial carcinoma

72
Q

What are the 2 categories of endometrial cacrcinoma?

A
  1. Hyperestrinism + Backgound of endometrial hyperplasia (TYPE 1)
  2. Less Hyperestrinism background (TYPE 2)
73
Q

What is a more common tyoe of Endometrial carcinoma that is assoc w/ obesity, DM, HPN, infetility?

A

Type 1 endometrial carcinoma

74
Q

What type of endometrial carcinoma has less hypertenism but is poorly-diff and aggressive type?

A

Type 2 endometrial carcinoma

75
Q

What are the gross and histo features of endometrial carcinoma?

A

Gross:
- bivalve, showing fleshy, white, nodular masses that carpet the endometrial surface

Histo
- Papillary, tubular, clear, and serous or w/ squamous differentiation

76
Q

What are the 2 histological types of Endometrial carcinoma? How do you differentiate them?

A

Type 1 = Endometrioid carcinoma & Adenocarcinoma with squamous differentiation

Type 2 = adenosquamous carcinoma, serous papillary carcinoma, clear cell carcinoma

77
Q

What are imporant histo feature sof Clear cell ccarcinoma?

A
  • polyglonal cells with clear eosinophilic cytoplasm
  • HObnail cells
  • High nuclear grade
78
Q

What are the histlogic features of Serous endometrial carcinoma?

A
  • papillary/micropapillary pattern
  • Psamomma bodies
  • high nuclear grade
79
Q

What are the degenerative changes in Leiomyoma?

A

Hyaline degeneration
Edema
Cystic degeneration
Calcification
Myxomatou

80
Q

What are the histologic features of Leiomyoma?

A

Cigar-shaped bipolar nuclei
Spindle cell proliferation
Scarce mitotic figures

81
Q

What are the gross & histo features of Malignant Mixed Mullerian tumor?

A

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

82
Q

What are the common CA of inflammation in the fallopian tubes?

A

N gonorrheae
Chlamydia
Mycoplasma homonis
Staph, Strep

83
Q

What causes SUppurative sapingitis in fallopian tubes?

A

N gonorrhorae

84
Q

What are the 2 types of fallopian tubes inflammation?

A

Suppurative salpangitis
Tuuberculous salpingiti

85
Q

What are the diff tumors and cysts of the fallopian tubes?

A

Paratubal cysts
Hydatids of Morgagni
Adenomatoid tumors (Mesethelioma)
Adenocarcinoma

86
Q

What is the most common primary lesion of the fallopian tube?

A

Paratubal cysts

87
Q

What lesion of the fallopian tubes is found near the fimbriated end of the tube or in the broad ligaments?

A

Hydatids of Morgagni

88
Q

What lesion of the fallopian tubes is located at the suberosa of the tube or int he mesosalpinx?

A

Adenomatoid tumors (Mesothelioma)

89
Q

What lesion of the fallopian tube presents as dominant tubal mass discovered during pelvic exam? What are assoc symptoms of this?

A

Adenocarcinoma

Assoc symptoms:
- abdominal discharge
- bleeding
- abnormal pap smear cells

Pathology (8 decks)

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