Uterus Flashcards
Acute endometritis is defined by the presence of what cells?
Abnormal neutrophils
Some neutrophils are normally present during menstruation
Chronic endometritis is defined by the presence of what type of cell?
Plasma cells
Lymphocytes are present in normal endometrium
List 3 common etiologies of endometritis
Ascending infection from the cervix (STD, PID, following medical procedure..)
IUDs
Retained products of conception post delivery
What is the presentation of endometritis?
Fever, abdominal pain, menstrual abnormalities
What are some long term complications of endometritis?
Infertility Ectopic pregnancy (we heal by scarring)
What are the three organisms most commonly responsible for sexually transmitted PID?
Chlamydia trachomatis
Neisseria gonorrhoeae
Polymicrobial
What is endometriosis?
The presence of endometrial glands and stroma outside of the endometrium
What is the criteria for diagnosis endometriosis?
2/3 must be present
- endometrial glands
- endometrial stroma
- hemosiderin pigment (indicating old blood)
What is a chocolate cyst?
Endometriosis in the ovary- cycles of growth and bleeding leads to a large old blood cyst in the ovary
What is the prevalence of endometriosis?
About 10% in women
What is the prevalence of endometriosis in infertile women?
50%
What is adenomyosis?
Presence of endometrial glands and stroma within the smooth muscle of the uterus (myometrium)
How does adenomyosis present clinically?
asymptomatic to irregular bleeding to pelvic pain
Describe the architecture of endometrial hyperplasia
glands > stromal hyperplasia
What is the hormonal cause of endometrial hyperplasia
Excess estrogen
Name two estrogen producing ovarian lesions
PCOS
Granulosa-theca cell tumor
Aside from ovarian lesions, name 2 other causes of excess estrogen production that can cause endometrial hyperplasia
Obesity
Failure of ovulation (peri-menopause)
What is the risk of endometrial hyperplasia progression to cancer if the histology shows non-atypical cells?
Short term risk of endometrial cancer is low
What is another name for atypical endometrial hyperplasia?
Endometrial intraepithelial hyperplasia (EIN)
Marked increased risk for endometrial cancer
What is the tumor suppressor gene indicated in EIN?
PTEN- a phosphatase protein product involved in the regulation of the cell cycle
Endometrioid carcinomas arise from which precursor lesions?
Endometrial hyperplasia
What are the risk factors for the development of endometrioid cancer?
Unopposed estrogen
Serous endometrial cancers arise from which precursor lesion?
None- they are sporadic
arises from atrophic endometrium
What is the mutation associated with sporadic serous endometrial cancers?
p53
WHat is the histology of serous endometrial canceR?
Papillary structures
Define stage I endometrial cancer
confined to uterine corpus
Define stage II endometrial cancer
Involves uterus and cervix
Define stage III endometrial cancer
Cancer extends beyond the uterus, but does not go beyond the true pelvis
Define stage IV endometrial cancer
Cancer extends outside the true pelvis or involves bladder mucosa and rectum
Endometrial polyps are benign neoplastic growth of what types of cells?
Monoclonal stromal cells and endometrial glands
Presents with abnormal uterine bleeding
Polyps are associated with what drug?
Tamoxifen- agonist in the endometrium!
What is the most common benign tumor in females?
Leiomyomas
Leiomyomas arise from which cell type?
myometrial smooth muscle cells
How common are leiomyomas?
30-50%
More common in blacks > whites
What is another name for leiomyoma?
Fibroid
What is the presentation of fibroids?
asymptomatic abnormal bleeding- stretching the endometrium Pelvic mass Pain Infertility
What are the chromosomal abnormalities most commonly associated with leiomyomas?
6, 12
They are monoclonal.
Are leiomyomas precursors to malignancy?
Almost never
From what cells do leiomyosarcomas arise?
They arise de novo from mesenchymal cells of the myometrium
Do leiomyosarcomas arise in menopausal or postmenopausal women?
Postmenopausal women- (not dependent on estrogen)
What is the clinical course of leiomyosarcomas?
They recur following surgical removal, can metastasize (lungs)
5 year survival rate is 40%
What is dysfunctional uterine bleeding?
Diagnosis of exclusion for abnormal uterine bleeding
What is the cause of uterine bleeding in prepubescent girls?
Precocious puberty
What is a common cause of abnormal uterine bleeding in adolescents?
Anovulatory cycles
What are the two main causes of abnormal uterine bleeding in women of reproductive age?
Complications of pregnancy (abortion, ectopic, trophoblastic disease)
Proliferations (leiomyoma, adenomyosis, polyps)
What are the most common causes of abnormal uterine bleeding in perimenopausal women?
Anovulatory cycles
Proliferations (polyps, hyperplasia, carcinoma)
What are the most common causes of abnormal bleeding in post-menopausal women?
Carcinoma
Polyps
Hyperplasia
Why does anovulatory cycles lead to abnormal bleeding?
Lack of progesterone –> endometrium breaks down as abnormal bleeding.
Endometrium grows with E2, but then there is no progesterone to promote the secretory phase. This leads to growth of the endometrium beyond its blood supply (progesterone is responsible for the growth of blood vessels –> abnormal bleeding)
When are anovulatory cycles most likely to occur?
Menarche and menopause
What are the two types of endometrial cancerS?
Endometrioid and serous
Endometrioid arises from endometrial hyperplasia in younger women (50/60)
Serous (papillary) carcinoma arises from an atrophic endometrium in older women (70+)
WHat are psammoma bodies and are they seen in endometrioid or serous endometrial cancer?
Psammoma bodies are necrotic papillary cores that become calcified- they are seen in serous type endometrial cancer
[also seen in papillary carcinoma of the thyroid, meningioma, papillary serous carcinoma of the endometrium and mesothelioma- tumor of the pleura classically related to asbestos]
Why is it important to know that leiomyomas appear as multiple white pearly whorled masses?
Multiple- because leiomyosarcoma appears as a single mass
Whorled mass- malignant variant appears necrotic with hemorrhage
