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Endocrine- MHD > Uterus > Flashcards

Uterus Flashcards

1
Q

Acute endometritis is defined by the presence of what cells?

A

Abnormal neutrophils

Some neutrophils are normally present during menstruation

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2
Q

Chronic endometritis is defined by the presence of what type of cell?

A

Plasma cells

Lymphocytes are present in normal endometrium

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3
Q

List 3 common etiologies of endometritis

A

Ascending infection from the cervix (STD, PID, following medical procedure..)
IUDs
Retained products of conception post delivery

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4
Q

What is the presentation of endometritis?

A

Fever, abdominal pain, menstrual abnormalities

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5
Q

What are some long term complications of endometritis?

A 
Infertility
Ectopic pregnancy (we heal by scarring)
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6
Q

What are the three organisms most commonly responsible for sexually transmitted PID?

A

Chlamydia trachomatis
Neisseria gonorrhoeae
Polymicrobial

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7
Q

What is endometriosis?

A

The presence of endometrial glands and stroma outside of the endometrium

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8
Q

What is the criteria for diagnosis endometriosis?

A

2/3 must be present

  • endometrial glands
  • endometrial stroma
  • hemosiderin pigment (indicating old blood)
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9
Q

What is a chocolate cyst?

A

Endometriosis in the ovary- cycles of growth and bleeding leads to a large old blood cyst in the ovary

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10
Q

What is the prevalence of endometriosis?

A

About 10% in women

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11
Q

What is the prevalence of endometriosis in infertile women?

A

50%

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12
Q

What is adenomyosis?

A

Presence of endometrial glands and stroma within the smooth muscle of the uterus (myometrium)

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13
Q

How does adenomyosis present clinically?

A

asymptomatic to irregular bleeding to pelvic pain

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14
Q

Describe the architecture of endometrial hyperplasia

A

glands > stromal hyperplasia

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15
Q

What is the hormonal cause of endometrial hyperplasia

A

Excess estrogen

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16
Q

Name two estrogen producing ovarian lesions

A

PCOS

Granulosa-theca cell tumor

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17
Q

Aside from ovarian lesions, name 2 other causes of excess estrogen production that can cause endometrial hyperplasia

A

Obesity

Failure of ovulation (peri-menopause)

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18
Q

What is the risk of endometrial hyperplasia progression to cancer if the histology shows non-atypical cells?

A

Short term risk of endometrial cancer is low

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19
Q

What is another name for atypical endometrial hyperplasia?

A

Endometrial intraepithelial hyperplasia (EIN)

Marked increased risk for endometrial cancer

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20
Q

What is the tumor suppressor gene indicated in EIN?

A

PTEN- a phosphatase protein product involved in the regulation of the cell cycle

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21
Q

Endometrioid carcinomas arise from which precursor lesions?

A

Endometrial hyperplasia

22
Q

What are the risk factors for the development of endometrioid cancer?

A

Unopposed estrogen

23
Q

Serous endometrial cancers arise from which precursor lesion?

A

None- they are sporadic

arises from atrophic endometrium

24
Q

What is the mutation associated with sporadic serous endometrial cancers?

A

p53

25
Q

WHat is the histology of serous endometrial canceR?

A

Papillary structures

26
Q

Define stage I endometrial cancer

A

confined to uterine corpus

27
Q

Define stage II endometrial cancer

A

Involves uterus and cervix

28
Q

Define stage III endometrial cancer

A

Cancer extends beyond the uterus, but does not go beyond the true pelvis

29
Q

Define stage IV endometrial cancer

A

Cancer extends outside the true pelvis or involves bladder mucosa and rectum

30
Q

Endometrial polyps are benign neoplastic growth of what types of cells?

A

Monoclonal stromal cells and endometrial glands

Presents with abnormal uterine bleeding

31
Q

Polyps are associated with what drug?

A

Tamoxifen- agonist in the endometrium!

32
Q

What is the most common benign tumor in females?

A

Leiomyomas

33
Q

Leiomyomas arise from which cell type?

A

myometrial smooth muscle cells

34
Q

How common are leiomyomas?

A

30-50%

More common in blacks > whites

35
Q

What is another name for leiomyoma?

A

Fibroid

36
Q

What is the presentation of fibroids?

A 
asymptomatic
abnormal bleeding- stretching the endometrium
Pelvic mass
Pain
Infertility
37
Q

What are the chromosomal abnormalities most commonly associated with leiomyomas?

A

6, 12

They are monoclonal.

38
Q

Are leiomyomas precursors to malignancy?

A

Almost never

39
Q

From what cells do leiomyosarcomas arise?

A

They arise de novo from mesenchymal cells of the myometrium

40
Q

Do leiomyosarcomas arise in menopausal or postmenopausal women?

A

Postmenopausal women- (not dependent on estrogen)

41
Q

What is the clinical course of leiomyosarcomas?

A

They recur following surgical removal, can metastasize (lungs)

5 year survival rate is 40%

42
Q

What is dysfunctional uterine bleeding?

A

Diagnosis of exclusion for abnormal uterine bleeding

43
Q

What is the cause of uterine bleeding in prepubescent girls?

A

Precocious puberty

44
Q

What is a common cause of abnormal uterine bleeding in adolescents?

A

Anovulatory cycles

45
Q

What are the two main causes of abnormal uterine bleeding in women of reproductive age?

A

Complications of pregnancy (abortion, ectopic, trophoblastic disease)

Proliferations (leiomyoma, adenomyosis, polyps)

46
Q

What are the most common causes of abnormal uterine bleeding in perimenopausal women?

A

Anovulatory cycles

Proliferations (polyps, hyperplasia, carcinoma)

47
Q

What are the most common causes of abnormal bleeding in post-menopausal women?

A

Carcinoma
Polyps
Hyperplasia

48
Q

Why does anovulatory cycles lead to abnormal bleeding?

A

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)

49
Q

When are anovulatory cycles most likely to occur?

A

Menarche and menopause

50
Q

What are the two types of endometrial cancerS?

A

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+)

51
Q

WHat are psammoma bodies and are they seen in endometrioid or serous endometrial cancer?

A

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]

52
Q

Why is it important to know that leiomyomas appear as multiple white pearly whorled masses?

A

Multiple- because leiomyosarcoma appears as a single mass

Whorled mass- malignant variant appears necrotic with hemorrhage

Endocrine- MHD (17 decks)

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