uterus

Question 1

Endometrial Biopsy

Answer 1

evaluates for malignancy and hyperplasia and it is a simple, quick, low risk office procedure

Question 2

endometrial hyperplasia (4)

Answer 2

1. simple hyperplasia
2. complex hyperplasia
3. simple hyperplasia with atypia (increase rissk for cancer)
4. complex hyperplasia with atypia (increase rissk for cancer)

Question 3

endometrial hyperplasia risk factors

Answer 3

1. age
2. genetics think of lynch syndrome
3. excessive estrogen stimulation

Question 4

presentation of endometrial hyerplasia (2)

Answer 4

1. menorrhagia

2. postmenopausal bleeding

Question 5

complex with atypia is treated with

Answer 5

total hysterectomy

Question 6

both simple hyperplasia and complex without atypia treatment

Answer 6

progesterone therapy

Question 7

most common gyn cancer in U.S

-2.5% lifetime risk but best survival of all the cancers

Answer 7

endometrial cancer

Question 8

Risk of being associated with malignancy or pre-malignancy:
Premenopausal women: 1.7%
Postmenopausal women: 5.4%

Answer 8

endometrial polyps

Question 9

inside uterine wall & more likely to cause AUB

Answer 9

Adenomyosis

Question 10

outside uterus & unlikely to cause AUB

Answer 10

Endometriosis

Question 11

when to think of adenomyosis

Answer 11

dysmenorrhea and menorrhagia

• due to endometrial glands trapped and the uterus looks bigger and softer

Question 12

treatments of adenomyosis

Answer 12

1. hormonal

2. hysterectomy

Question 13

having fibroids means you don’t have hyperplasia

Answer 13

fallllse

Question 14

treatments of submucosal fibroids

Answer 14

1. treatments used for AUB

2. hysteroscopic resection

Question 15

treatments of large intramural or subserosal fibroids

Answer 15

1. myomectomy
2. hysterectomy
3. uterine artery/fibroid embolization (shrinks)

Question 16

fibroids in submucosal

Answer 16

more bleeding

Question 17

fibroids subserosal

Answer 17

more likely to feel that pain/pressure

Question 18

Benign endometrial glands and stroma deeply within myometrium with diffusely enlarged uterus

Answer 18

adenomyosis

Question 19

is the presence of endometrial tissue outside the endometrium and myometrium

Answer 19

Endometriosis

Question 20

Pathological diagnosis of endometriosis is made by identifying 2 of the following 3 features in a biopsy of the endometriotic focus:

Answer 20

1. Endometrial glands
2. Endometrial stroma
3. Hemosiderin (due to hemorrhage)

Question 21

There are 4 theories of pathogenesis for endometriosis:

Answer 21

1. Regurgitation theory (reflux of endometrial fragments up the tubes)
2. Metaplastic theory (metaplasia of the pelvic peritoneum)
3. Metastatic theory (transport of endometrial fragments via lymphatics and vessels)
4. Stem cell differentiation into endometrial tissue

Question 22

What is the most common tumor in the female genital tract?

Answer 22

leiomyoma (fibroids)- a benign tumor of smooth muscle cells

Question 23

leiomyoma sites

Answer 23

most commonly in the myometrium but may arise in other sites in the female genital tract

Question 24

Subserosal leiomyomas may become

Answer 24

pedunculated.

Question 25

leiomyoma detached from uterus, with blood supply from another site

Answer 25

“parasitic” leiomyoma

Question 26

Rare (<1% of uterine malignancies).
Arise de novo, not within existing leiomyomas.
Peak at older age (50-60 years).
Present with abnormal bleeding, pain or a mass.
Prognosis depends on stage.
Spread is intraperitoneal, to lymph nodes, and hematogenously to the lungs, liver and brain.

Answer 26

leiomyosarcoma

Question 27

prognosis of leiomyosarcoma

Answer 27

worse than for epithelial tumors

Question 28

3 features in leiomyosarcoma

Answer 28

1. Necrosis
2. Mitotic count increase
3. Cytological atypia

Question 29

carcinoma in endometrial polyps?

Answer 29

While carcinoma may rarely be found within a polyp, there is no evidence to suggest that polyps are premalignant.

Question 30

common, present in 1/4 women

more common in women over 40 yr of age

Answer 30

endometrial polyp

Question 31

3 histological features of an endometrial polyps :

Answer 31

1. Dilated endometrial glands
2. Fibrotic stroma
3. Thick walled blood vessels

Question 32

Under the influence of high levels of unopposed estrogen, the endometrium undergoes

Answer 32

hyperplasia.

Question 33

Causes of hyperplasia

Answer 33

1. Anovulation
2. Exogenous estrogen
3. Endogenous estrogen e.g. ovarian tumor
4. Obesity (estrogens are formed in peripheral adipose tissue from androstenedione).

Question 34

the ration of gland to stroma in endometrial hyperplasia

Answer 34

gland > stroma

Question 35

_______ appears as part of a continuum from normal proliferative phase endometrium to carcinoma.

Answer 35

Hyperplasia

Question 36

progression to carcinoma in hyperplasia is slow or fast

Answer 36

slow- years

Question 37

• Most common invasive malignant neoplasm of the female genital tract, accounting for 6% of cancer cases in women
• The common age group is postmenopausal, with a 55-65 year peak.

Answer 37

endometrial carcinoma

Question 38

2 morphological types of endometrial carcinom

Answer 38

1. endometrioid- resembles the proliferative phase

2. serous- resembles fallopian tube epithelium

Question 39

endometrial carcinoma type 1 and what is it driven by?

Answer 39

endometrioid type and it is driven by estrogen and it is found in younger pt

Question 40

endometrial carcinoma type 2 and what is it driven by

Answer 40

serous, clear cell driven by p53 and it is found in older pt

Question 41

2 types of endoemtrial carcinosarcoma

Answer 41

1. malignant glands

2. malignant stroma: homologous or heterologous

Question 42

endometrial carcinosarcoma rhabdomyosarcoma or chondrosarcoma

Answer 42

malignant stroma- heterologous

Question 43

endometrial carcinosarcoma fibroblastic, endometrial, smooth muscle

Answer 43

malignant stroma- homologous

Question 44

pre-test probability for a post-menopausal woman that comes in with bleeding from uterus

Answer 44

12% for cancer