uterus Flashcards
Endometrial Biopsy
evaluates for malignancy and hyperplasia and it is a simple, quick, low risk office procedure
endometrial hyperplasia (4)
- simple hyperplasia
- complex hyperplasia
- simple hyperplasia with atypia (increase rissk for cancer)
- complex hyperplasia with atypia (increase rissk for cancer)
endometrial hyperplasia risk factors
- age
- genetics think of lynch syndrome
- excessive estrogen stimulation
presentation of endometrial hyerplasia (2)
- menorrhagia
2. postmenopausal bleeding
complex with atypia is treated with
total hysterectomy
both simple hyperplasia and complex without atypia treatment
progesterone therapy
most common gyn cancer in U.S
-2.5% lifetime risk but best survival of all the cancers
endometrial cancer
Risk of being associated with malignancy or pre-malignancy:
Premenopausal women: 1.7%
Postmenopausal women: 5.4%
endometrial polyps
inside uterine wall & more likely to cause AUB
Adenomyosis
outside uterus & unlikely to cause AUB
Endometriosis
when to think of adenomyosis
dysmenorrhea and menorrhagia
- due to endometrial glands trapped and the uterus looks bigger and softer
treatments of adenomyosis
- hormonal
2. hysterectomy
having fibroids means you don’t have hyperplasia
fallllse
treatments of submucosal fibroids
- treatments used for AUB
2. hysteroscopic resection
treatments of large intramural or subserosal fibroids
- myomectomy
- hysterectomy
- uterine artery/fibroid embolization (shrinks)
fibroids in submucosal
more bleeding
fibroids subserosal
more likely to feel that pain/pressure
Benign endometrial glands and stroma deeply within myometrium with diffusely enlarged uterus
adenomyosis
is the presence of endometrial tissue outside the endometrium and myometrium
Endometriosis
Pathological diagnosis of endometriosis is made by identifying 2 of the following 3 features in a biopsy of the endometriotic focus:
- Endometrial glands
- Endometrial stroma
- Hemosiderin (due to hemorrhage)
There are 4 theories of pathogenesis for endometriosis:
- Regurgitation theory (reflux of endometrial fragments up the tubes)
- Metaplastic theory (metaplasia of the pelvic peritoneum)
- Metastatic theory (transport of endometrial fragments via lymphatics and vessels)
- Stem cell differentiation into endometrial tissue
What is the most common tumor in the female genital tract?
leiomyoma (fibroids)- a benign tumor of smooth muscle cells
leiomyoma sites
most commonly in the myometrium but may arise in other sites in the female genital tract
Subserosal leiomyomas may become
pedunculated.
leiomyoma detached from uterus, with blood supply from another site
“parasitic” leiomyoma
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.
leiomyosarcoma
prognosis of leiomyosarcoma
worse than for epithelial tumors
3 features in leiomyosarcoma
- Necrosis
- Mitotic count increase
- Cytological atypia
carcinoma in endometrial polyps?
While carcinoma may rarely be found within a polyp, there is no evidence to suggest that polyps are premalignant.
common, present in 1/4 women
more common in women over 40 yr of age
endometrial polyp
3 histological features of an endometrial polyps :
- Dilated endometrial glands
- Fibrotic stroma
- Thick walled blood vessels
Under the influence of high levels of unopposed estrogen, the endometrium undergoes
hyperplasia.
Causes of hyperplasia
- Anovulation
- Exogenous estrogen
- Endogenous estrogen e.g. ovarian tumor
- Obesity (estrogens are formed in peripheral adipose tissue from androstenedione).
the ration of gland to stroma in endometrial hyperplasia
gland > stroma
_______ appears as part of a continuum from normal proliferative phase endometrium to carcinoma.
Hyperplasia
progression to carcinoma in hyperplasia is slow or fast
slow- years
- 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.
endometrial carcinoma
2 morphological types of endometrial carcinom
- endometrioid- resembles the proliferative phase
2. serous- resembles fallopian tube epithelium
endometrial carcinoma type 1 and what is it driven by?
endometrioid type and it is driven by estrogen and it is found in younger pt
endometrial carcinoma type 2 and what is it driven by
serous, clear cell driven by p53 and it is found in older pt
2 types of endoemtrial carcinosarcoma
- malignant glands
2. malignant stroma: homologous or heterologous
endometrial carcinosarcoma rhabdomyosarcoma or chondrosarcoma
malignant stroma- heterologous
endometrial carcinosarcoma fibroblastic, endometrial, smooth muscle
malignant stroma- homologous
pre-test probability for a post-menopausal woman that comes in with bleeding from uterus
12% for cancer
