Uterus and Endometrium Pathology Flashcards
What is the most frequent cause of abnormal uterine bleeding?
Anovulatory cycle
What are the most common bacterial infections to cause acute endometriosis?
Group A Hemolytic Strep
Staph
What is the most common bacteria to cause chronic endometriosis?
Chlamydia
Sx’s = abnormal bleeding, pain, discharge, and infertility
Chronic Endometriosis
What are the main 4 associations with chronic endometriosis?
Chronic PID
Retained gestational tissue
IUD’s
TB
Def: presence of ectopic endometrial tissue outside the uterus
Endometriosis
What differentiated ectopic endometrial tissue from normal endometrial tissue?
Increased E production d/t increased aromatase in ectopic tissue and release of pro-inflammatory factors
Endometriosis is associated with a 3x increased risk of _____
Endometrioid ovarian cancer
What mutations are most common in endometriosis?
PTEN
ARID1A
Morph: red-blue/yellow-brown nodules beneath the mucosal/serosal surfaces with ovarian cysts with brown fluid from previous hemorrhage (Chocolate cysts)
Endometriosis
What are the major Sx’s of endometriosis?
Dysmenorrhea, dyspareunia
Pelvic pain
Infertility
Dysuria and pain on defecation
Def: endometrial tissue within the uterine wall (myometrium)
Adenomyosis
What are the major Sx’s of adenomyosis?
Menomerorrhagia
Colicky dysmenorrhea
Dyspareunia
Pelvic pain
Morph: irregular nests of endometrial stroma within the myometrium
Adenomyosis
Def: exophytic masses projecting into the endometrial cavity
Endometrial polyps
Sx’s = abnormal bleeding d/t ulceration or necrosis
Endometrial polyps
What cancer may endometrial polyps give rise to?
Adenocarcinoma
Endometrial polyps are associated with the use of what?
Tamoxifen
What is d/t prolonged E stimulation of the endometrium and the precursor to endometrial carcinoma?
Endometrial hyperplasia
What mutation is most common in endometrial hyperplasia?
PTEN
Pts with which syndrome have an increased risk of endometrial carcinoma and breast cancer?
Cowden syndrome
Morph: increased gland:stroma ratio with no atypia
Non-atypical endometrial hyperplasia
Morph: complex patterns of proliferating glands displaying nuclear atypia and rounded cells with loss of perpendicular orientation to basement membrane
Atypical endometrial hyperplasia
Well-differentiated cells that arise in the setting of endometrial hyperplasia
Endometrial carinoma
What mutation is most common in endometrial carcinoma?
PTEN
Poorly differentiated cells that arise in the setting of endometrial atrophy
Serous carcinoma
What mutation is most common in serous carcinoma?
TP53
What is serous carcinoma associated with?
Peritoneal disease
What are the Sx’s of carcinoma of the endometrium?
Irregular/post-menopausal bleeding with excessive leukorrhea
What are the 4 stages of carcinoma of the endometrium
Stage 1 = confined to uterus
Stage 2 = uterus and cervix
Stage 3 = outside uterus, within true pelvis
Stage 4 = outside true pelvis, in bladder/rectum
Def: endometrial adenocarcinomas with a malignant mesenchymal component that can take a number of forms
Malignant Mixed Mullerian Tumors (carcinosarcoma)
What mutations are most common in MMMT’s
PTEN
TP53
PIK3CA
Morph: bulky, polypoid mass that may protrude into the cervical os
MMMT
Def: E sensitive, large, broad-based endometrial polypoid growths that may prolapse through the cervical os
Adenosarcoma
Def: multiple benign SM neoplasms
Leiomyomas (Fibroids)
What are the major Sx’s of Leiomyomas?
AUB
Urinary frequency
Impaired fertility
Sudden pain from infarct
Morph: sharply circumscribed, discrete, round, firm, gray-white tumors within them myometrium with a whorled pattern on cut section
Leiomyoma (Fibroid)
What is the mutation associated with Leiomyomas?
MED12
Def: arise from myometrium or endometrial stromal precursor cells
Leiomyosarcoma
Morph: nuclear atypia, high mitotic index, and zonal necrosis
Leiomyosarcoma
What mutation is associated with Leiomyosarcomas?
MED12
What should pts be worried about following surgery for removal of Leiomyosarcomas?
Recurrance
