Uterus Pathology Flashcards
1
Q
Endometritis (acute and chronic)
A
- Both usually related to preg or IUD or chronic infection
- Acute = microabscesses (neutrophils)
- Chronic = plasma cells and lymphocytes
2
Q
Endometriosis
A
- Endometrial tissue (glands and stroma) outside of uterus; functional (respond to hormones); seen as hemorrhagic or chocolate cysts b/c respond to hormones so bleed
- Sites - ovary, uterine ligament, rectovaginal septum, pelvic peritoneum, GI (appendix)
- May undergo malignant transformation –> endometrioid carcinoma or clear cell carcinoma
3
Q
Adenomyosis
A
- when there is endometrial tissue deep into myometrium layer
4
Q
How does endometriosis present?
A
- Pelvic pain, infertility in 1/3, menstrual irregularities, bleeding
- Esp in 20-30 yo; 10% of women
5
Q
Causes of Abnormal Uterine Bleeding by Age
A
- Pre-pubertal - precocious puberty
- Pubertal - anovulatory cycle, coagulation disorder
- Child-Bearing Age - preg complications, organic lesions, anovulatory cycle
- Menopausal / post-menopausal - more concerned for organic lesions (carcinoma, hyperplasia, polyps); anovulatory cycle, shedding and endometrial atrophy too
6
Q
Anovulatory Cycle (causes)
A
- prolonged unopposed estrogen due to lack of ovulation –> random breakdown of stroma w/o secretory phase; see proliferation w/ stroma and gland breakdown on histo
- Causes - hormone problem, ovarian tumor, polycystic ovaries, obesity, under-nutrition
7
Q
Endometrial Polyp (3 parts of histo dx)
A
- very vascular, sessile mass;
1- fibrotic stroma
2- centrally located vessels
3- lined by epithelium on 3 sides
- Associated w/ tamoxifen use
8
Q
Leiomyomas
A
AKA fibroids
- benign smooth muscle tumors in 75% reprod females; clonal neoplasms
- Can also cause cyclic pain and heavy period b/c many are ER pos (respond to hormone)
- Intramural (within), submucosal, subserosal (feel on outside)
- Discrete tan/white firm (whirling) tumors
- Histo: uniform smooth muscle bundles that resemble normal tissue; few mitoses
9
Q
2 Forms of Benign Fibroid Mets
A
- Benign Metastasizing Leiomyomas - spread hematogenously (lung and bone); ER pos
- Disseminated Peritoneal Leiomyomas - mult small peritoneal nodules
10
Q
Leiomyosarcoma
A
RARE
- Occur in older pts than fibroids (40-60 yo)
- More nuclear atypia, mitoses, necrosis, hemorrhages
- Usually single and de novo (not from fibroid precursor)
11
Q
Endometrial Hyperplasia (including categories)
A
- Prolonged estrogen stimulation (anovulation or inc estrogen production or exogenous estrogen) –> proliferation of glands
- Histo: proliferation of glands; inc gland to stroma ratio (> 1:1)
- Present w/ abnormal bleeding
- Associated w/ menopause, polycystic ovarian disease, functional granulosa cell tumors (make estrogen), prolonged estrogen replacement therapy
- Classification
- Architecture - simple v. complex (glands close together and clover leaf indents)
- Atypia - non atypical nuclei (uniform; resemble normal nuclei) v. atypical (enlarged nuclei, irregular, stratified, abundant mitoses)
12
Q
What gene is associated w/ endometrial hyperplasia?
A
- Inactivation/deletion of PTEN tumor suppressor gene –> endometrial cells more sensitive to estrogen
13
Q
Which type of endometrial hyperplasia has greatest risk of cancer?
A
Atypical complex has highest risk of progression to cancer
So usually treat w/ hysterectomy (can still give progesterone if want to have kids)
14
Q
Endometrial Carcinoma In General
A
- MOST COMMON GYNO MALIGNANCY
- Risks (hyper-estrogen states)
- Obesity, HTN, DM, anovulatory cycle, infertility/nullparity (preg is high prog time), PCOS, granulosa cell tumors, tamoxifen, radiation, exogenous estrogen
- Often present w/ vaginal bleeding
- Tx - surgery +/- irradiation; 90% 5 yr survival if stage 1
15
Q
Type I v. Type II Endometrial Carcinoma
A
- Type 1 (estrogen dep) - 80%
- Unopposed estrogen
- Pre-cancerous endometrial hyperplasia
- Genetics - PTEN
- Histo: proliferation of back to back malignant glands w/o stroma between
- Grade 1 - well diff; gland pattern
- Grade 2 - mod diff; glands b/n sheets of malignant cells
- Grade 3 - poor diff; solid sheets of cells
- Inc freq w/ obesity, DM, HTN, infertility
- Favorable prognosis
- Type 2 (estrogen indep) - 20%
- No pre-cancerous lesion
- Older population
- Genetics - p53
- No grading system; all high grade w/ poor prognosis
