Uterus Pathoma

Question 1

What is asherman syndrome?

Answer 1

Secondary amenorrhea from loss of basal layer and scarring. From aggressive curettage (scraping of uterine wall in surgery)

Question 2

How do you get bleeding in anovulatory cycle?

Answer 2

Endometrium grows on top of previous growth b/c driven by estrogen proliferative stage without the progesterone secretory stage. So you get cells overgrow blood supply

Question 3

Acute vs chronic endometritis?

Answer 3

Chronic will have PLASMA CELLS. Presents as uterine bleeding, pain and infertility.

Both acute and chronic are fever bleeding and pain. And often from retained products from conception. Chronic can be from chlamydiy, IUD, TB (granuloma)

Question 4

What drug has a side of effect of endometrial polyp?

Answer 4

Tamoxifen for breast cancer. It is a SERM that is pro estrogen in uterus

Question 5

3 theories of endometriosis deco?

Answer 5

Retrograde mensturation: some product goes backwards (leading theory). MOST IMPORTANT

Metaplastic: mullerian duct produced shit in the wrong place

Lymphatic dissemination: see endometriousus to weird places like lung

Question 6

What is a chocolate cyst?

Answer 6

Endometriosis to the ovary and looks like chocolate from bloody debris

Question 7

Endometriosis to pouch of douglas?

Answer 7

hurts to shit!

Question 8

What is adenomyosis?

Answer 8

Endometriosis into myometrium. (think Adeno with secretory and myo with muscle, so name makes sense). KNOW THAT IT WILL BE ON TESTs!!

Question 9

Dx of endometriosis?

Answer 9

Laparoscopy with surface lesions that are blue/black/brown

Question 10

Rx: of endometriosis?

Answer 10

hormone manipulation/ablation/salpingo-oophorectomy to remove stimulation +/- hysterectomy

Question 11

Postmenopausal bleeding in fat women can be caused by what?

Answer 11

Endometrial hyperplasia b/c it is unappeased estrogen causing it! (fat makes estrone) and no progesterone to fight it

Question 12

Is endometrial hyperplasia a big concern?

Answer 12

If on histology you see cellular atypic, it can progress to carcinoma!!!!!

Question 13

What genetic trait makes you at risk for endometrial carcinoma?

Answer 13

HNPCC.

Question 14

What is most common carcinoma of female genital tract?

Answer 14

Endometrial carcionnma

Question 15

What are the 2 pathways to endometrial carcinoma?

Answer 15

1. endometrial hyperplasia from unopposed estrogen (you would have seen cellular atypic). Endometrioid looks like normal endometrium. 50-60 years old. Mutationts in PTEN suppressor
2. Sporadic pathway: no hyperplasia. Atrophic endometrium causes it and it is old women

Question 16

Genetic mutation in endometrial carcionma for hyperplasia type?

Answer 16

PTEN suppressor is changed

Question 17

Genetic mutation in sporadic pathway of endomtrial carcinoma?

Answer 17

P53 mutation

Question 18

What do you see on his to for sporadic pathway endometrial carcinoma

Answer 18

Serous papillary and psammoma bodies (easy to remember b/c papillary thyroid also had psamomma bodies)

Question 19

What is the bad kind of endometrial carcinoma? What causes it?

Answer 19

Serous papillary endometrial carcinoma and P53 mutation in atrophying endometrium. It is in elderly women

Question 20

What is a leiomyoma? Is it concerning?

Answer 20

Smooth muscle benign proliferation. Not concerning especially if multiple growths. They will enlarge in preggers and shrink in menopause (makes sense, estrogen sensitive).

Question 21

Smooth msucle mass of myometrium, what do you hope it looks like?

Answer 21

White whorley is important b/c benign. If hemorrhage or necrosis, likely leiomyosarcoma

Question 22

Does leiomyoma become malignant?

Answer 22

NO NO NO IT DOES NOT! Which is good because tons of women have leiomyoma

Question 23

Leiomyoma causes what problems?

Answer 23

Mass, changes shape of uterus and might not be able to get plantation of ova. Can stretch endometrium and cause bleeding

Question 24

How do you know if a smooth muscle mass of myometrium is leiomyosarcoma? (there are 4 ways, on is a very helpful hint in particular)

Answer 24

One mass suggests sarcoma (thats the biggie)

hemorrhage/necrosis

post menopausal (leiomyoma would shrink normally after menopause

Cellular atypia on histology