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Human Reproduction > Week 4: Uterus > Flashcards

Week 4: Uterus Flashcards

1
Q

Types of endometrial pathology

A
  • Endometriosis
  • Pathology with abnormal uterine bleeding
    • adenomyosis
    • endometrial infections
    • uterine neoplasms: Benign and malignant
      • endometrial polyps
      • Endometrial tumors
      • Myometrial tumors
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2
Q

Normal endometrium histology

A
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3
Q

Normal proliferative endometrium histology

A
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4
Q

What is endometriosis?

A

Presence of non-neoplastic endometrial glands and stroma in abnormal locations outside the uterus

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5
Q

Endometriosis epidemiology

A

common in reproductive aged women = 10%

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6
Q

Symptoms of endometriosis

A
  • Cyclic or chronic pelvic pain
  • dysparuenia
  • infertility
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7
Q

Endometriosis locations

A
  • Fallopian tube
  • Ovary
  • Peritoneum
  • Bowel
  • Bladder serosa
  • Among many others
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8
Q

Endometriosis gross histology

A

May form blood-filled “chocolate cysts” in ovary and other sites

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9
Q

Etiology of Endometriosis

A

three theories

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10
Q

OVary gross histology

A
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11
Q

Ovarian endometrioma gross histology

A

Chocolate cyst

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12
Q

Ovarian endometrioma AKA

A

Chocolate cyst

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13
Q

Chocolate cyst AKA

A

Ovarian endometrioma

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14
Q

Endometrial histology

A
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15
Q

Endometriosis in ureter wall histology

A
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16
Q

Endometriosis in bowel wall

A
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17
Q

Question

A

C. Hydronephrosis (urine blocked by endometriosis causing urine build-up upstream)

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18
Q

What is adenomyosis

A
  • Similar to endometriosis but the location differs
  • Presence of ectopic endometrial glands and stroma deep (greater than 2-3 mm) in the myometrium (should be on endometrial cavity surface)
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19
Q

Epidemiology of Adenomyosis

A

Prevalence of 15-25%

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20
Q

Symptoms of Adenomyosis

5 listed

A
  • Pelvic pain
  • Dysmenorrhea
  • Menorrhagia
  • Dyspareunia
  • Uterine enlargement
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21
Q

Adenomyosis etiology

A

Idiopathic

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22
Q

Adenomyosis gross histology

A
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23
Q

Histology of adenomyosis

A
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24
Q

Histology of adenomyosis

A
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25
Q

Causes of abnormal uterine bleeding

A
  • Dysfunctional uterine bleeding (DUB)
  • Complications of pregnancy
  • Organic lesions
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26
Q

DUB AKA

A

Dysfunctional uterine bleeding

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27
Q

Causes of DUB

A

Hormonal imbalances:

  • anovulatory cycles
  • inadequate luteal phase
  • OCPs
  • peri/postmenopausal changes
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28
Q

Complications of pregnancy that can cause abnormal uterine bleeding

A
  • Abortion
  • trophoblastic disease
  • ectopic pregnancy
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29
Q

Organic lesions of the Endometrium that can cause abnormal uterine bleeding

A
  • Polyps
  • Endometritis
  • Hyperplasia
  • carcinoma
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30
Q

Organic lesions of the Myometrium that can cause abnormal uterine bleeding

A
  • Adenomyosis
  • Leiomyomas
  • Leiomyosarcoma
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31
Q

Organic lesions of the cervix that can cause abnormal uterine bleeding

A
  • Polyps
  • Carcinoma
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32
Q

Causes of Abnormal vaginal bleeding in Adolescence

A

DUB (hormonal imbalances)

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33
Q

Causes of Abnormal vaginal bleeding in Reproductive age

A
  • Complications of pregnancy
  • DUB
  • Organic lesions
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34
Q

Causes of Abnormal vaginal bleeding in Perimenopause

A
  • DUB
  • Organic lesions
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35
Q

Causes of Abnormal vaginal bleeding in Postmenopausal women

A
  • Atrophy
  • Organic lesions (cancer < 10%)
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36
Q

What are endometrial polyps?

A
  • Focal overgrowth of glands and stroma
    • monoclonal proliferation of endometrial stroma with non-neoplastic glands
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37
Q

Epidemiology of endometrial polyps

A
  • Age usually > 40 years old
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38
Q

Clinical presentation of endometrial polyps

A
  • irredular vaginal bleeding
  • rarely infertility
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39
Q

Histological features of endometrial polyps

A
  • Thick-walled vessels
  • altered stroma
  • Irregular gland architecture
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40
Q

Histological features of endometrial polyps

A
  • Thick-walled vessels
  • altered stroma
  • Irregular gland architecture
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41
Q

Risk factors for endometrial polyps

6 listed

A
  • Age > 40 years old
  • HTN
  • Obesity
  • Late menopause
  • endometriosis
  • Tamoxifen anti-estrogen therapy
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42
Q

Gross histology of endometrial polyp

A
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43
Q

What is Endometritis?

A
  • Abnormal inflammation of the uterine lining
    • may be acute or chronic
    • usually presents with bleeding, pelvic pain and fever (if acute)
  • Acute endometritis is typically bacterial infection
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44
Q

Endometritis clinical presentation

A
  • bleeding
  • pelvic pain
  • fever (if acute)
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45
Q

Etiologies of Acute endometritis

A

Typically caused by a bacterial infection due to

  • Retained products of conception after delivery
  • Foreign body such as IUD
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46
Q

Histological features of acute endometritis?

A

Neutrophils in endometrium

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47
Q

Histological features of acute endometritis

A

Neutrophils in endometrium

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48
Q

Treatment of acute endometritis

A

Treated with antibiotics

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49
Q

Clinical presentation of chronic endometritis

A
  • Low-grade inflammation
  • less severe symptoms
    • bleeding
    • pelvic pain
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50
Q

Histological features of chronic endometritis

A
  • Loss of cervical barrier between vagina and uterine cavity
  • plasma cells in endometrial stroma
51
Q

Chronic endometritis etiologies

A

infectious agents may be related to PID

  • Chlamydia
  • Ureaplasma
  • Mycoplasma
52
Q

Pathophysiology of chronic endometritis

A

loss of cervical barrier between vagina and uterine cavity

53
Q

Treatment of chronic endometritis

A

can be treated with antibiotics

54
Q

Causes of abnormal bleeding due to reproductive status

A
  • Cycling endometrium
    • reproductive aged women
    • Proliferative or secretory phase of menstrual cycle
  • Non-cycling endometrium
    • mostly peri or postmenopausal women
    • increasingly more common in reproductive aged women with obesity epidemic
    • includes precancers and cancers
55
Q

What are the diagnostic categories of non-cycling endometrium

A
  • Changes reflecting menopause
    • atrophic endometrium
  • Changes reflecting hormone therapy
    • oral contraceptive effect
    • Hormone Replacement Thearpy (HRT)
  • Changes reflecting prolonged estrogen exposure unopposed by progesterone
    • abnormal proliferative endometrium (includes cancer)
56
Q

Risk factors for endometrioid adenocarcinoma with unopposed estrogen

57
Q

Effects of estrogen on the endometrium

58
Q

Effects of progesterone on the endometrium

A

Anti-proliferation

59
Q

Normal state of hormones in the endometrium

A

Balance of estrogen and progesterone

60
Q

Imbalance of hormones in the endometrium

A

imbalance with excess estrogen can lead to abnormal proliferation, endometrial hyperplasia and cancer

61
Q

Series of events from increased estrogen in the endometrium

A
  • Gland crowding
    • at expense of endometrial stroma (glands increase)
  • Glandular architecture is abnormal
    • with irregular gland shapes and sizes
  • nuclear atypia
    • from unregulated gland proliferation

leads to endometrial hyperplasia (precancer) which can lead to endometrial adenocarcinoma AKA Endometrial intraepithelial neoplasia or EIN

62
Q

Architectural changes in endometrial hyperplasia

A
  • Simple endometrial hyperplasia
    • Round tubular glands with crowding and dilation
  • Complex endometrial hyperplasia (EIN)
    • Crowded complex glands with branching
  • Nuclear atypia
    • Nuclei enlarged, irregular, coarse chromatin, prominent nucleoli
63
Q

Diagnostic spectrum of endometrial adenocarcinoma

A
  1. Simple Endometrial Hyperplasia
  2. Complex Endometrial Hyperplasia without nuclear atypia
  3. Complex endometrial hyperplasia with nuclear atypia (AKA Endometrial Intraepithelial Neoplasia (EIN))
  4. Endometrial adenocarcinoma
64
Q

Risk of progression to endometrial cancer with untreated hyperplasia

  • Simple hyperplasia without nuclear atypia
  • Complex hyperplasia without nuclear atypia
  • Complex hyperplasia with nuclear atypia
A
  • Simple hyperplasia without nuclear atypia: 1-3%
  • Complex hyperplasia without nuclear atypia: 3%
  • Complex hyperplasia with nuclear atypia: 23-48%
65
Q

Histological features of normal proliferative endometrium

66
Q

Histological features of simple endometrial hyperplasia

67
Q

Histological features of Complex endometrial hyperplasia

68
Q

Endometrial adenocarcinoma epidemiology

A
  • most common gynecologic tumor in US with approx. 34,900 new cases/year (followed by ovary and cervix)
  • peak age 55-65+ years
  • increasingly seen in younger women with high BMI
69
Q

Endometrial adenocarcinoma presentation

A

Abnormal uterine bleeding, usually preceeded by endometrial hyperplasia

70
Q

Risk factors for endometrial adenocarcinoma

A
  • Unopposed estrogen
  • obesity
  • diabetes mellitus
  • hypertension
  • nulliparity
  • late menopause
  • peak age 55-65+ years
  • increasingly seen in younger women with high BMI
71
Q

Endometrial adenocarcinoma types

A

two types

  • Type 1: Endometrioid (90%)
  • Type 2: Serous, clear cell, carcinosarcoma (10%)
72
Q

Diagnostic criteria of endometrial adenocarcinoma

A
  • Crowded back-to-back glands with little to no intervening stroma
  • complex cribiform architecture with glands within glands
  • Cytologic atypia as described
73
Q

Diagnostic criteria of endometrial adenocarcinoma gross histological features

A
  • initially tumor is present only lining endometrial cavity but may invade into uterine myometrium
    • then has access to lymphatics and may metastasize
    • prognosis worsens with depth of invasion
74
Q

Endometrial adenocarcinoma gross histology

75
Q

Endometrial adenocarcinoma gross histology

76
Q

Endometrial adenocarcinoma histological features

77
Q

Endometrial adenocarcinoma histological features

78
Q

Endometrial adenocarcinoma histological features

79
Q

Endometrial adenocarcinoma histological features

80
Q

Endometrial adenocarcinoma histological features

81
Q

Endometrial adenocarcinoma type I

82
Q

Endometrial adenocarcinoma type 2

83
Q

Serous endometrial adenocarcinoma histological features

84
Q

Natural history of endometrial carcinoma

85
Q

Question

86
Q

What is Uterine Leiomyoma (fibroid)

A

Common benign smooth muscle neoplasm that is steroid hormone (estrogen & progesterone) dependent:

  • Increase in size during pregnancy
  • Regress after menopause
87
Q

Age of Benign smooth muscle neoplasm

A

seen in about 75% of women after 30 years, peak age 20-40 years

88
Q

Symptoms of Uterine Leiomyoma

A
  • usually none
  • abnormal uterine bleeding, may lead to iron deficiency anemia
  • pelvic pain
  • Infertility and/or miscarriage
89
Q

Uterine Leiomyoma AKA

90
Q

Symptoms of Uterine Leiomyoma size changes

A
  • Increase in size during pregnancy
  • Regress after menopause
91
Q

Symptoms of Uterine Leiomyoma

A
  • Usually none
  • abnormal uterine bleeding, may lead to iron deficiency anemia
  • pelvic pain
  • infertility, miscarriage
92
Q

Uterine Leiomyoma gross histology

93
Q

Histological features of Uterine Leiomyoma

94
Q

Histological features of Uterine Leiomyoma

95
Q

What is Uterine Leiomyosarcoma

A
  • Malignant uterine smooth muscle tumor not usually derived from leiomyoma
  • *Not hormonally responsive*
96
Q

Uterine Leiomyosarcoma histological features for diagnosis

A
  • Increases mitotic rate > 10/10 HPF
  • High Cellularity
  • Nuclear pleomorphism
  • Tumor necrosis
97
Q

Uterine Leiomyosarcoma common sites of invasion & metastasis

A

may be Highly aggressive and invade

  • rectum
  • bladder
  • ureters
  • tends to recur

Common sites of metastasis

Hematogenous metastasis: lungs

98
Q

Gross histology of Leiomyosarcoma

99
Q

Histological features of Uterine Leiomyosarcoma

100
Q

Histological features of Uterine Leiomyosarcoma

101
Q

Tumors of the endometrial stroma

A

Low and high grade types

Low grade stromal sarcoma

High grade stromal sarcoma

102
Q

Low grade stromal sarcoma

103
Q

Low grade stromal sarcoma histological features

104
Q

Histological features of Low grade stromal sarcoma

105
Q

Low grade stromal sarcoma histological features

106
Q

High grade stromal sarcoma

107
Q

High grade stromal sarcoma histological features

108
Q

High grade stromal sarcoma histological features

109
Q

What is the most common type of Endometrial Adenocarcinoma?

A

Endometrial adenocarcinoma type I

110
Q

Endometrial adenocarcinoma type I etiology

A

Arises in the setting of endometrial hyperplasia

111
Q

Endometrial adenocarcinoma type I risk factors

A
  • Obesity
  • DM
  • HTN
  • Infertility
  • Unopposed Estrogen stimulation
112
Q

Endometrial adenocarcinoma type I associated genes

A
  • PTEN mutations (30-80%)
  • PIK3CA mutations in 40%
113
Q

Endometrial adenocarcinoma type I common sites of metastatsis

A
  • indolent behavior
  • Lymphatic spread
114
Q

Endometrial adenocarcinoma type II occurs in

A

older women than type I

115
Q

Endometrial adenocarcinoma type II etiology

A

Arises in the setting of vaginal atrophy

Thin physique

no estrogen link

116
Q

Endometrial adenocarcinoma type II genes

A

P53 mutations seen in 90% of serous carcinoma

117
Q

Endometrial adenocarcinoma type II common sites of metastasis

A
  • Aggressive behavior
  • Intraperitomeal and lymphatic spread
118
Q

Endometrial carcinoma common sites of metastasis via direct invasion

A
  • Bladder
  • Rectum
  • Ureters
119
Q

Endometrial carcinoma common sites of metastasis via lymphatics

A
  • Pelvic/peri-aortic nodes
  • High risk of pelvic recurrence
120
Q

Endometrial carcinoma common sites of metastasis via hematogenous spread

A
  • Lungs
  • Liver
121
Q

Common subtypes of Type II Endometrial carcinoma

A
  • Serous carcinoma (most common)
  • Clear cell carcinoma
122
Q

Common subtypes of Type I Endometrial carcinoma

A

Endometrioid carcinoma

123
Q

What is Menometrorrhagia?

A

Menometrorrhagia is a condition in which prolonged or excessive uterine bleeding occurs irregularly and more frequently than normal. It is thus a combination of metrorrhagia and menorrhagia.

Human Reproduction (40 decks)

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