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Pathology > Weibliche Geschlechtsorgane - Corpus > Flashcards

Weibliche Geschlechtsorgane - Corpus Flashcards

0
Q

Endometritis

  1. What are the common cause for endometritis?
A

Endometritis often is a cosequence of pelvic inflammatory disease
and is frequently due to N. Gonorrhoeae or C. Trachomatis

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1
Q

Endometritis

What is the requirement to diagnoze chronic endometritis?

A

Chronic endometritis

  • presence of plasma cells (lymphocytes normally are seen in the
    Endometrium)
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2
Q

Endometritis

  1. What does the histologic examination reveal?
A

1.

  • neutrophilic infiltrate in the superficial endometrium and glands
  • stromal lymphoplasmacytic infiltrate
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3
Q

Endometritie

What does the histological examination reveals when having a chlamydial infection of the endometrium?

A

Prominent lymphoid follicles are more commonly seen

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4
Q

Endometritis

  1. What kind of endometritis causes Tuberculosis
  2. What other symptomes are related to tuberculosis-endometritis
A
  1. tuberculosis causes granulomatous endometritis
  2. this is frequently associated with tuberculous salpingitis
    and peritonitis
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5
Q

Endometritis

What could be a reason for endometritis (if it is her fault)?
What could be the cure?

A
  • retained(behalten, speichern) products of conception-
    miscarriage or delivery or a foreign body such as an
    intrauterine device
  • Removing of the offending tissue or foreign body typically
    results in resolution
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6
Q

Endometritis

What are the clinically symptoms of endometritis?

What are possible risks?

A

All forms of endometritis:

  • fever
  • abdominal pain
  • menstrual abnormalities
  • increased risk of infertility
  • increased risk of ectopic pregnancy (Extrauteringravidität)
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7
Q

Adenomyosis

What does Adenomyosis mean?

A

Adenomyosis uteri = Befall der Gebärmuttetmuskulatur

Growth of the basal layer of the endometrium down into myometrium
-> nests of endometrial stroma, glands, or both, are found deep in
the myometrium interposed (dazwischenbringen) between
muscle bundles

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8
Q

Adenomyosis

  1. What happens because of the aberrant(abnormal) presence
    of endometrial tissue?
A
  1. This endometrial tissue located down in the muscles induces
    reactive hypertophy of the myometrium, resulting in an
    enlarged, globular uterus, often with thickened uterine wall
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9
Q

Adenomyosis

1. How are mestrual bleeding and Adenomyosis connected?
Symptoms

A
  1. the glands in adenomyosis derive(abstammen) from the stratum
    basalis of the endometrium
    -> they do not undergo cyclic bleeding
    -> Nevertheless, adenomyosis may produce menorrhagia,
    dysmenorrhea, and pelvic pain before the onset of
    menstruation
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10
Q

Endometriosis

What is the definition of endometriosis?

A

Endometriosis is defined by the presence of endometrial glands and stroma outside the endomyometrium

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11
Q

Endometriosis

How many women get endometriosis?

A

Women in their reproductive years: 10%

Women with infertility: 50%

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12
Q

Endometriosis

What parts of the body are affected by endometriosis?

A

Endometriosis is multifocal and often involves pelvic structures
-> ovaries, puch of Douglas, uterine ligaments, tubes, and
rectovaginal septum

-> less freuquently: distant areas of the peritoneal cavity
or periumbilical tissue are involved

-> uncommonly: distant sites like lymph nodes, heart, bone …

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13
Q

Endometriosis

What is the reason of endometriosis?
Name the three theories!

A
  1. Regurgiation theory
    • mentrual backflow through the fallopian tubes (Eileiter)
      leads to implantation
  2. Metaplastic theory
    • the source is endometrial differentiation of coelomic
      epithelium (orgin of endometrium)
  3. Vascular or lymphatic dissemination (Verbreitung) theory
    • this explains extrapelvic or inteanodal implants

Conceivably(möglicherweise): all pathways could be valid

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14
Q

Endomertiosis

  1. What is the morphologic difference between endometriosis and
    adenomyosis?
  2. How do endometriosis lesions look like?
  3. When ovaries are involved, how does the lesions may look like?
A
  • in contrast to adenomyosis, endometriosis almost always
    contains functioning endometrium, which undergoes cylic
    bleeding
  1. because blood collects in these aberrant foci, they usually
    appear grossly as red-brown nodules or implants
    They range in size from microscopic to 1-2 cm
     With seepage (aussickern) and organization of the blood,
     widespread fibrosis occure, leading to adhesions among
     pelvic structures, sealing (Verschluss) of the tubal fimbriated
     ends, and distortion (Entstellung) of the ovaries and oviducts
  1. When ovaries are involved, the lesions max form large, blood-
    filled cysts that turn brown (chocolate cysts!!!!!!)
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15
Q

Endomyositis

  1. what are the clinical symptoms?
A
  1. They depend on the distribution(Vorkommen) of the lesion!
  • general: severe (stark) dysmenorrhea and pelvic pain
    resulting from intrapelvic bleeding and periuterine
    adhesions
  • Extensive scarring of the oviducts often produces discomfort
    in the lower abdominal quadrants and eventuallx serility
  • recta, wall involvment max produce pain on defection
  • involvment of the uterine bladder serosa can cause dyspareunia
    (Painful intercourse) and dysuria
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16
Q

Abnormal Uterine Bleeding

  1. What means menorrhagia?
  2. What means metrorrhagia?
A
  1. Menorrhagia: profuse (überreichlich) or prolonged bleeding
    at the time of the period
  2. metrorrhagia: irregular bleeding between the periods
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17
Q

Abnormal Uterine Bleeding

Name five common causes for Abnormal Uterine Bleeding!

A
  1. endometrial polyps
  2. leiomyomas
  3. endometrial hyperplasia
  4. endometrial carcinoma
  5. endometritis
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18
Q

Abnormal Uterine Bleeding

Name the possible reason for Abnormal Uterine Bleeding
depending on the age!

Prepuberty
Adolescence
Reproductive age
Perimenopause
Postmenopause
A

Prepuberty: Precocious (frühreif) puberty (hypothalamic, pituitary-
Hyophyese, or ovarian orgin)

Adolescence: Anovulatory (ohne Eisprung) cycle

Reproductive age:
- complications of pregnancy (abortion, trophoblastic disease,
ectopic pregnancy)

  • Proliferations (leiomyoma, adenomyosis, polyps, endometrial
    hyperplasia, carcinoma)
  • Anovulatory cycle
  • Ovulatory dysfunctional bleeding (e.g. Inadequate luteal phase)

Perimenopause: Anovulatory cycle
irregular shedding (abstoßen)
Proliferations (carcinoma, hyperplasia, polyps)

Postmenopause: Proliferation (carcinoma, hyperplasia, polyps)
Endometrial atrophy

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19
Q

Abnormal Uterine Bleeding - Failure of ovulation

  1. Name the reasons for anovulatory cycles!
A

Anovulatory cycles are very common

1)

  • hypothalamic-pituitary axis
  • adrenal dysfunction
  • thyroid dysfunction

2)
- functional ovarian lesions producing excess estrogen

3)

  • malnutrition
  • obesity (Fettheit)
  • debilitating (schwächend) disease

4)
- severe (schwer) physical or emotional stress

20
Q

Abnormal Uterine Bleeding -Failure of ovulation

  1. What do all reasons of anovulatory cycles have?
A

1.

- Excess of estrogen relative to progesterone

21
Q

Abnormal Uterine Bleeding - failure of ovulation

  1. Anovulatory cycles - What happens with the endometrium?
A

1.
The endometrium goes through a proliferative phase that is not follwed by the normal scretory phase.

The endometrial glands may develop mild cystic changes or appear disorderly. The glands are dilated

The endometrial stroma, which requires progesterone for growth,
may be scarce (knapp, rar)

-> This combination of abnormalities makes the endometrium prone(neigen) to breakdown and abnormal bleeding

22
Q

Abnormal Uterine Bleeding - inadequate luteal phase

  1. Discribe the inadequate luteal phase and the cause of bleeding
A

The corpus luteum may fail to mature normally or may regress
(verschlechtern) Prematurely leading to a relative lack of progesterone.
The endometrium under these circumstances fail to show the expected secretory changes

23
Q

Abnormal Uterine Bleeding - contraceptive-induced bleeding

  1. why?
A 
1.
Older oral contraceptives containing synthetic estrogens and progestin induced a variety of endometrial responses,
- including a lush
- decidua-like stroma
- inactive, nonsecretory glands

The pills in current use no longer cause these abnormalitis

24
Q

Proliferative Lesions of the Endometrium and Myometrium

Please, count the four most common proliferative lesions of the corpus uteri!

What do these lesions have incommon?

A
  1. Endometrial polyps
  2. Endometrial hyperplasia
  3. Endometrial carcinoma
  4. Smooth muscle tumors

—> they all tend to produce abnormal uterine bleeding as their
earliest manifestation

25
Q

Endometrial Hyperplasia

How does the endometrium proliferate?

A

The key of endometrial proliferation is estrogen.
A high estrogen excess, relative to progestin, can cause endometrial hyperplasia!!
As more estrogen is left, the more serious is the hyperplasia

26
Q

Endometrial Hyperplasia

Why is endomatrial hyperplasia so dangerous?

A

Because endometrial hyperplasia creates endometrial carcinoma!

27
Q

Endometrial Hyperplasia

List the potential causes of estrogen excess!

A
  1. failure of ovulation (such as is seen in perimenopause)
  2. prolonged administration of estrogenic steroids, without
    counterbalancing progestin
  3. Estrogen producing ovarian lesions
  4. obesity (Fat tissue converts sterioid precursors -> estrogen)
  • anovulatory cycle
  • polysystic ovary syndrom
  • estrogen producing ovarian tumor
  • obesity
  • estrogen therapy without counterbalacing progestin
28
Q

Endometrial Hyperplasia

What pathologic facts are important for the course of the disease?

A
  1. architectual crowding: simple vs. complex
  2. presence or absence of cytologic atypia

The risk of developing carcinoma is related to the presence of cellular atypia

29
Q

Endometrial Carcinoma

  1. How frequent are endometrial carcinoma?
  2. Who is affected?
A
  1. Endometrial carcinoma is the most frequent cancer in the femal
    genital tract!
  2. Women between 55-65
30
Q

Endometrial Carcinoma

Name the two kinds of Endometrial Carcinoma!

A
  1. endometrioid carcinoma

2. serous carcinoma

31
Q

Endometrial Carcinoma - endometrioid carcinoma

  1. What women are especially affected?
  2. With what is endometrioid carcinoma associated?
A
  1. perimenopausal women
  2. Endometrioid cancer is associated with estrogen excess and
    endometrial hyperplasia
32
Q

Endometrial Carcinoma - endometrioid carcinoma

  1. How oft doe the endometrioid carcinoma occure in relation
    to the other carcinoma (percent)?
  2. Name the 5 risk factors!
A
  1. 80% endometrioid carcinoma
  2. obesity, diabetes, hypertension, infertility, exposure to
    unopposed estrogen
33
Q

Endometrial Carcinoma - endometrioid carcinoma

  1. Estrogen causes endometrioid carcinoma! Name two
    possible estrogen stimulating factors/disease, which may
    cause endometrioid carcinoma!
    Endo
A

Estrogen replacement therapy

Estrogen-secreting ovarian tumors

34
Q

Endometrial Carcinoma - endometrioid carcinoma

  1. What illness is associated with endometrial carcinoma?
A
  1. breast carcinoma, because it is also estrogen-dependent
35
Q

Endometrial Carcinoma - endometrioid carcinoma

  1. Name the gen wich is affected!
A

Mutation in -> mismatch repair genes and the tumor suppressor
gene PTEN - are early events in the stepwise development of
endometrioid carcinoma

36
Q

Endometrial Carcinoma - endometrioid carcinoma

  1. What histological types does the endometrioid carcinoma
    include?
  2. Tumor orgin is the mucosa -> myometrium -> enter vascular
    spaces and may also metastasize to regional lymph nodes.
    How many gardes does the endometrioid carcinoma has?
A

1.

  • mucinous
  • tubal (ciliated)
  • squamous
  1. Grade 1-3
37
Q

Endometrial Carcinoma - serous carcinoma

  1. Who is endangered by serous carcinoma and what is the
    pathology which causes serous carcinoma?
A
  1. serous carcinoma arises in the setting of endometrial atrophy!!
    in older postmenopausal women!!!
38
Q

Endometrial Carcinoma - serous carcinoma

  1. How common is the serous cercinoma?
A
  1. just about 15% of endometrial carcinoma
39
Q

Endometrial Carcinoma - serous carcinoma

  1. What gen variation do nearly all serous carcinoma have
    incommon?
A

Nearly all cases have mutation in the TP53 tumor supressor gene

Immunohistochemistry often reveals high level of p53 in serous
carcinoma

40
Q

Endometrial Carcinoma - serous carcinoma

  1. What is the histological caracteristic?
A

1.

  • small tufts (Büschel) and papillae
  • much greater cytologic atypia
41
Q

Endometrial Carcinoma - serous carcinoma

  1. How bad are serous carcinoma?
A
  1. They behave very aggressively and are high grade
42
Q

Endometrial Carcinoma

  1. What 2 side-symptoms are associated with endometrial
    carcinoma?
  2. What happens with the uterus?
  3. Do these tumors grow fast or slow?
  4. What is the 5 years survival rate for early-stage?
A

1.

  • leukorrhea (Weißfluss)
  • irregular bleeding
  1. The uterus enlages and may become affixed to surrounding
    structures as the cancer infiltrates surrounding tissue
  2. Usualy slow
  3. 90%, higher stages however are dramatically worst
43
Q

Endometrial Carcinoma - endometrial polyps

  1. What do endometrial polyps may cause?
A

1.

  • abnormal uterine bleeding
  • the risk of giving rise to a cancer
44
Q

Endometrial Carcinoma - Leiomyoma

  1. What are leiomyoma?
A

1.
- benign tumors that arise from the smooth muscle cells in
the myometrium
- they are also called fibroids
- They grow because of estrogen and contraceptives

45
Q

Endometrial Carcinoma - Leiomyoma

  1. What is the color of leiomyomas?
  2. How do they look?
A
  1. gray-white (and firm)
    • They are sharply circumscribed
    • whorled (Windung) cut surface
    • often multiple
46
Q

Endometrial Carcinoma - Leiomyoma

  1. What are the symptoms? What are the risk?
A
  1. Leiomyomas are often asynptomatic!!!
    They may cause menorrhagiaThey almost never transform into sarcomasThey may be the reason of infertility
47
Q

Endometrial Carcinoma - Leiomyoma

  1. Where does a leiomyoma cones from?
  2. How does a leiomyoma looks like?
  3. What are the patho-histological characteristics of
    leimyosarcoma?
A
  1. de novo
  2. It is a soft, hemorrhagic, necrotic mass
  3. tumor necrosis, cytologic atypia, and mitotic activitx

—> you need all three features for an diagnosis

Pathology (12 decks)

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