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Repro 2 > Uterus - Dobson > Flashcards

Uterus - Dobson Flashcards

1
Q

2 layers of endometrium

A

Functional layer

Basal layer

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2
Q

Histology of menstrual phase

A

Functional layer sheds, bleeding into stroma (fibrin, RBCs, inflammatory cells), stromal breakdown

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3
Q

Histology of proliferative phase

A
  • Rapid growth of glands and stroma
  • Straight, tubular glands
  • No mucus or vacuolization
  • Pseudostratified columnar cells along glands
  • Numerous mitotic figures
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4
Q

Endothelial histology of secretory phase

A
  • Subnuclear –> supranuclear (week 3) vacuoles in glandular epithelium
  • Dilated glands (18-24)
  • Tortuous glands (week 4)
  • Serrated/saw-tooth
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5
Q

Stromal histology of secretory phase

A
  • Spiral arterioles
  • Increased ground substance and edema
  • Stromal cell hypertrophy and CYTOPLASMIC EOSINOPHILIA (predecidual change)
  • Resurgence of mitoses
  • High glycogen and lipid (decidualized cells)
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6
Q

AUB definition

A

Uterine bleeding that lacks an underlying organic/structural abnormality

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7
Q

AUB most commonly due to ____

Common times?

A

Anovulation (no ovulation)

Menarche, peri-menopause

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8
Q

Anovulation causes what hormonal imbalance?

A

Unopposed estrogen (no corpus luteum to make progesterone)

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9
Q

Metabolic disturbance causes of AUB

A

Obesity, malnutrition, chronic systemic disease

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10
Q

Endocrine causes of AUB

A

Thyroid, adrenal, pituitary

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11
Q

Ovarian lesion causes of AUB

A

Functioning tumors, polycystic ovary disease

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12
Q

In anovulation, what will not be seen on morphology?

What causes bleeding?

A

No secretory changes or vacuolization or predecidual changes

Glands break down and shed, causing bleeding

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13
Q

If anovulation is symptomatic (bleeding), what can be assumed?

A

Repeated cycles of no ovulation (not just 1)

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14
Q

Fever, vaginal bleeding, pelvic pain; recently pregnant; neutrophils in the endometrial stroma

Cause?

A

Acute endometritis

Retained products of conception

Group A strep, staph, others

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15
Q

Abnormal vaginal bleeding, pain, discharge, infertility; PLASMA CELLS in the endometrial stroma

Causes? (4)

A

Chronic endometritis (plasma cells = pathognomonic)

Chronic PID, retained POC, IUD, TB

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16
Q

Neutrophils AND plasma cells in the endometrial stroma

A

Chlamydia-associated chronic endometritis

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17
Q

Endometriosis - define

Most common locations

A

Ectopic endometrial tissue outside of the uterus

Ovaries, uterine ligaments, rectovaginal septum, others

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18
Q

4 theories of endometriosis

A
  • Regurgitation (retrograde flow of menses)
  • Metastases
  • Metaplastic (change of coelomic epithelium of mullerian origin)
  • Stem cell (BM cells)
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19
Q

Things seen in the endometriosis tissue AND the normal endometrium of women with endometriosis ONLY (2)

Treatment of endometriosis?

A
  • High release of pro-inflammatory and growth cytokines
  • High estrogen production by stromal cells (high aromatase)

Aromatase inhibitors

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20
Q

AUB, red/blue or yellow/brown nodules on or beneath mucosa or serosa

When extensive, can cause _____

A

Powder burn marks - endometriosis

—> fibrous adhesions

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21
Q

Distorted, cystic ovaries w/ brown fluid (dried blood)

A

Chocolate cyst – ovarian endometriosis

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22
Q

Endometriosis MUST have ____ tissue to be diagnosed as such

Can also have ___ tissue

A

Endometrial stroma

Endothelial

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23
Q

Symptoms of endometriosis (possible)

A

Pelvic pain, dysmenorrhea or menometrorrhagia, infertility, dyspareunia, painful defecation, dysuria

24
Q

Exophytic mass(es) that project into endometrial cavity – found on routine scope

Later they ulcerate, leading to ____

A

Endometrial polyps

–> AUB

25
Q

Endometrial polyps - what might you ask your patient?

A

Has she taken Tamoxifen (estrogen blocker)

26
Q

Endometrial hyperplasia - definition

Cause

A

Glandular proliferation –> increased gland:stroma ratio

Prolonged estrogen stimulation

27
Q

Causes of endometrial hyperplasia

A

Prolonged estrogen stimulation:

  • Anovulation
  • Obesity (fat aromatase = androgen –> estrogen)
  • Menopause (low progesterone
  • Polycystic ovarian syndrome (high estrone)
  • Functioning granulosa tumors of ovary
  • Cortical stromal hyperplasia (excessive ovary fxn)
  • Prolonged estrogen replacement therapy
28
Q

Endometrial hyperplasia - genetics (causes what?)

Familial syndrome?

A

PTEN inactivation –> PI3K/AKT overactivation –> enhanced signaling of estrogen receptor when activated

Cowden syndrome (PTEN loss) - high endometrial/breast cancer

29
Q

2 categories of endometrial hyperplasia

A

Non-atypical

Atypical (EIN)

30
Q

Increased gland:stroma ratio, varied gland size and shape, some intervening stroma remains

Potential consequence?

A

Non-atypical hyperplasia

—> cystic atrophy (when estrogen is removed)

31
Q

Complex pattern of proliferating glands, nuclear atypica, back-to-back w/ branching, loss of orientation to BM, vesicular (open) chromatin

How to differentiate from cancer?

A

Atypical hyperplasia (endometrial intraepithelial neoplasia)

Cancer = NO INTERVENING STROMA

32
Q

Treatments for endometrial hyperplasia

A

Reproductive age = progesterone

Older or unresponsive = hysterectomy

33
Q

Most common age group of endometrial cancer

Most common early sign of endometrial cancer

A 
Postmenopausal women (55-65)
Irregular or postmenopausal bleeding
34
Q

2 types of endometrial cancer

A

Type 1 = endometrial carcinoma

Type 2 = serous carcinoma

35
Q

60 y/o women w/ obesity and abnormal GTT. Presents w/ abnormal bleeding from her vagina. Tests show abnormal endometrial growth. Pathology shows crowded but normal-looking glands, vesicular chromatin, and no intervening stroma.

What are her 5 most common gene mutations?
What was her precursor?

A

Type 1 (endometrial) carcinoma

PTEN, MLH1 (DNA MMR), KRAS, PIK3CA, ARID1A

Via endometrial hyperplasia

36
Q

3 forms of endometrioid (type 1) carcinoma

What morphologic characteristic do they all share (apart from hyperplasia)?

A

Well differentiated – all well-formed glands
Moderately differentiated - less than 50% solid sheets of cells
Poorly differentiated - > 50% solid growth pattern

NO INTERVENING STROMA

37
Q

***3 classic associations w/ endometrioid carcinoma

A

Obesity, DM, Hypertension

38
Q

Type 2 (serous) carcinoma…

  • Frequently in _____
  • By definition, _____
  • Arises in setting of _____
  • Overlaps with _____
A
  • African americans
  • Poorly differentiated (grade 3)
  • Endometrial atrophy (sporadic)
  • Ovarian serous carcinoma
39
Q

Type 2 (serous) carcinoma – difference in genetics compared to Type 1

A

Type 2 = TP53 EARLY (90%)

Type 1 = TP53 LATE & only in poorly-differentiated (50%)

40
Q

Type 2 (serous) carcinoma – precursor

How does it differ from the cancer?

A

Serous endometrial intraepithelial carcinoma

NO STROMAL INVASION

41
Q

70 y/o women presents w/ abnormal bleeding from her vagina. Tests show an endometrial mass. Pathology shows a small atrophic uterus with a large bulky tumor that deeply infiltrates the myometrium.

Most likely methods of spread?

A

Type 2 (serous) carcinoma

–> lymphatics or tubes –> extrauterine spread

42
Q

Some type 2 carcinomas can have a glandular growth pattern. How to differentiate from type 1?

A

Type 2 = marked cytologic atypia (NOT normal-looking)

43
Q

Endometrial tumor w/ glandular and mesenchymal (stromal, muscle, cartilage, etc.) elements

Typical genetics?
Typical metastasis characteristic?

A

Carcinosarcoma (malignant mixed mullerian tumors)

CARCINOMA genetics (TP53, PTEN, PIK3CA), NOT stromal

Epithelial components ONLY

44
Q

MMMTs - typical presentation

Extrauterine mesenchymal elements mean _______

A

Postmenopausal woman w/ bleeding

Worse prognosis

45
Q

JAZF1-SUZ12 translocation

A

Pure endometrial STROMAL neoplasms (nodules, sarcomas)

46
Q

Potential finding later on w/ stromal sarcoma

A

Distant mets DECADES LATER

47
Q

Sharply circumscribed, round, firm, gray-white tumors within the uterine wall. Whorled pattern w/ oval nuclei w/ slender bipolar cytoplasmic processes

3 location possibilities

A

Leiomyoma (fibroids)

  • Intramural (w/in the heart of the myometrium)
  • Submucosal (just beneath endometrium)
  • Subserosal (just beneath outer serosa)
48
Q

Leiomyoma - genetics

A

MED12 mutations (70%), HMGIC translocations (40%)

49
Q

Potential symptoms of leiomyoma (normal woman)

A
  • Abnormal bleeding
  • Urinary frequency
  • Impaired fertility
  • Sudden pain (infarction)
50
Q

Potential symptoms of leiomyoma (pregnancy)

A
  • Abortion
  • Fetal malpresentation
  • Uterine inertia (doesn’t contract well)
  • Post-partum hemorrhage
51
Q

2 rare subtypes of leiomyoma

A
  • Benign metastasizing (extends into vessels and spreads)

- Disseminated peritoneal leiomyomatosis (multiple small peritoneal nodules)

52
Q

Lung disease, TSC2 mutation, leiomyoma

A

Lymphangioleiomyomatosis

53
Q

Mass in uterine wall, whorled pattern of SM bundles
Nuclear atypia, mitotic index, zonal necrosis

What classically indicates malignancy? (w/o anything else)

A

Leiomyosarcoma

10+ mitoses per 10 high power fields

54
Q

Leiomyosarcoma…

5+ mitoses per 10 HPFs is sufficient if ______

A

Nuclear atypia or large epithelioid cells are present too

55
Q

Leiomyosarcoma - what to know about progression

How does it get there? (vessel)

A

> 50% metastasize hemoatogenously (lungs esp.)

Inferior vena cava

Repro 2 (28 decks)

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