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REI Written Boards > Uterus > Flashcards

Uterus Flashcards

1
Q

What does the presence of plasma cells (B cells) indicate on an EMB and what is the frequency?

A

Chronic endometritis, present in 10% biopsies done for AUB

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2
Q

When does implantation occur?

A

5-7 days after ovulation

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3
Q

What are the 3 cytokines expressed by the endometrium during implantation?

A

CSF-1, IL-1, LIF

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4
Q

What does the blastocyst express during implantation?

A

Heparin binding EGF (HB-EGF)

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5
Q

What are integrins?

A

Cell surface receptors involved in cell-cell and cell-matrix binding
Integrin expression is temporally related to implantation

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6
Q

What the important integrins found during implantation?

A

alpha-5, beta-6 integrin

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7
Q

What happens to NK cell concentration during implantation?

A

Increases

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8
Q

Define AUB?

A

Menstrual flow outside of normal volume (80cc), duration (5d), regularity or frequency (q21-35d)

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9
Q

What is Reeds Syndrome?

A
  • Rare inherited condition characterized by multiple cutaneous leiomyomas and, in women, uterine leiomyomas.
  • Predisposes for renal cell cancer, an association denominated hereditary leiomyomatosis and renal cell cancer
  • Increased risk of uterine leiomyosarcoma
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10
Q

What is the most common cause of AUB?

A

Fibroids

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11
Q

What is the mechanism of growth of fibroids?

A

TGF-β dysregulation

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12
Q

Describe the onset of menses

A

Instead of vascular events, the new model of the initiation of menstruation is an enzymatic autodigestion of the functional layer of the endometrium and its subsurface capillary plexus

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13
Q

Describe cessation events of menses

A

Coagulation mechanisms, local vasoconstriction, and re-epithelialization -> homeostasis

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14
Q

What are the embryological origins of the kidneys?

A

Metanephric

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15
Q

What are the embryological origins of the Wolffian ducts?

A

Mesonephric

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16
Q

What are the embryological origins of the Mullerian ducts?

A

Paramesonephric

17
Q

What is the most common uterine anomaly associated with RPL?

A

Septum

18
Q

When is canalization of the vagina complete?

A

22 weeks gestation

Starts around 18 weeks gestation

19
Q

Which is the uterine anomaly associated with poorest reproductive outcome?

A

Septum

20
Q

What is the risk of pregnancy loss associated with a uterine septum?

A

65% risk of pregnancy loss

Bicornuate = 30-40%

21
Q

What is the risk of pregnancy loss associated with a unicornuate uterus?

A

50% risk of pregnancy loss

22
Q

What is the risk of pregnancy loss associated with a uterine didelphys?

A

40% risk of pregnancy loss

23
Q

What is the risk of pregnancy loss associated with a bicornuate uterus?

A

30-40% risk of pregnancy loss

24
Q

When does the ambisexual period of mullerian development occur and what is it?

A

Up to 8 weeks and is the period when both ducts co-exist

25
Q

When do the paramesonephric ducts fuse?

A

~10 weeks; forms a T shape

26
Q

Describe the risk of pregnancy loss associated with a unicornuate uterus in the first trimester?

A

24% risk of SAB in 1st trimester

27
Q

Describe the risk of preterm delivery associated with a unicornuate uterus?

A

20% risk of PTD

28
Q

Describe the risk of SAB in second trimester associated with a unicornuate uterus?

A

10% 2nd trimester SAB

29
Q

Is an HSG able to differentiate between a bicornuate and septate uterus?

A

No

30
Q

What is the hypothesized role played by Human leukocyte antigen G (HLA-G) in implantation?

A

Modulates cytokine secretion to control trophopblastic cell invasion and to maintain a local immunotolerance

31
Q

What are the effects of P4 on implantation?

A

High P4 levels -> perivascular growth/decidualization -> suppression of prostaglandin, cytokine, MMP expression

32
Q

What are the most abundant lymphoid cells in perimenstrual endometrium?

A

NK cells

33
Q

Describe concentration of NK cells during proliferative and secretory phase?

A
  • Few present in proliferative phase

- Comprise 15-25% of cells in stroma during secretory phase – possibly due to endometrial PRL production?

34
Q

What are the proposed purpose of NK cells in implantation?

A

May have a role in initiating/maintaining decidualization, modulate trophoblast invasion & placentation

35
Q

How is endometrial dating performed? (9 features)

A

Glandular Changes:

  1. Tortuosity
  2. Mitoses
  3. Orientation of nuclei (pseudostratfied or palisading)
  4. Subnuclear cytoplasmic vacuoles (first histologic sign of ovulation)
  5. Secretory exhaustion (luminal secretions)

Stromal Changes:

  1. Edema
  2. Mitoses
  3. Predecidua
  4. Granular Lymphocyte infiltrate
36
Q

Describe the granular lymphocyte infiltrate component of endometrial dating

A

CD3+ T cells only 1-2% of lymphoid cells in endometrium and increase prior to menstruation
Ratio of CD4 (helper-) / CD8 (cytotoxic-T cells) in endometrium is reversed compared w/ peripheral blood
CD8 cells active during proliferative phase, diminished in secretory phase
Few B cells and plasma cells present

37
Q

When does prostaglandin content reach its highest levels and what are the specific prostaglandins observed?

A

Prostaglandin content (PGF2a/PGE2) in secretory endometrium reaches highest levels at menstruation

38
Q

Name the cell types seen in the healthy endometrium that are known to vary by the menstrual cycle.

A

Macrophages, neutrophils and NK cells

39
Q

Describe the features of B and T cells

A

Part of adaptive immunity that are activated by specific antigen

REI Written Boards (20 decks)

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