Female Genital System 2 Flashcards
(8 cards)
What is endometrial hyperplasia, and what causes it?
Endometrial hyperplasia is an exaggerated proliferation of endometrial glands with an increase in the gland to stroma ratio > 3:1 due to excess, prolonged estrogen stimulation relative to progesterone. It is caused by excess endogenous estrogen (e.g., failure of ovulation, estrogen-producing ovarian lesions, obesity) or excess exogenous estrogen (e.g., prolonged administration of estrogenic steroid without counterbalanced progesterone).
What are the two main categories of endometrial carcinoma, and how do they differ?
The two main categories of endometrial carcinoma are:
1. Endometrioid type (commonest type, well-differentiated, associated with excess estrogen levels and endometrial hyperplasia with atypia).
2. Serous type (less common, more aggressive, associated with P53 gene mutation).
What are the risk factors for endometrioid endometrial carcinoma?
The risk factors for endometrioid endometrial carcinoma include:
1. Obesity.
2. Infertility (nullipara, anovulation).
3. Prolonged estrogen replacement therapy.
4. Estrogen-secreting ovarian tumors (granulosa cell tumor, polycystic ovary).
5. Mutations in tumor suppressor gene PTEN.
What are the gross and microscopic features of endometrioid endometrial carcinoma?
Grossly: It appears as a fungating exophytic mass or diffuse thickening of the endometrium.
Microscopically: It shows abnormal irregular glands closely packed together in a ‘back to back’ appearance, lined by malignant columnar epithelium with cellular atypia, containing necrotic debris, and with scanty stroma.
What is a leiomyoma, and what are its characteristics?
A leiomyoma is a benign tumor of the smooth muscle cells of the uterine myometrium, also called fibroids due to its firmness. It is stimulated by estrogen and progesterone, and it shrinks post-menopausally. It is more common in blacks than whites and is associated with rearrangement of chromosomes 6 and 12. Malignant transformation to leiomyosarcoma is extremely rare.
What are the gross features of leiomyoma?
Grossly, leiomyomas are often multiple masses (could be single), sharply circumscribed, well-demarcated from the surrounding myometrium by a false capsule (nonencapsulated). They appear as firm gray-white masses with a whorled cut appearance. Macroscopically, they can be intramural (within the myometrium), submucosal (beneath the endometrium), or subserosal (beneath the serosa).
What are the histological features of leiomyoma?
Histologically, leiomyoma shows interlacing smooth muscle bundles which resemble normal myometrium running in different directions, separated by connective tissue fibers. There may be foci of fibrosis, calcification, and hemorrhage.
What is leiomyosarcoma, and what are its characteristics?
Leiomyosarcoma is a malignant tumor that arises from mesenchymal cells of the myometrium, occurring in postmenopausal women. It appears as a soft, hemorrhagic, necrotic mass, almost always solitary. It is highly metastatic, spreading hematogenously to distant organs (e.g., lung, bone). Diagnostic histological features include necrosis, atypia, and mitotic activity.
