Flashcards in GYN path 2 Deck (31)
What is endometrial hyperplasia?
Non-physiologic, non-invasive proliferation of endometrium
What is the cause of endometrial hyperplasia?
Increased, unopposed estrogen effect
What is the clinical presentation of endometrial hyperplasia?
What age group is more affected with endometrial hyperplasia?
Perimenopausal years (anovulatory cycles leads to relative dec in progesterone, things are unbalanced)
What are the risk factors for endometrial hyperplasia?
-Ovarian lesions, obesity, hypertension, diabetes, reproductive factors (late menopause, early menarche, nulliparity=no births), smoking
What are some protective factors for endometrial hyperplasia?
-Large # births
-Old age at first birth
-Long birth pd
-Short premenopausal delivery-free pd
What are the histologic features of endometrial hyperplasia?
-Abundant material with curettage
-Inc gland-to-stroma ratio
-Irregular gland shape/size
What are the classifications of endometrial hyperplasia?
Hyperplasia without atypia (simple or complex=based on glandular complexity and amt of stroma)
Hyperplasia with atypia (simple or complex)
What classification type is most at risk for cancer?
Hyperplasia with atypia
What is the difference between hyperplasia and carcinoma?
-Invasion of endometrial stroma--any of the 3
1. Irregular infiltration of glands associated with altered fibroblastic stroma (desmoplastic response=growth of fibrous or connective tissue)
2. Confluent glandular pattern uninterrupted by stroma (cribriform glands=like honeycomb cereal)
3. Extensive papillary pattern (fibrovascular cores lined by epithelial cells)
What is endometrial carcinoma?
Most common malignant tumor of female genital tract
What are the two types of endometrial carcinoma?
Type I: estrogen dependent (endometrioid type, related to hyperplasia)
Type II: estrogen independent (serous/clear cell type, not related to hyperplasia)
What is the difference between type I and type II with regards to unopposed estrogen?
What is the difference between type I and type II with regards to menopausal status?
I: pre and peri
What is the difference between type I and type II with regards to precursor lesion?
I: Atypical hyperplasia
II: Intraepithelial carcinoma
What is the difference between type I and type II with regards to tumor grade?
What is the difference between type I and type II with regards to myometrial invasion?
(both are variable)
What is the difference between type I and type II with regards to histologic subtypes?
II: Serous, clear cell
What is the difference between type I and type II with regards to behavior?
What is the difference between type I and type II with regards to genetic alterations?
I: PTEN mut, K-ras mut, Microsatellite instability (proliferation)
II: P53 mut (no proliferation with abnormal nuclei)
What is stage I endometrial carcinoma?
Confined to uterus
IA: confined to endomet
IB: invades 50% myomet
What is stage II endometrial carcinoma?
IIA: Glandular involvement only
IIB: cervical and stromal involvement
What is stage III endometrial carcinoma?
Uterine serosa, adnexa, pos cytology, vaginal or pelvic LN metastases
What is stage IV endometrial carcinoma?
Invasion of bladder or bowel mucosa or distant metastases
What is the prognosis for endometrial carcinoma?
Survival rate of 75-80%
African Americans=poorer prognosis
Survival for localized disease is 90%
What are the symptoms/signs of cervical cancer?
Abnormal vaginal bleeding, post-coital bleeding
What are the risk factors for cervical cancer?
HPV 16, 18
Less evidence: >6 sexual partners, smoking, early age 1st interocourse, immunosuppresion
What are the precursor lesions to cervical cancer?
Dysplasia of inc severity (CIN1-3), detection by pap and histology
Where do precursor lesions to cervical cancer occur?
Squamocolumnar jxn (transformation zone)
What viral genes of high risk HPV cause the cellular transformation?
E6 and E7 genes