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Flashcards in GYN path 2 Deck (31)
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1

What is endometrial hyperplasia?

Non-physiologic, non-invasive proliferation of endometrium

2

What is the cause of endometrial hyperplasia?

Increased, unopposed estrogen effect

3

What is the clinical presentation of endometrial hyperplasia?

Abnormal bleeding

4

What age group is more affected with endometrial hyperplasia?

Perimenopausal years (anovulatory cycles leads to relative dec in progesterone, things are unbalanced)

5

What are the risk factors for endometrial hyperplasia?

Exogenous: estrogens

Endogenous:
-Ovarian lesions, obesity, hypertension, diabetes, reproductive factors (late menopause, early menarche, nulliparity=no births), smoking

6

What are some protective factors for endometrial hyperplasia?

-Large # births
-Old age at first birth
-Long birth pd
-Short premenopausal delivery-free pd

7

What are the histologic features of endometrial hyperplasia?

-Abundant material with curettage
-Diffuse abnormality
-Inc gland-to-stroma ratio
-Irregular gland shape/size
-Mitotic activity

8

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)

9

What classification type is most at risk for cancer?

Hyperplasia with atypia

10

What is the difference between hyperplasia and carcinoma?

Carcinoma has...
-Myometrial invasion
-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)

11

What is endometrial carcinoma?

Most common malignant tumor of female genital tract

12

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)

13

What is the difference between type I and type II with regards to unopposed estrogen?

I: present

II: absent

14

What is the difference between type I and type II with regards to menopausal status?

I: pre and peri

II: post

15

What is the difference between type I and type II with regards to precursor lesion?

I: Atypical hyperplasia

II: Intraepithelial carcinoma

16

What is the difference between type I and type II with regards to tumor grade?

I: Low

II: High

17

What is the difference between type I and type II with regards to myometrial invasion?

I: minimal

II: deep

(both are variable)

18

What is the difference between type I and type II with regards to histologic subtypes?

I: Endometrioid

II: Serous, clear cell

19

What is the difference between type I and type II with regards to behavior?

I: Indolent

II: Aggressive

20

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)

21

What is stage I endometrial carcinoma?

Confined to uterus
IA: confined to endomet
IB: invades 50% myomet

22

What is stage II endometrial carcinoma?

Cervical involvement
IIA: Glandular involvement only
IIB: cervical and stromal involvement

23

What is stage III endometrial carcinoma?

Uterine serosa, adnexa, pos cytology, vaginal or pelvic LN metastases

24

What is stage IV endometrial carcinoma?

Invasion of bladder or bowel mucosa or distant metastases

25

What is the prognosis for endometrial carcinoma?

Survival rate of 75-80%
African Americans=poorer prognosis
Survival for localized disease is 90%

26

What are the symptoms/signs of cervical cancer?

Abnormal vaginal bleeding, post-coital bleeding

27

What are the risk factors for cervical cancer?

HPV 16, 18
Less evidence: >6 sexual partners, smoking, early age 1st interocourse, immunosuppresion

28

What are the precursor lesions to cervical cancer?

Dysplasia of inc severity (CIN1-3), detection by pap and histology

29

Where do precursor lesions to cervical cancer occur?

Squamocolumnar jxn (transformation zone)

30

What viral genes of high risk HPV cause the cellular transformation?

E6 and E7 genes

31

What is necessary for dev of cancer?

HPV persistence since immune system can often reverse low grade lesions