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What are the indications for endometrial biopsy?

1. Determine cause of abnormal uterine bleeding
2. Eval endo in infertile pts
3. Evacuation
4. Assess the response of endometrium to hormone therapy


What is the first histologic evidence of ovulation?

Abundant subnuclear vacuoles in epithelial cells


What is the interval phase?

There are 36-48 hours between ovulation and the first histologic changes of the endometrium


What are the histologic dating pts to look at?

-Glandular changes
-Stromal changes


What histologic features are present at day 17?

Uniform subnuclear vacuoles, single row of nuclei


What histologic features are present at day 20-21?

Intraluminal secretions, mared stromal edema "naked nuclei"


What histologic features are present at day 23-24?

Prominent spiral arteries, predecidual change around spiral arteries


What histologic features are present at day 26-27?

Confluent sheets of predecidua, lymphocytes


What is menorrhagia?

Excessive bleeding in both amt and duration of flow occurring at regular intervals


What is metrorrhagia?

Bleeding, not usually heavy, occurring at irregular intervals


What is menometrorrhagia?

Excessive bleeding with prolonged pd of flow occurring at freq and irregular intervals


What is dysmenorrhea?

Painful menses


What is postmenopausal bleeding?

Abnormal bleeding at least 1 year after menopause


What is dysfunctional uterine bleeding (DUB)?

Alteration of the normal cyclical hormonal stimulation of the endometrium. There is no underlying organic disorder and it usually indicates ovulatory dysfunction. It excludes postmenopausal bleeding and presence of pathological processes.


What is a common histologic finding in DUB?

Stromal and glandular breakdown with no secretory endometrium. Collapse of stroma into "stromal blue balls" and evidence of bleeding.


Describe the process of glandular and stromal breakdown

When there is no progesterone, but normal estrogen ovulation doesn't occur. However, estrogen causes the endometrial lining to continue to grow. The glands become enlarged, irregular and disordered. Once it gets too big for the blood supply, it breaks down and bleeding occurs.

There is a non-secretory background, collapse of stroma into aggregates (stromal balls), nuclear debris and reparative epithelial changes and evidence of bleeding


What is endometrial atrophy?

Common cause of bleeding in postmenopausal women. Due to lack of estrogen stimulation


What is the histology with endometrial atrophy?

Dilation of cystic glands with no mitosis (may result in thickened endometrial stripe) . Less cellular, fibrotic stroma with few glands and evidence of bleeding


What are endometrial polyps?

Localized hyperplasia of the basal endometrium. Do not respond to cycling hormones in a normal manner. They can break down and bleed irregularly. They have no malignant potential, but there can exist a carcinoma within them.


What do endometrial polyps look like grossly?

Vary in size, can be sessile (flat) or pedunculated (floppy)


What is the histology of endometrial polyps?

Larger tissue fragments with dense, fibrotic stroma and thick-walled arteries. Irregular glands that may be dilated or focally crowded. Separate fragments of normal endometrium (background).


What is a Leiomyoma?

Benign smooth muscle tumor that can happen anywhere but usually occurs in the corpus/body of the uterus


What demographic is Leiomyoma most common in?

African Americans get them at a younger age, more commonly symptomatic and larger


What is the etiology of a leiomyoma?

Caused by some hormonal event because they occur during reproductive age and regress after menopause and they have a high sensitivity to estrogen.


What is the most freq tumor of the female genital tract?



What are the symptoms of a leiomyoma?

-Abnormal bleeding
-Infertility and/or spontaneous abortions


What is the gross appearance of a leiomyoma?

Well circumscribed, solid, white/tan, whorled, no necrosis of hemorrhage, thinning of endometrium over leiomyoma


What is the histologic appearance of leiomyoma?

-Cells look like the layer of the uterus from which they arise
-Abundant pink cytoplasm with uniform nuclei and rare mitoses


What is a leiomyosarcoma?

Malignant smooth muscle tumor


Gross features of leiomyosarcoma?

-Loss of whroled pattern
-No margin
-Softer, less rubbery, less resilient
-Absence of bulging surface


Histology of leiomyosarcoma?

Invasion of surrounding myometirum, vascularization, inc cellularity, nuclear atypia, inc mitosis, coagulative necrosis


What is endometriosis?

Endometrial tissue outside the uterine cavity. Effects women in reporductive years


What are the most freq sites of endometriosis?

Pelvic peritoneum, ovaries


What are the risk factors for endometriosis and what reduces risk?

-Genetic, menstruarion

Dec risk:
-Multiparous women (>1 child), OCP


What are the 3 theories of pathogenesis of endometriosis?

1. Transplantation of endometrial fragments to ectopic sites
2. Metaplasia of peritoneum
3. Induction of undifferentiated mesenchyme in ectopic sites to form endometriotic tissue


What is the most likely pathogenesis of endometriosis and explain it

-Menstrual products flow retrograde throug tube to peritoneal cavity
-Uncommon sites explained by vascular or lymphatic spread or direct implantation like surgical scars


What are the symptoms of endometriosis?

-Secondary dysmenorrhea, pelvic pain, infertility, dyspareunia (painful sex)


Gross features of endometriosis

Tiny bruises on surface of tissue. CAn form chocolate cysts if in ovaries because blood accumulates


What is adenomyosis?

Presence of endometrial tissue in uterine wall (myometrium). Presumably represents down growth of endometrial tissue into and between smooth muscle fascicles of myometrium


What are the symptoms of adenomyosis?

Menometrorrhagia, dysmenorrhea, dyspareunia, pelvic pain


What is adenomyosis grossly?

Functional endoemtrial nests within myometrium, producing foci of hemorrhagic cysts in uterine wall