Gynecologic Pathology I

Question 1

Indications for endometrial biopsy

Answer 1

determine cause of abnormal uterine bleeding, evacuation of ectopic pregnancy, assess response of endometrium to hormone tx

Question 2

____ phase is the first 36-48 hours between ovulation and first histologic changes due to ovulation

Answer 2

interval

Question 3

What is the first histologic evidence of ovulation

Answer 3

abundant subnuclear vacuoles

Question 4

Histologic features of proliferative endometrium

Answer 4

mitoses, round regular glands, stratified nuclei

Question 5

Histologic features of early secretory endometrium

Answer 5

subnuclear vacuoles, single row of nuclei

Question 6

Histologic features of mid secretory endometrium (day 20-21)

Answer 6

prominent spiral arteries and predecidual change around them

Question 7

Histologic features of late secretory endometrium (day 26-27)

Answer 7

confluent sheets of predecidua (pink) and lymphocytes

Question 8

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

Answer 8

Menorrhagia

Question 9

Bleeding, usually not heavy, occurring at irregular intervals.

Answer 9

Metrorrhagia

Question 10

Excessive bleeding with prolonged period of flow occurring at frequent and irregular intervals.

Answer 10

Menometrorrhagia

Question 11

Painful menses

Answer 11

Dysmenorrhea

Question 12

Abnormal bleeding that occurs at least one year after menopause.

Answer 12

Postmenopausal bleeding.

Question 13

Abnormal bleeding prior to puberty may indicate

Answer 13

precocious puberty

Question 14

Adolescent abnormal bleeding may indicate

Answer 14

dysfunctional bleeding or complications of pregnancy

Question 15

Abnormal bleeding during reproductive years may indicate

Answer 15

complications of pregnancy, endometritis, dysfunctional bleeding, lesions

Question 16

Abnormal bleeding in later years may indicate

Answer 16

atrophy, carcinoma, lesions

Question 17

Alteration of the normal cyclical hormonal stimulation of the endometrium that is not postmenopausal bleeding or that does not occur in the presence of a pathologic process.

Answer 17

Dysfunctional uterine bleeding DUB

Question 18

Clinically, DUB indicates _____

Answer 18

ovulatory dysfunction

Question 19

Common histologic finding of DUB

Answer 19

stromal and glandular breakdown

Question 20

Pathophysiology of DUB

Answer 20

without progesterone, estrogen will result in continued proliferation –> gland enlargement, irregular, disordered –> insufficient vascular support –> breakdown and bleeding

Question 21

Collapse of stroma form what histological feature?

Answer 21

stromal blue balls –> collapsed, condensed balls with attenuated epithelial surface

Question 22

____ is a result of lack of estrogen stimulation causing 25-50% of abnormal uterine bleeding in postmenopausal women.

Answer 22

endometrial atrophy –> cystic change of glands is common

Question 23

cystic atrophy of endometrium

Answer 23

stroma is less cellular and fibrotic; glands are cystically enlarged//no mitoses

Question 24

localized hyperplasia of basal endometrium present with abnormal bleeding and with no malignant potential

Answer 24

endometrial polyps

Question 25

Grossly, endometrial polyps can be ____ or ____ . (think jellyfish)

Answer 25

sessile or pedunculated

Question 26

Histologic features of polyps

Answer 26

irregular glands, thick walled blood vessels

Question 27

Benign smooth muscle tumor of the corpus, cervix, uterine ligaments, or ovaries.

Answer 27

leiomyoma/fibroids

Question 28

T/F leiomyomas are more common in AAs

Answer 28

T

Question 29

How are leiomyomas classified?

Answer 29

location

Question 30

leiomyoma in wall of myometrium

Answer 30

intramural

Question 31

leiomyoma under endometrium

Answer 31

submucosal

Question 32

leiomyoma on outer surface of uterus

Answer 32

subserosal

Question 33

symptoms of leiomyoma

Answer 33

uterine enlargement, multiple leiomyomas, abnormal bleeding, painful menses, infertility, spontaneous abortion

Question 34

complications of a pedunculated fibroid

Answer 34

torsion, infarction, separation from uterus = parasitic leiomyoma

Question 35

Difference between endometrial polyp and submucosal leiomyoma under hysteroscopy

Answer 35

submucosal leiomyoma has thinner membrane with visualizable blood vessel

Question 36

Difference between submucosal leiomyoma and endometrial polyp

Answer 36

former is a tumor of the myometrium and the latter arises from the endometrium

Question 37

Typical leiomyoma cut surface

Answer 37

well circumscribed, bulges from myometrium, solid white/tan, whorled appearance, no necrosis or hemorrhage

Question 38

Typical leiomyoma histological features

Answer 38

uniform, bland spindled muscle cells with fascicular arrangement, abundant pink cytoplasm, uniform/oval/cigar nuclei, fine chromatin, rare mitoses

Question 39

malignant counterpart of leiomyoma of the smooth muscle of uterus

Answer 39

leiomyosarcoma

Question 40

Which groups have higher rate of leiomyosarcoma?

Answer 40

AAs and pts on tamoxifen

Question 41

leiomyosarcoma gross features

Answer 41

loss of whorls, irregular margin, yellow, necrosis, hemorrhage

Question 42

Diagnostic features of leiomyosarcoma

Answer 42

invasion of myometrium, vascular invasion, increased cellularity, nuclear atypia, increased mitotic activity, coagulative necrosis

Question 43

Endometrial tissue (glands and stroma) outside uterine cavity in women of reproductive age --> pelvic peritoneum and ovaries.

Answer 43

endometriosis

Question 44

Risk factors for endometriosis

Answer 44

genetic, increased exposure to menstruation (cervical stenosis, volume of retrograde menstruation, duration of flow)

Question 45

3 theories of endometriosis pathophysiology

Answer 45

transplantation, metaplasia, induction

Question 46

endometriosis transplantation

Answer 46

endometrial fragments migrate to ectopic sites

Question 47

endometriosis metaplasia

Answer 47

metaplasia of peritoneum

Question 48

endometriosis induction

Answer 48

induction of undifferentiated mesenchyme in ectopic sites to form endometriotic tissue

Question 49

Chocolate cyst

Answer 49

endometriotic cyst of ovary --> thick brown cyst content

Question 50

Symptoms of endometriosis

Answer 50

secondary dysmenorrhea, pelvic pain, ascites, dyspareunia, infertility

Question 51

T/F there is no correlation between severity of symptoms and extent of endometriosis

Answer 51

T

Question 52

Presence of endometrial tissue within the uterine wall.

Answer 52

adenomyosis --> downgrowth of tissue into and between smooth muscle fascicles

Question 53

Symptoms of adenomyosis

Answer 53

menometorrhagia, dysmenorrhea, dyspareunia, pelvic pain

Question 54

Gross features of adenomyosis

Answer 54

functional endometrial nests within myometrium producing foci of hemorrhagic cysts in uterine wall