Lecture 14: Gynecologic Pathology I

Question 1

If it is day 18 and you have proliferation, what does that mean?

Answer 1

It means it is an anovulating cycle, or she has yet to ovulate

Question 2

What are the histological features of proliferative endometrium?

Answer 2

Mitoses
Stratified nuclei
Round REGULAR glands

Question 3

What are the histological features
of secretory endometrium (right
after ovulation)?

Answer 3

Abundant subnuclear vacuoles
Looks like the endometrium
Is secreting shit
Glandular appearance still there
But ABNORMAL

Question 4

What are the histological features of secretory endometrium 6 days after ovulation?

Answer 4

Loss of glands

SPIRAL ARTERIES

Question 5

What does endometrium look like if she is about to menstruate?

Answer 5

Confluent sheets of predecidua

LYMPHOCYTES

Question 6

What is dysfunctional uterine bleeding (DUB)?

Answer 6

A very specific (nonspecific) disorder where no ovulation occurs
Alteration of the normal cyclical hormonal stimulation of the endometrium
No underlying organic disorder!
Clinically DUB indicates ovulatory dysfunction
EXCLUDES
i. postmenopausal bleeding
ii. Presence of specific pathological processes
(inflammation, polyps, hyperplasia, carcinoma, exogenous, complications of pregnancy, exogenous hormones)

Question 7

What is the histological sign that ovulation did not occur?

Answer 7

Stromal Blue Balls

Question 8

What are the common histologic findings for Dysfunctional uterine bleeding (DUB)?

Answer 8

1. Stromal breakdown
   STROMAL BLUE BALLS
2. Glandular breakdown
3. Non-secretory background

Question 9

Why is there stromal and glandular breakdown in DUB?

Answer 9

No progesterone/no ovulation
Proliferation of glands OUTGROW blood supply
And when endometrium outgrows blood supply (because it couldn’t stop proliferating in the first place) then you have a problem
Breakdown of glands/stroma with bleeding

Question 10

What are the causes of abnormal vaginal bleeding?

Answer 10

1. Extrauterine causes (trauma)
2. Menorrhagia
3. Metrorrhagia
4. Menometrorrhagia
5. Dysmenorrhea
6. Postmenopausal bleeding

Question 11

What is Menorrhagia?

Answer 11

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

Question 12

What is Metrorrhagia?

Answer 12

Bleeding, usually not heavy, occurring at irregular intervals
Kind of like the metro train stopping at irregular intervals

Question 13

What is menometrorrhagia?

Answer 13

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

Question 14

What is Dysmenorrhea?

Answer 14

Painful menses

Question 15

What is abnormal uterine bleeding?

Answer 15

Any non-physiologic uterine bleeding
Common sign of a number of different uterine disorders
	-infection
	-polyps, fibroids
	-pregnancy
	-neoplasia
	-clotting disorders

Question 16

What are the three benign causes of ABNORMAL uterine bleeding?

Answer 16

1. Endometrial atrophy
2. Endometrial polyps
3. Endometrial leiomyomas

Question 17

What are the key characteristics of endometrial atrophy?

Answer 17

1. Cause 25-50% of abnormal uterine bleeding in POSTMENOPAUSAL women
2. Lack of estrogen stimulation
3. Cystic change of glands is common
   
   • result in thickened endometrial stripe

Question 18

What are the histological features

Of endometrial atrophy?

Answer 18

1. Stroma is less cellular and fibrotic
2. glands are cystically enlarged
3. no mitotic activity
4. Thickened endometrial stripe
   Little strips of glands and blood

Question 19

What is an endometrial stripe?

Answer 19

The thickness of the endometrium

Question 20

What is curettage?

Answer 20

A medical procedure where you scoop part of the uterus

Question 21

What are the key characteristics of endometrial polyps?

Answer 21

1. originates from localized hyperplasia
2. Most common in 4th and 5th decades
3. Present with abnormal bleeding
4. No malignant potential, but carcinoma may be found within them

Question 22

What are the gross features of endometrial polyps?

Answer 22

Vary greatly in size

Sessile (flat) or pedunculated (flapping around)

Question 23

What are the histological features of endometrial

polyps?

Answer 23

Larger tissue fragments with dense stroma and
Thick walled arteries
Glands IRREGULAR, dilated, may be crowded focally
Separate fragments of normal endometrium

Question 24

What is a leiomyoma?

Answer 24

Benign smooth muscle tumor

Question 25

What are the key characteristics of Leiomyoma?

Answer 25

1. Benign SMOOTH MUSCLE tumor occurs in - corpus - cervix - uterine ligaments - ovaries 2. Most frequent tumor of female genital tract 3. most common in African americans 4. Etiology = tumor of the reproductive period

Question 26

What is Intramural leiomyoma? Submucosal? | Subserosal?

Answer 26

Within wall of myometrium Just underneath the endometrium Outer surface of the uterus

Question 27

Why do patients with myometrial tumor Present with bleeding?

Answer 27

Because myometrial leiomyoma will cause endometrium to slough off

Question 28

What is the difference between endometrial polyp and submucosal leiomyoma?

Answer 28

Polyp is a hyperplasia rather than tumor Polyp is hyperplasia from ENDOMETRIUM Leiomyoma is TUMOR from MYOMETRIUM

Question 29

What is a symptom of leiomyoma?

Answer 29

Enlarged uterus | You might think patient is pregnant

Question 30

What are the histological features of | Leiomyoma?

Answer 30

``` Uniform bland spindled cells Fasccular arrangements Lack of glands Looks like it starts from myometrium Oval, cigar shaped nuclei ```

Question 31

What is leiomyosarcoma?

Answer 31

MALIGNANT counterpart of leiomyoma -most common pure sarcoma of uterus Incidence = rare, 2-3 of 1000 women Caused by tamoxifen

Question 32

What is a sarcoma?

Answer 32

A malignant tumor of CONNECTIVE or NONEPITHELIAL TISSUE | Comes from mesenchymal cells

Question 33

What are the histologic features of leiomyosarcoma?

Answer 33

1. Invasion of surrounding myometrium 2. vascular invasion BLOODY AS FUCK 3. increased cellularity 4. nuclear atypia 5. increased mitotic activity 6. coagulative necrosis 7. LOSS of WHORLED pattern 8. NO BULGE

Question 34

What is endometriosis?

Answer 34

When cells from the uterine lining (endometrium) appear and flourish OUTSIDE the uterine cavity, most commonly in the abdominal cavity Endometrial tissue outside the uterine cavity Happens in women of reproductive years Most frequent sites are pelvic peritoneum and ovaries

Question 35

What are the theories of endometriosis pathogenesis?

Answer 35

1. TRANSPLANTATION of endometrial fragments to ectopic sites - retrograde flow of menses 2. metaplasia of peritoneum 3. INDUCTION of undifferentiated mesenchyme in ectopic sites to form endometriotic tissue

Question 36

What is the gross appearance of endometriosis?

Answer 36

1. black nodule 2. vesicle formation 3. red/blue nodules 4. yellow/brown nodules

Question 37

What are the classic symptoms of endometriosis?

Answer 37

1. Secondary dysmenorrhea 2. Dyspareunia (painful sexual intercourse) 3. Pelvic pain 4. Infertility 5. Pelvic mass, ascites 6. chocolate cyst 7. hemoptysis, rectal bleeding, hematuria

Question 38

What are the characteristics of adenomyosis?

Answer 38

A medical condition characterized by ECTOPIC glandular tissue found in muscle So endometrium found in the myometrium 1. Presence of endometrial tissue within the uterine wall (myometrium) 2. remains in continuity with the endometrium, presumably representing downgrowth of endometrium tissue into and between smooth muscle fascicles of myometrium 3. microscopically, irregular nests of endometrial stroma, with or without glands

Question 39

What are symptoms of adenomyosis?

Answer 39

1. menometrorrhagia 2. dysmenorrhea 3. Dyspareunia 4. Pelvic pain