Repro - Pathology (Cervical & Endometrial Pathology) Flashcards Preview

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Flashcards in Repro - Pathology (Cervical & Endometrial Pathology) Deck (44)
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1
Q

What is endometritis? What characterizes it on histology?

A

Inflammation of the endometrium (with plasma cells and lymphocytes)

2
Q

What typically causes endometritis?

A

Associated with retained products of conception following delivery (vaginal/C-section)/miscarriage/abortion or foreign body such as IUD.

3
Q

Why do retained products of conception cause endometritis?

A

Retained material in uterus promotes infection by bacterial flora from vagina or intestinal tract.

4
Q

What is the treatment for endometritis?

A

Treatment: gentamicin + clindamycin with or without ampicillin

5
Q

What is endometriosis?

A

Non-neoplastic endometrial glands/stroma outside of the endometrial cavity.

6
Q

Where can endometriosis be found? Which sites are most common?

A

Can be found anywhere; most common sites are ovary, pelvis, and peritoneum

7
Q

How does endometriosis appear in the ovary?

A

In the ovary, appears as an endometrioma (blood-filled “chocolate cyst”)

8
Q

What are 3 potential reasons for endometriosis?

A

Can be due to (1) retrograde flow, (2) metaplastic transformation of multipotent cells, or (3) transportation of endometrial tissue via the lymphatic system.

9
Q

What 7 symptoms/signs characterize endometriosis?

A

Characterized by cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia (pain with defacation), infertility; NORMAL-SIZED uterus

10
Q

What are 5 treatments for endometriosis?

A

Treatment: NSAIDs, OCPs, progestin, GnRH agonists, surgery

11
Q

What characterizes cervical dysplasia/carcinoma in situ on histology?

A

Disordered epithelial growth; begins at basal layer of squamocolumnar junction (transition zone) and extends outward

12
Q

What are the classifications of cervical dysplasia/carcinoma in situ? On what are these classifications based?

A

Classified as CIN 1, CIN 2, CIN 3 (severe dysplasia or carcinoma in situ), depending on extent of dysplasia

13
Q

With what pathogenic strains is cervical dysplasia/carcinoma in situ associated? Why do these strains cause cancer?

A

Associated with HPV 16 and HPV 18, which product both the E6 gene product (inhibits p53 suppressor gene) and E7 gene product (inhibits RB suppressor gene).

14
Q

What can happen with cervical dysplasia/carcinoma in situ if left untreated?

A

May progress slowly to invasive carcinoma if left untreated

15
Q

How does cervical dysplasia/carcinoma in situ typically present? How is it diagnosed?

A

Typically asymptomatic (detected with Pap smear) or presents as abnormal vaginal bleeding (often postcoital)

16
Q

What are the risk factors for cervical dysplasia/carcinoma in situ?

A

Risk factors: multiple sexual partners (#1), smoking, early sexual intercourse, HIV infection.

17
Q

What kind of cells are often involved in invasive cervical carcinoma?

A

Often squamous cell carcinoma

18
Q

Why is Pap smear such a useful test? What histological finding does it detect?

A

Pap smear can catch cervical dysplasia (koilocytes - wrinkled, “raisinoid” nuclei”, some of which have clearing or a perinuclear halo) before it progresses to invasive carcinoma

19
Q

What is a possible medical complication with regard to invasive cervical carcinoma progression, and what causes this?

A

Lateral invasion can block ureters, causing renal failure

20
Q

What is adenomyosis? What causes it?

A

Extension of endometrial tissue (glandular) into the uterine myometrium; Caused by hyperplasia of the basalis layer of the endometrium

21
Q

What symptoms/signs are associated with adenomyosis?

A

Dysmenorrhea, menorrhagia. Uniformly ENLARGED, SOFT, globular uterus

22
Q

What is the uterus like in endometriosis? How does that compare to the uterus in adenomyosis?

A

Endometriosis - Normal-sized uterus; Adenomyosis - Enlarged, soft, globular uterus

23
Q

What is the treatment for adenomyosis?

A

Treatment: Hysterectomy

24
Q

What is an adenomyoma (polyp)? What might it contain?

A

Well-circumscribed collection of endometrial tissue within the uterine wall; May contain smooth muscle cells

25
Q

Where can an adenomyoma extend, and how?

A

Can extend into the endometrial cavity in the form of a polyp

26
Q

What are 2 types of endometrial proliferation?

A

(1) Endometrial hyperplasia (2) Endometrial carcinoma

27
Q

What is endometrial hyperplasia, and what usually causes it?

A

Abnormal endometrial gland proliferation usually caused by excess estrogen stimulation

28
Q

How does endometrial hyperplasia relate to endometrial carcinoma?

A

Increased risk for endometrial carcinoma

29
Q

How does endometrial hyperplasia manifest clinically?

A

Clinically manifests as postmenopausal vaginal bleeding.

30
Q

What are 4 risk factors of endometrial hyperplasia?

A

Risk factors include anovulatory cycles, hormone replacement therapy, polcystic ovarian syndrome, and granulosa cell tumor.

31
Q

What is the most common gynecologic malignancy?

A

Endometrial carcinoma

32
Q

At what age range is the peak occurrence of endometrial carcinoma?

A

Peak occurrence at 55-65 years old

33
Q

How does endometrial carcinoma present clinically? What is typically in the patient’s history?

A

Clinically presents with vaginal bleeding. Typically preceded by endometrial hyperplasia.

34
Q

What are 6 risk factors for endometrial carcinoma?

A

Risk factors include (1) prolonged use of estrogen without progestins, (2) obesity, (3) diabetes, (4) hypertension, (5) nulliparity, and (6) late menopause.

35
Q

What feature worsens prognosis for endometrial carcinoma?

A

Increased myometrial invasion –> decreased prognosis

36
Q

What is the most common tumor in females?

A

Leiomyoma (fibroid)

37
Q

Which patient population has an increased incidence of leiomyoma (fibroid)?

A

Increased incidence in blacks.

38
Q

What is the a leiomyoma (fibroid)? Can it be malignant?

A

Benign smooth muscle tumor; malignant transformation is rare; Does not progress to leiomyosarcoma

39
Q

What is important to know about the nature of leiomyoma in the context of hormones? What are implications of this?

A

Estrogen sensitive - tumor size increases with pregnancy and decreases with menopause.

40
Q

What age range is the peak occurrence for leiomyoma (fibroid)?

A

Peak occurrence at 20-40 years old.

41
Q

How does leiomyoma (fibroid) typically present clinically? What are potential complications?

A

May be asyptomatic, cause abnormal uterine bleeding, or result in miscarriage. Severe bleeding may lead to iron deficiency anemia.

42
Q

How does leiomyoma (fibroid) typically appear on imaging/histology?

A

Often presents with multiple discrete tumors; Whorled pattern of smooth muscle bundles with well-demarcated boarders

43
Q

List gynecologic tumors in order of decreasing incidence in the US. How does this differ worldwide?

A

Endometrial > Ovarian > Cervical (data pertain to the United States; cervical cancer is most common worldwide)

44
Q

List gynecologic tumors in order of decreasingly worse prognosis.

A

Worst prognosis - Ovarian > Cervical > Endometrial