The Uterus

Question 1

endometrial hyperplasia subtype with highest risk of cancer progression

Answer 1

complex hyperplasia with atypia

Question 2

endometrial hyperplasia

Answer 2

• older age
• genetics (Lynch)
• xs estrogens

Question 3

causes of xs estrogen stimulation

Answer 3

• PCOS/chronic anovulation
• obesity
• unopposed ERT
• estrogen secreting tumor
• tamoxifen therapy
• nulliparity/no breast-feeding

Question 4

low risk endometrial hyperplasia tx

Answer 4

progestin therapy (thins endometrium)

Question 5

high risk endometrial hyperplasia tx

Answer 5

hysterectomy

Question 6

endometrial hyperplasia histo

Answer 6

atypical glands sep by stroma

Question 7

endometrial cancer

Answer 7

atypical glands fused together without stroma

Question 8

most comm gynecologic cancer in US

Answer 8

endometrial cancer

Question 9

endometrial cancer tx

Answer 9

surgery (hysterectomy and bilateral salpingo-oophorectomy)

-poss pelvic and para-aortic lymph node sampling

Question 10

staging of uterine CA

Answer 10

FIGO

1. confined to uterus/invades myometrium
2. cervix
3. serosa/vagina/nodes
4. bladder or bowel mucosa/ distant mets

Question 11

endometrial polyps tx

Answer 11

-resection if irregular or post-menopausal bleeding

post-menopausal women have a higher risk of malignancy

Question 12

endometriosis vs adenomyosis

Answer 12

both cause dysmenorrhea

adenomyosis is also assoc w/ menorrhagia

Question 13

outside uterus and unlikely to cause AUB

Answer 13

endometriosis

Question 14

inside uterine wall and more likely to cause AUB

Answer 14

adenomyosis

Question 15

adenomyosis tx

Answer 15

hormonal

• LNG-IUD
• depo

hysterectomy if highly symp and completed child bearing

Question 16

diffusely enlarged, globular uterus - feels soft

Answer 16

adenomyosis

Question 17

leiomyomas

Answer 17

• benign tumor of myometrium
• usu multiple tumors
• premenopaousal women

Question 18

leiomyomas tx if submucosal

Answer 18

tx for AUB

hysteroscopic resection

Question 19

leiomyomas tx if large/intramural

Answer 19

• myomectomy
• hysterectomy (use GnRH agonist to shrink size before surgery)
• UAE, UFE (embolization)

Question 20

GnRH agonist used to shrink leiomyoma before surgery

Answer 20

leuprolide

Question 21

adenomyosis

Answer 21

• benign endometrial glands and stroma deeply within myometrium
• diffusely enlarged uterus (vs nodular enlargement of leiomyomas)
• pt present w abnml bleeding/dysmenorrhea/enlarged uterus

Question 22

pathologic dx of endometriosis

Answer 22

• endometrial glands
• endometrial stroma
• hemosiderin

Question 23

theories of endometriosis pathogenesis

Answer 23

Regurgitation theory**
Metaplastic theory
Metastatic theory
Stem cell differentiation

Question 24

accepted theory of endometriosis

Answer 24

movement of mestrual tissue thru Fallopian tubes –> ovaries, peritoneum

Question 25

most common tumor in female genital tract

Answer 25

leiomyoma (fibroid) benign tumor of smc

Question 26

leiomyomas arise most commonly in the

Answer 26

myometrium

Question 27

most common location of leiomyomas

Answer 27

intramural

Question 28

cigar-shaped nuclei and abundant eos cytoplasm

Answer 28

leiomyoma

Question 29

leiomyosarcoma

Answer 29

- rare - DE NOVO - peak at older age, post-menopausal - abnml bleeding/pain/mass - prognosis dec on stage - spread is intraperitoneal to nodes and hematogenously to lungs, liver, or brain

Question 30

features of leiomyosarcoma

Answer 30

- necrosis - mitotic count inc - cytological atypia

Question 31

STUMP

Answer 31

smooth-muscle tumor of undetermined malignant potential if hard to distinguish leiomyoma vs leiomyosarcoma

Question 32

leiomyosarcoma histo

Answer 32

``` hypercellular pleomorphic nuclei hyperchromatic nuclei increased mitoses atypical mitoses (necrosis) (hemorrhage) ``` sm actin, desmin +

Question 33

endometrial polyp malignant potential

Answer 33

CA may rarely be found within a polyp, but no evidence to suggest that polyps are premalignant

Question 34

3 histological features of endometrial polyps

Answer 34

- dilated endometrial glands - fibrotic stroma - thick walled blood vessels

Question 35

endometrial hypERplasia

Answer 35

via influence of high levels of unopposed estrogen

Question 36

How would obesity lead to endometrial hypERplasia?

Answer 36

estrogens are formed in peripheral adipose tissue from androstenedione xs estrogen --> endometrial hyperplasia

Question 37

normal proliferative phase endometrium

Answer 37

gland:stoma ratio | <1:1

Question 38

enlarged, crowded, poorly oriented nuclei

Answer 38

atypia

Question 39

endometrial carcinoma risk fx

Answer 39

- age - estrogen - diabetes - smoking - genetic (LYNCH)

Question 40

Mutations in type II endometrial cancer

Answer 40

K-ras, p53, HER2neu

Question 41

2 types of ovarian carcinoma

Answer 41

1. endometrioid | 2. serous

Question 42

type I endometrial carcinoma (endometrioid type)

Answer 42

- endometrial type epithelium - estrogen-driven - hypERplasia - lower grade - superficially invasive - better prognosis

Question 43

type II endometrial carcinoma (serous type)

Answer 43

- Fallopian tube type endothelium - estrogen-INDEPENDENT - driven by p53 - no hyperplasia - deep invasion - POOR PROGNOSIS, AGGRESSIVE

Question 44

carcinosarcoma

Answer 44

``` malignant glands malignant stroma (homologous or heterologous) ```

Question 45

carcinosarcoma, heterologous type

Answer 45

rhabdomyosarcoma chondrosarcoma