uterine pathology

Question 1

what layer is shed during menses

Answer 1

functionalis

Question 2

mucosa of uterus

Answer 2

made up of glandular and stromal cells which both respond to hormonal activity
tumors can originate in either cell type

Question 3

proliferative phase

Answer 3

mitotic figures in cells with small tubular glands

Question 4

secretory phase

Answer 4

day 14-16 progesterone surge
first change is subnuclear vaculization
can be certain pt has ovulated

Question 5

late secretory phase

Answer 5

clear spaces move above nuceli and secretions dumped into lumen

Question 6

if implantation takes place

Answer 6

secretory changes even more apparent and get arias stella reaction -> can determine pregnancy

Question 7

menstrual phase

Answer 7

balls of stromal cells, fragments of glands, and blood

Question 8

dysfunctional uterine bleeding

Answer 8

unscheduled bleeding, presumed to be hormonal dysfnx

Dx of exclusion

Question 9

oligomenorrhea

Answer 9

intervals of greater then 35 days

Question 10

polymenorrhea

Answer 10

intervals less then 24 days

Question 11

menorrhagia

Answer 11

excessive bleeding with normal intervals

Question 12

metorrhagia

Answer 12

excessive flow and duration at normal intervals

Question 13

menometorrhagia

Answer 13

irregular menses

Question 14

withdrawal bleeding

Answer 14

bleeding following the withdrawal of hormones

Question 15

anovulatory cycles

Answer 15

results in increases prolonged unopposed E stim
resulting endometrium is unstable and breaks down -> bleeding
Bx shows irregular dialted glands, no P effect, and stromal breakdown
very common around menarche and perimenopausal period

Question 16

inadequate luteal phase

Answer 16

abnormal corpus luteum fnx -> low p in secretory phase

typically presents as infertility with menorrhagia or amenorrhea

Question 17

acute endometritis

Answer 17

Bx shows neutrophils
limited to infections that arise after delivery or miscarriage
infection is usually polymicrobial
Tx0 with endometrial cavity curetting and abx

Question 18

chronic endometritis

Answer 18

Bx shows plasma cells

usually d/t chronic PID, retained products of conception, IUDs, TB

Question 19

endometriosis

Answer 19

presence of endometrial tissue (glands and stroma) outside of uterus can occur anywhere there is peritoneal lining
3x increase in ovarian CA

Question 20

adenomyosis

Answer 20

presence of endometrial tissue in myometrium
forms a discrete mass called adenomyoma
can coexist with endometriosis

Question 21

most common presentation of endometriosis

Answer 21

infertility
cyclic dysmenorrhea
cyclic pelvic pain

Question 22

endometriomas

Answer 22

tumors of endometriosis on ovary

can cause chocolate cyst

Question 23

endometriosis of cervix

Answer 23

powder burn appearance

Question 24

endometrial polyps

Answer 24

benign endometrial polyp, not polypoid endometrial mass
may be peduculated or sessile
benign, but may have foci of neoplastic cells
surgery

Question 25

endometrial hyperplasia

Answer 25

important cause of abnormal bleeding increased proliferation of endometrial glands relative to stroma strong relationship with endometrial carcinoma hyperplasia and carcinoma share specific mutations

Question 26

endometrial hyperplasia is associated with what?

Answer 26

prolonged E stimulation which can be d/t anovulaton, endogenous or exogenous source

Question 27

risk factors for endometrial hyperplasia

Answer 27

``` obesity DM II menopause PCOD granulosa cell tumors or ovary prolonged E replacement therapy ```

Question 28

progression of hyperplasia

Answer 28

Benign (simple and complex patterns) -> EIN (complex clonal hyperplasia with atypia) -> Carcinoma (invasion)

Question 29

genetic alterations in endometrial hyperplasia and CA

Answer 29

inactivation of PTEN tumor suppressor gene on chrom 10 | Cowden syndrome

Question 30

cowden

Answer 30

AD disorder with PTEN mutation and high rate of endometrial CA

Question 31

loss of PTEN

Answer 31

activation of PI3K-AKT -> mTOR -> cell growth | leads to warburg effect and can detect with PET scans

Question 32

if you see the word atypia what must you do

Answer 32

hysterectomy | if invasive check lymph nodes

Question 33

endometrioid adenocarcinoma type I

Answer 33

peak age 45-55, uncommon <40 | associated with conditions of increased E

Question 34

mutations in endometrioid adenocarcinoma type I

Answer 34

PTEN | microsatellite instability in KRAD associated with HNPCC (lynch syndrome)

Question 35

typical presentation of endometrioid adenocarcinoma type I

Answer 35

abnormal bleeding, amenorrhea >6 months | spread by direct extension with late spread to nodes and mets

Question 36

risk factors for endometrial CA

Answer 36

``` age E therapy tamoxifen therapy early menarche late menopause nullparity PCOS obesity DM E secreting tumor lynch syndrome cowden syndrome ```

Question 37

PTEN staining

Answer 37

stains brown in normal cells, however ABSENT in endometrioid adenocarcinoma type I cells

Question 38

non-endometrioids adenocarcinoma (type II)

Answer 38

serous carcinoma post menopausal disease 55-65 mutations in p53

Question 39

p53 stain

Answer 39

CA cells stain +, normal cells stain - are ALL high grade lesions 3/3 with aggressive course spread early thru lymph and retrograde along fallopian tubes

Question 40

MMMT

Answer 40

malignant mixed mullerian tumors carcinosarcomas often present with bulky polypoid mass has both epi and mesenchymal components

Question 41

non-endometrioids adenocarcinoma (type II)

Answer 41

stains + for p53 | papilla have stromal and vessels inside covered with malignant epi outside

Question 42

endometrial stromal neoplasms

Answer 42

adenosarcomas endometrial stromal nodule endometrial stromal sarcoma

Question 43

adenosarcomas

Answer 43

present as large sessile polyps that may protrude thru os malignant stroma with benign glands must differentiate from benign polyps

Question 44

endometrial stromal nodule

Answer 44

benign mass w/o clinical significance, except must be differentiated from sarcoma

Question 45

endometrial stromal sarcoma

Answer 45

spindle cell neoplasm confirmed stain for CD10 differentiate from stromal nodule by diffuse infiltration of myometrium lymph invasion, 5 yr survival 50%

Question 46

leiomyoma

Answer 46

aka fibroids benign smooth mm neoplam mutation in MED12 (unique to smooth m tumors of uterus)

Question 47

symptoms of leiomyoma

Answer 47

``` bleeding pain/sense of pelvic fullness urinary frequency infertility miscarriage (2nd trimester) ```

Question 48

leiomyosarcoma

Answer 48

do not appear to arise in leiomyomas malignant smooth m neoplams subset also have MED12 mutation

Question 49

differentiating leiomyosarcoma from leiomyoma

Answer 49

can invade into or out of wall HIGH mitotic rate (>10) differentiates from fibroids cytological atypia, tumoral necrosis and hemorrhage peak 40-60 mets by blood vessels 40% 5 yr

Question 50

types of leiomyomatas

Answer 50

submucosal- most likely to bleed intramural- may or may not bleed subserosal- may cause urinary frequency

Question 51

salpingitis

Answer 51

part of PID spectrum acute bacterial salpingitis is suppurative (60:40 G:C) if ends of tube scar shut -> hydrosalpinx or pyosalpinx can also cause tubo-ovarian abscesses complications include adhesions, infertility, and ectopics

Question 52

paratubal cysts

Answer 52

arise in mullerian remnant at the fimbriated end of tube or in broad lig translucent thin-walled unicameral

Question 53

endometrial Bx with ectopic

Answer 53

arias stella effect, but no chorionic villi of placenta

Question 54

adenocarcinoma of fallopian tube

Answer 54

increasing believed to be source of high grade serous carcinomas of ovary/peritoneum