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Uterus Flashcards

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1
Q

What is the normal endometrial cycle in reproducting age?

A

Menstruating phase (0-5 days)
Proliferative Phase (6-14 days)
Secretory phase (15-28 days)

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2
Q

What hormones decrease in the absence of implantation of a fertilizing egg in the menstruating phase?

A

Estrogen
Progesterone
LH

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3
Q

What are the histological features in the menstruating phase?

A

Disintegration of functional layer => menstrual bleeding => stromal hemorrhage

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4
Q

What phase of of the endometrial cycle has INC Estrogen levels, stratum functionalis is regenerated from the stratum basalis?

A

Proliferative phase (6-14days)

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5
Q

What are the physiologic events of Proliferative phase?

A
  • endometrial thickness
  • CT, arteries, granular structures
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6
Q

What are the histological features during the Proliferative phase?

A

Straight, tubular glands
Pseudostratified columnar, non-vacuolated lining epithelia
Presence of mitotic figures
Compact, spindly stroma

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7
Q

What happens to the glands in the Secretery phase?

A

Convoluted & endometrial cells INC glycogen stores

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8
Q

What hormone primarily drives the Secretory phase of the endometrial cycle?

A

Progesterone

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9
Q

What are the histo features of the Secretory phase of the endometrial cycle?

A

Early secretory (day 17-19)
- secretory vacuoles filled with glycogen
- supranuclear vacuoles (“piano keys”)
Mild secretory (day 20-22)
- Intraluminal secretions
- Maximal stromal edema
Late secretory (day 23-28)
- Tortuous, serrated, saw-tooth appearance of endometrial glands

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10
Q

What is endometrial activity during pregnancy & menopause?

A

Pregnancy
- retains secretory phenotype & stroma
- myometrium undergoes mechano-adaptation

Menopause
- endometrium becomes inactive & may undergo atrophy

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11
Q

How much is the ave blood loss/cycle?

A

20-60mL

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12
Q

What are the causes of abnormal uternine bleeding in Prepuberty & Adolescence?

A

Prepuberty = precocious puberty
Adolescence = anovulatory cycle, coagulation disorders

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13
Q

What are the uterine causes of bleeding in reproductive age?

A

Complicaitons of pregnancy
Anatomic lesions
Dysfunctional uterine bleeding

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14
Q

What are the causes of uterine bleeding in Perimenopausal, Postmenopausal women?

A

Perimenopausal
- Dysfunctional uterine bleeding
- anatomic lesions (carcinoma, hyperplasia, polyps

Postmenopausal
- Endometrial atrophy
- anatomic lesions (carcinoma, hyperplasia, polyps

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15
Q

What condition has an abnormal uterine bleeding that is not associated with organic disease of the uterus but with endocrine disturbances?

A

Dysfunctional uterine bleeding

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16
Q

What are the categories of Dysfunctional uterine bleeding?

A

Anovulatory bleeding
Lutral phase abnormalities

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17
Q

What are the diff conditions seen in anovulatory bleeding & luteal phase abnormalities?

A

Anovulatory bleeding
- disordered proliferative
- glandulo-stromal breakdown

Luteal phase abnormalities
- inadequate luteal pahse
- irregular shedding

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18
Q

What are the 2 hormones responsible for dysfunctional uterine bleeding and which one is more common?

A

Estrogen - more common
Progesterone

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19
Q

What is the most common form of dysfunctional uterine bleeding where there is a excessive estrogenic stimulation w/o ovulation

A

ANovulatory bleeding

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20
Q

What is the predisposing condition of Anvoulatory bleeding?

A

Endometrial hyperplasia

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21
Q

What is the pathologic findings of anovulatory bleeding?

A

Dependent on unpposed estrogen stimulation

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22
Q

What are the 2 patterns of ANovulatory bleeding?

A

Disordered proliferativeGandulo-stromal breakdown

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23
Q

What are the morphologic features of DUB?

A

Glandulo-stromal breakdown -> Stromal condensation
No secretory activity
Endometrial hyperplasia & metaplasia

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24
Q

What are the histo features of Disordered Proliferative?

A
  • Proliferative glands w/o secretory devt -> glandula rarchitecctural variation is the most important finding
  • stroma: spindled
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25
What are the histo changes seen in abnormal endometrial bleeding?
- Proliferative, non-secretory, and focal bg - not uniformed abnormal glandular & stromal breakdown - heterogenous pattern with fragments of intact, non-shedding endometrium
26
What causes Luteal phase defect in reproductive age & perimenopausal women?
abnormal secretory phase patterns w/ assoc non-menstrual breakdown and bleeding
27
What is the pathogenesis of luteal phase defects?
failure of corpus luteum to develop normally after ovulation underdeveloped corpus luteum that produce def in progesterone secretion
28
What are the clin features of Inadequate luteal phase?
Premenstrual bleeding Hypermenorrhea Habitual 1st trimester abortion Infertility Failure of basal body temp to exhibit normal post-ovulatory elevation
29
What are the histo features seen in Inadequate luteal phase?
Secretory endometrium that lags behind in development = glands show secretory changes yet lack marked tortuosity & secretory excretion
30
What causes inadequate luteal phase?
deficient progesterone secretion, inadequate secretory development
31
What are the diff requirements for dx of Inadequate Luteal Phase?
- Secretory lag & underdeveloped secretory changes - clinical correlatin - atleast 2 biopsies showing lag in devt
32
What is the cause of irregular shedding of luteal phase defects?
failure of the CL to involute or regress normally --> persistent function w/ secretion of Progesterone
33
What are the morphologic features seen in irregular shedding?
stellate shapes as they involute
34
What are the microscopic findings?
1. admixture of predominantly secretory (star-shaped) and some proliferative glands 2. irregular maturation pattern from fragment to fragment stromal predecidualization 3. Glandular & stromal breakdown
35
What are the clinical features of inadequate luteal phase?
Premenstrual bleeding Hypermenorrhea Habitual 1st trimester abortion Infertility Failure of basal body temperature to exhibit normal post-ovulatory elevation
36
What are the causes of inadequate Luteal phase?
- deficient Progesterone secretion, inadeqaute secretory development - ovulation occurs, but secretory changes are inadequate
37
What are the requirements for diagnosis of inadequate luteal phase?
- clinical correlation to the cndition - atleast 2 biopsies showing lag in devt - secretory lag & underdeveloped secretory changes must be demonstrated in atleast 2 consecutive cycles
38
What is the cause of irregular shedding during the luteal pahse?
failure of the corpus lutem to involute or regress normally
39
What are the morphological features of irregular shedding?
- Stellate shapes as they involute Histo - admixture of secretory (star-shaped) & some proliferative glands - glandular and stromal breakdwon
40
What is the medical term for blood within the uterine cavity?
Hematometra
41
Give 3 out of 6 conditions that we see with acute endometriosis?
Pregnancy Postdeliver/abortion Retianed products of conception Puerperium Perineal/cervical lacerations Trauma to genitals & instrumentation
42
What are the microscopic findings in acute endometriosis?
Microabscesses in the lumen of the endometrial glands & storma Destruciton of glandular epithelium Abundant neutrophilic infiltration
43
What can happen if acute endometriosis progresess in to a severe condition?
Pyometra - exudates accumulate as a bag of pus in the uterine cavity
44
What are the clinical features of Chronic endometriosis?
On-and-off low grade fever Abdominal pain Foul-smelling purulent lochia Uterine or pelvic tenderness
45
What are other causes of Chronic endometriosis?
Actinomyces Granulomatous inflam in TB Fungi Parasites
46
What gram positive anaerobe can cause chronic endometriosis?
Actinomyces israelli
47
What disorders are assoc to chronic endometriosis?
Chronic PID Retained gestational/placental tissues ff abortion & postpartum IUD Milary TB Idipathic
48
What condition has exophytic masses of var size that project sinto the endometrial cavity?
Endometrial polyp
49
What drug induces the formation of Endometrial polyp?
Tamoxifen
50
What are the gross & histo features of endometrial polyp?
Gross: - pedunculated, sessile, polypoid mass filling up the endometrial cavity - attached by a stalk Histo - surface (columnar) epithelium on 3 sides - cystic dilation (SWISS CHEESE APPEARANCE)
51
Where can Adenomyosis /Endometriosis reside in? Give 3
Ovaries Myometrium Fallopian tube Uterine ligaments Rectovaginal septum Pelvic peritoneum
52
What are the clinical consequences of Adenomyosis & Endometriosis?
Infertility Dysmenorrhea Pelvic pain Ovarian cyst transformation (CHOCOLATE CYST)
53
What are the causes of Adenomyosis/Endometriosis?
Regurgitation theory Benign metastasis theory Metaplastic theory Extrauterine stem/Progenator cell theory
54
What theory states that endometrial tissue implants at ectopic site via retrograde flow of menstrual endometrium?
Regurgitation theory
55
What theory states that endometrial tissue from uterus can spread to distant sides via hematogenous spread or through lymphatic channels?
Benign metastasis theory
56
What theory states that endometrium arise directly from coelemic epithelium or the mesothelium of pelvis and abdomen?
Metaplastic theory
57
What theory states that stem or progenitor cells from BM differnetiates into the endometrial tissue?
Extrauterine stem or Progenator cell theory
58
What hormone is used to treat Endometriosis?
Estrogen
59
What are the gross findings in Endometriosis?
Small black red nodules on uterine serosa
60
What condition has endometriotic implants found in the uterine corpus?
Adenomyosis
61
What condition has implants appearing tumoral or resembles leiomyoma?
Adenomyoma
62
What are the gross findings of Adenomyosis?
- Globular and enlarged corpus luteum - thickened, fibrous, firm with fasciculated and WHORLED appearance - Cigarette burn lesiosn scattered within the wall
63
What are the microscopic features of Adenomyosis?
- Ectopic endometrial glands and the stroma (Embedded in myometrium) - Myometrial fibrosis and hypertrophy
64
What are the clin features of Adenomyosis? Give 4
Infertility Dysmenorrhea Bleeding Menstrual irreg Cyst transformation of ovary Uterine enlargement Low risk for malignant transformation
65
What disorder has proliferation of endometrial glands relative to the stroma resulting from unpposed Estrogenic stimulation of the endometrial tissue?
Endometrial hyperplaia
66
What are the 2 types of endometrial hyperplasia?
Non-atypical endometrial hyperplasia Atypical endometrial hyperplasia
67
What are the gross and histo features of Endometrial hyperplasia?
Gross: - lush and thickened, with the edematou glistening, creamy, yellow, white appearance Histo: - INC number of endometrial glands relative to the stroma
68
What are the 3 main categories of hyperplasia?
Simple hyperplasia Complex hyperplasia without atypia COmplex hyperplasia with atypia
69
What is a distinct characterisitc of Non-atypical endometrial hyperplasia?
Closely packed glands with gland to stroma ratio of >3:1
70
What are distinct characteristics of Complex Hyperplaia (non-atypical endometrial hyperplasia)?
Crowded, back to back glands Stratified epithelium Clelular stroma Increased glands, less stroma
71
What condition is aka Corpus Cancer syndrome?
Endometrial carcinoma
72
What are the 2 categories of endometrial cacrcinoma?
1. Hyperestrinism + Backgound of endometrial hyperplasia (TYPE 1) 2. Less Hyperestrinism background (TYPE 2)
73
What is a more common tyoe of Endometrial carcinoma that is assoc w/ obesity, DM, HPN, infetility?
Type 1 endometrial carcinoma
74
What type of endometrial carcinoma has less hypertenism but is poorly-diff and aggressive type?
Type 2 endometrial carcinoma
75
What are the gross and histo features of endometrial carcinoma?
Gross: - bivalve, showing fleshy, white, nodular masses that carpet the endometrial surface Histo - Papillary, tubular, clear, and serous or w/ squamous differentiation
76
What are the 2 histological types of Endometrial carcinoma? How do you differentiate them?
Type 1 = Endometrioid carcinoma & Adenocarcinoma with squamous differentiation Type 2 = adenosquamous carcinoma, serous papillary carcinoma, clear cell carcinoma
77
What are imporant histo feature sof Clear cell ccarcinoma?
- polyglonal cells with clear eosinophilic cytoplasm - HObnail cells - High nuclear grade
78
What are the histlogic features of Serous endometrial carcinoma?
- papillary/micropapillary pattern - Psamomma bodies - high nuclear grade
79
What are the degenerative changes in Leiomyoma?
Hyaline degeneration Edema Cystic degeneration Calcification Myxomatou
80
What are the histologic features of Leiomyoma?
Cigar-shaped bipolar nuclei Spindle cell proliferation Scarce mitotic figures
81
What are the gross & histo features of Malignant Mixed Mullerian tumor?
Gross: - Bulky & polypoid may protrude through the cervical os Histo: - area of adenocarcinoma present as Endometrioid, serous, or clear cell mixed with malignant mesenchymal elements
82
What are the common CA of inflammation in the fallopian tubes?
N gonorrheae Chlamydia Mycoplasma homonis Staph, Strep
83
What causes SUppurative sapingitis in fallopian tubes?
N gonorrhorae
84
What are the 2 types of fallopian tubes inflammation?
Suppurative salpangitis Tuuberculous salpingiti
85
What are the diff tumors and cysts of the fallopian tubes?
Paratubal cysts Hydatids of Morgagni Adenomatoid tumors (Mesethelioma) Adenocarcinoma
86
What is the most common primary lesion of the fallopian tube?
Paratubal cysts
87
What lesion of the fallopian tubes is found near the fimbriated end of the tube or in the broad ligaments?
Hydatids of Morgagni
88
What lesion of the fallopian tubes is located at the suberosa of the tube or int he mesosalpinx?
Adenomatoid tumors (Mesothelioma)
89
What lesion of the fallopian tube presents as dominant tubal mass discovered during pelvic exam? What are assoc symptoms of this?
Adenocarcinoma Assoc symptoms: - abdominal discharge - bleeding - abnormal pap smear cells

Pathology (8 decks)

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