Uterus and Endometrium Pathology

Question 1

What is the most frequent cause of abnormal uterine bleeding?

Answer 1

Anovulatory cycle

Question 2

What are the most common bacterial infections to cause acute endometriosis?

Answer 2

Group A Hemolytic Strep

Staph

Question 3

What is the most common bacteria to cause chronic endometriosis?

Answer 3

Chlamydia

Question 4

Sx’s = abnormal bleeding, pain, discharge, and infertility

Answer 4

Chronic Endometriosis

Question 5

What are the main 4 associations with chronic endometriosis?

Answer 5

Chronic PID
Retained gestational tissue
IUD’s
TB

Question 6

Def: presence of ectopic endometrial tissue outside the uterus

Answer 6

Endometriosis

Question 7

What differentiated ectopic endometrial tissue from normal endometrial tissue?

Answer 7

Increased E production d/t increased aromatase in ectopic tissue and release of pro-inflammatory factors

Question 8

Endometriosis is associated with a 3x increased risk of _____

Answer 8

Endometrioid ovarian cancer

Question 9

What mutations are most common in endometriosis?

Answer 9

PTEN

ARID1A

Question 10

Morph: red-blue/yellow-brown nodules beneath the mucosal/serosal surfaces with ovarian cysts with brown fluid from previous hemorrhage (Chocolate cysts)

Answer 10

Endometriosis

Question 11

What are the major Sx’s of endometriosis?

Answer 11

Dysmenorrhea, dyspareunia
Pelvic pain
Infertility
Dysuria and pain on defecation

Question 12

Def: endometrial tissue within the uterine wall (myometrium)

Answer 12

Adenomyosis

Question 13

What are the major Sx’s of adenomyosis?

Answer 13

Menomerorrhagia
Colicky dysmenorrhea
Dyspareunia
Pelvic pain

Question 14

Morph: irregular nests of endometrial stroma within the myometrium

Answer 14

Adenomyosis

Question 15

Def: exophytic masses projecting into the endometrial cavity

Answer 15

Endometrial polyps

Question 16

Sx’s = abnormal bleeding d/t ulceration or necrosis

Answer 16

Endometrial polyps

Question 17

What cancer may endometrial polyps give rise to?

Answer 17

Adenocarcinoma

Question 18

Endometrial polyps are associated with the use of what?

Answer 18

Tamoxifen

Question 19

What is d/t prolonged E stimulation of the endometrium and the precursor to endometrial carcinoma?

Answer 19

Endometrial hyperplasia

Question 20

What mutation is most common in endometrial hyperplasia?

Answer 20

PTEN

Question 21

Pts with which syndrome have an increased risk of endometrial carcinoma and breast cancer?

Answer 21

Cowden syndrome

Question 22

Morph: increased gland:stroma ratio with no atypia

Answer 22

Non-atypical endometrial hyperplasia

Question 23

Morph: complex patterns of proliferating glands displaying nuclear atypia and rounded cells with loss of perpendicular orientation to basement membrane

Answer 23

Atypical endometrial hyperplasia

Question 24

Well-differentiated cells that arise in the setting of endometrial hyperplasia

Answer 24

Endometrial carinoma

Question 25

What mutation is most common in endometrial carcinoma?

Answer 25

PTEN

Question 26

Poorly differentiated cells that arise in the setting of endometrial atrophy

Answer 26

Serous carcinoma

Question 27

What mutation is most common in serous carcinoma?

Answer 27

TP53

Question 28

What is serous carcinoma associated with?

Answer 28

Peritoneal disease

Question 29

What are the Sx's of carcinoma of the endometrium?

Answer 29

Irregular/post-menopausal bleeding with excessive leukorrhea

Question 30

What are the 4 stages of carcinoma of the endometrium

Answer 30

Stage 1 = confined to uterus Stage 2 = uterus and cervix Stage 3 = outside uterus, within true pelvis Stage 4 = outside true pelvis, in bladder/rectum

Question 31

Def: endometrial adenocarcinomas with a malignant mesenchymal component that can take a number of forms

Answer 31

Malignant Mixed Mullerian Tumors (carcinosarcoma)

Question 32

What mutations are most common in MMMT's

Answer 32

PTEN TP53 PIK3CA

Question 33

Morph: bulky, polypoid mass that may protrude into the cervical os

Answer 33

MMMT

Question 34

Def: E sensitive, large, broad-based endometrial polypoid growths that may prolapse through the cervical os

Answer 34

Adenosarcoma

Question 35

Def: multiple benign SM neoplasms

Answer 35

Leiomyomas (Fibroids)

Question 36

What are the major Sx's of Leiomyomas?

Answer 36

AUB Urinary frequency Impaired fertility Sudden pain from infarct

Question 37

Morph: sharply circumscribed, discrete, round, firm, gray-white tumors within them myometrium with a whorled pattern on cut section

Answer 37

Leiomyoma (Fibroid)

Question 38

What is the mutation associated with Leiomyomas?

Answer 38

MED12

Question 39

Def: arise from myometrium or endometrial stromal precursor cells

Answer 39

Leiomyosarcoma

Question 40

Morph: nuclear atypia, high mitotic index, and zonal necrosis

Answer 40

Leiomyosarcoma

Question 41

What mutation is associated with Leiomyosarcomas?

Answer 41

MED12

Question 42

What should pts be worried about following surgery for removal of Leiomyosarcomas?

Answer 42

Recurrance