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Repro 2 > Uterus - Dobson > Flashcards

Uterus - Dobson Flashcards

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1
Q

2 layers of endometrium

A

Functional layer

Basal layer

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2
Q

Histology of menstrual phase

A

Functional layer sheds, bleeding into stroma (fibrin, RBCs, inflammatory cells), stromal breakdown

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3
Q

Histology of proliferative phase

A
  • Rapid growth of glands and stroma
  • Straight, tubular glands
  • No mucus or vacuolization
  • Pseudostratified columnar cells along glands
  • Numerous mitotic figures
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4
Q

Endothelial histology of secretory phase

A
  • Subnuclear –> supranuclear (week 3) vacuoles in glandular epithelium
  • Dilated glands (18-24)
  • Tortuous glands (week 4)
  • Serrated/saw-tooth
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5
Q

Stromal histology of secretory phase

A
  • Spiral arterioles
  • Increased ground substance and edema
  • Stromal cell hypertrophy and CYTOPLASMIC EOSINOPHILIA (predecidual change)
  • Resurgence of mitoses
  • High glycogen and lipid (decidualized cells)
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6
Q

AUB definition

A

Uterine bleeding that lacks an underlying organic/structural abnormality

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7
Q

AUB most commonly due to ____

Common times?

A

Anovulation (no ovulation)

Menarche, peri-menopause

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8
Q

Anovulation causes what hormonal imbalance?

A

Unopposed estrogen (no corpus luteum to make progesterone)

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9
Q

Metabolic disturbance causes of AUB

A

Obesity, malnutrition, chronic systemic disease

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10
Q

Endocrine causes of AUB

A

Thyroid, adrenal, pituitary

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11
Q

Ovarian lesion causes of AUB

A

Functioning tumors, polycystic ovary disease

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12
Q

In anovulation, what will not be seen on morphology?

What causes bleeding?

A

No secretory changes or vacuolization or predecidual changes

Glands break down and shed, causing bleeding

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13
Q

If anovulation is symptomatic (bleeding), what can be assumed?

A

Repeated cycles of no ovulation (not just 1)

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14
Q

Fever, vaginal bleeding, pelvic pain; recently pregnant; neutrophils in the endometrial stroma

Cause?

A

Acute endometritis

Retained products of conception

Group A strep, staph, others

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15
Q

Abnormal vaginal bleeding, pain, discharge, infertility; PLASMA CELLS in the endometrial stroma

Causes? (4)

A

Chronic endometritis (plasma cells = pathognomonic)

Chronic PID, retained POC, IUD, TB

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16
Q

Neutrophils AND plasma cells in the endometrial stroma

A

Chlamydia-associated chronic endometritis

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17
Q

Endometriosis - define

Most common locations

A

Ectopic endometrial tissue outside of the uterus

Ovaries, uterine ligaments, rectovaginal septum, others

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18
Q

4 theories of endometriosis

A
  • Regurgitation (retrograde flow of menses)
  • Metastases
  • Metaplastic (change of coelomic epithelium of mullerian origin)
  • Stem cell (BM cells)
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19
Q

Things seen in the endometriosis tissue AND the normal endometrium of women with endometriosis ONLY (2)

Treatment of endometriosis?

A
  • High release of pro-inflammatory and growth cytokines
  • High estrogen production by stromal cells (high aromatase)

Aromatase inhibitors

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20
Q

AUB, red/blue or yellow/brown nodules on or beneath mucosa or serosa

When extensive, can cause _____

A

Powder burn marks - endometriosis

—> fibrous adhesions

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21
Q

Distorted, cystic ovaries w/ brown fluid (dried blood)

A

Chocolate cyst – ovarian endometriosis

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22
Q

Endometriosis MUST have ____ tissue to be diagnosed as such

Can also have ___ tissue

A

Endometrial stroma

Endothelial

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23
Q

Symptoms of endometriosis (possible)

Study These Flashcards
A

Pelvic pain, dysmenorrhea or menometrorrhagia, infertility, dyspareunia, painful defecation, dysuria

24
Q

Exophytic mass(es) that project into endometrial cavity – found on routine scope

Later they ulcerate, leading to ____

Study These Flashcards
A

Endometrial polyps

–> AUB

25
Endometrial polyps - what might you ask your patient?
Has she taken Tamoxifen (estrogen blocker)
26
Endometrial hyperplasia - definition Cause
Glandular proliferation --> increased gland:stroma ratio Prolonged estrogen stimulation
27
Causes of endometrial hyperplasia
Prolonged estrogen stimulation: - Anovulation - Obesity (fat aromatase = androgen --> estrogen) - Menopause (low progesterone - Polycystic ovarian syndrome (high estrone) - Functioning granulosa tumors of ovary - Cortical stromal hyperplasia (excessive ovary fxn) - Prolonged estrogen replacement therapy
28
Endometrial hyperplasia - genetics (causes what?) Familial syndrome?
PTEN inactivation --> PI3K/AKT overactivation --> enhanced signaling of estrogen receptor when activated Cowden syndrome (PTEN loss) - high endometrial/breast cancer
29
2 categories of endometrial hyperplasia
Non-atypical | Atypical (EIN)
30
Increased gland:stroma ratio, varied gland size and shape, some intervening stroma remains Potential consequence?
Non-atypical hyperplasia ---> cystic atrophy (when estrogen is removed)
31
Complex pattern of proliferating glands, nuclear atypica, back-to-back w/ branching, loss of orientation to BM, vesicular (open) chromatin How to differentiate from cancer?
Atypical hyperplasia (endometrial intraepithelial neoplasia) Cancer = NO INTERVENING STROMA
32
Treatments for endometrial hyperplasia
Reproductive age = progesterone | Older or unresponsive = hysterectomy
33
Most common age group of endometrial cancer | Most common early sign of endometrial cancer
``` Postmenopausal women (55-65) Irregular or postmenopausal bleeding ```
34
2 types of endometrial cancer
Type 1 = endometrial carcinoma | Type 2 = serous carcinoma
35
60 y/o women w/ obesity and abnormal GTT. Presents w/ abnormal bleeding from her vagina. Tests show abnormal endometrial growth. Pathology shows crowded but normal-looking glands, vesicular chromatin, and no intervening stroma. What are her 5 most common gene mutations? What was her precursor?
Type 1 (endometrial) carcinoma PTEN, MLH1 (DNA MMR), KRAS, PIK3CA, ARID1A Via endometrial hyperplasia
36
3 forms of endometrioid (type 1) carcinoma What morphologic characteristic do they all share (apart from hyperplasia)?
Well differentiated -- all well-formed glands Moderately differentiated - less than 50% solid sheets of cells Poorly differentiated - > 50% solid growth pattern NO INTERVENING STROMA
37
***3 classic associations w/ endometrioid carcinoma
Obesity, DM, Hypertension
38
Type 2 (serous) carcinoma... - Frequently in _____ - By definition, _____ - Arises in setting of _____ - Overlaps with _____
- African americans - Poorly differentiated (grade 3) - Endometrial atrophy (sporadic) - Ovarian serous carcinoma
39
Type 2 (serous) carcinoma -- difference in genetics compared to Type 1
Type 2 = TP53 EARLY (90%) | Type 1 = TP53 LATE & only in poorly-differentiated (50%)
40
Type 2 (serous) carcinoma -- precursor How does it differ from the cancer?
Serous endometrial intraepithelial carcinoma NO STROMAL INVASION
41
70 y/o women presents w/ abnormal bleeding from her vagina. Tests show an endometrial mass. Pathology shows a small atrophic uterus with a large bulky tumor that deeply infiltrates the myometrium. Most likely methods of spread?
Type 2 (serous) carcinoma --> lymphatics or tubes --> extrauterine spread
42
Some type 2 carcinomas can have a glandular growth pattern. How to differentiate from type 1?
Type 2 = marked cytologic atypia (NOT normal-looking)
43
Endometrial tumor w/ glandular and mesenchymal (stromal, muscle, cartilage, etc.) elements Typical genetics? Typical metastasis characteristic?
Carcinosarcoma (malignant mixed mullerian tumors) CARCINOMA genetics (TP53, PTEN, PIK3CA), NOT stromal Epithelial components ONLY
44
MMMTs - typical presentation Extrauterine mesenchymal elements mean _______
Postmenopausal woman w/ bleeding Worse prognosis
45
JAZF1-SUZ12 translocation
Pure endometrial STROMAL neoplasms (nodules, sarcomas)
46
Potential finding later on w/ stromal sarcoma
Distant mets DECADES LATER
47
Sharply circumscribed, round, firm, gray-white tumors within the uterine wall. Whorled pattern w/ oval nuclei w/ slender bipolar cytoplasmic processes 3 location possibilities
Leiomyoma (fibroids) - Intramural (w/in the heart of the myometrium) - Submucosal (just beneath endometrium) - Subserosal (just beneath outer serosa)
48
Leiomyoma - genetics
MED12 mutations (70%), HMGIC translocations (40%)
49
Potential symptoms of leiomyoma (normal woman)
- Abnormal bleeding - Urinary frequency - Impaired fertility - Sudden pain (infarction)
50
Potential symptoms of leiomyoma (pregnancy)
- Abortion - Fetal malpresentation - Uterine inertia (doesn't contract well) - Post-partum hemorrhage
51
2 rare subtypes of leiomyoma
- Benign metastasizing (extends into vessels and spreads) | - Disseminated peritoneal leiomyomatosis (multiple small peritoneal nodules)
52
Lung disease, TSC2 mutation, leiomyoma
Lymphangioleiomyomatosis
53
Mass in uterine wall, whorled pattern of SM bundles Nuclear atypia, mitotic index, zonal necrosis What classically indicates malignancy? (w/o anything else)
Leiomyosarcoma 10+ mitoses per 10 high power fields
54
Leiomyosarcoma... 5+ mitoses per 10 HPFs is sufficient if ______
Nuclear atypia or large epithelioid cells are present too
55
Leiomyosarcoma - what to know about progression How does it get there? (vessel)
> 50% metastasize hemoatogenously (lungs esp.) Inferior vena cava

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