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Flashcards in Uterus Path Deck (52)
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1

Proliferative Phase time

Day 1-13
Proliferative (estrogen)
1-4 menstruation

2

Ovulation time

Day 14

3

Secretory (progesterone) time

Day 15-28

4

Glands Proliferative vs secretory endometrium

Proliferative- Straight
Secretory- Coiled

5

Epithelium proliferative vs secretory endometrium

Proliferative- Cuboidal to tall single to double layer
Secretory- Tall w/ vacuoles single layer

6

Stroma proliferative vs secretory endometrium

Proliferative- Dense stroma, compact cells
Secretory- Edematous stroma, plump cells
Conspicous arterioles

7

Metrorhagia (epimenorrhea)

Irregular non cyclical bleeding

8

Primary Dysmenorrhea

Onset at menarche (abnormal activity of nerves and muscles of cervix

9

Secondary dysmenorrhea

Later in life (Endometriosis, leiomyoma)
Infertility
Mass formation

10

Primary amenorrhea

No menarche
Hypoplastic uterus, Imperforate hymen, endocrine issues

11

Secondary amenorrhea

After initiation of menarche
Pregnancy, lactation, endocrine, stress

12

Dysfunctional uterine bleeding
Etiology?

Abnormal endometrial cycle
1. Unopposed estrogen effect
2. Exogenous progesterone effect
3. Inadequate luteal phase
4. Persistent luteal phase

13

Unopposed estrogen effect etiology

Anovulatory cycles
- Extremes of reproductive life
-Polycystic ovaries
- Obesity/ stress
-Endocrine disorders
-Excess physical activity

Estrogen producing neoplasms
- Granulosa cell tumor ovary
-Adrenal cortical adenoma

14

Exogenous progesterone effect etiology

OCP
Abundant stroma, edema
Glands small/atrophic-> lack priming by estrogen

15

Inadquate luteal phase etiology

Irregular ripening
Inadequate corpus luteum function (drop in progesterone)
Poorly developed secretory endometrium
• Breaks down irregularly (DUB)
• Bx: Poor and immature secretory glands
• Low Progesterone, FSH, LH

16

Persistent luteal phase etiology

• Normal menstruation is induced by abrupt cessation of
progesterone secretion by corpus luteum
• If corpus luteum continues to secrete low levels of
progesterone – protracted and irregular shedding
• Periods regular but bleeding excessive and prolonged (10 –
14 days)
• Bx. – persistent secretory even after 5 days of
menstruation

17

Endometriosis etiology

endometrial tissue outside of uterus
• Common sites – ovaries, uterine ligaments,
rectovaginal septum, cul de sac, git, appendix,
laprotomy scars

18

Adenomyosis

endometrial tissue within the uterine
wall, 20% uteri

19

Endometriosis
Pathogenesis

• ? Metastatic pathogenesis, metaplasia of celomic
epithelium
• ? Inflammatory cascade (?prostaglandins, estrogen)

20

Endometriosis changes

• Glands, stroma undergo cyclical bleeding, hemosiderin
deposition, fibrosis, adhesions
• Chocolate cysts ovary
• Tubal scars – infertility

21

Regression of endometriosis seen in

Following pregnancy
Oral contraceptive use

22

Endometritis

Cyclic shedding of endometrium
No foothold
Constant irritation

23

Acute endometritis etiology

Postpartum (puerperal sepsis), offensive lochia (discharge)
- Ascending gonococcal/Chlamydia
- Pyometrum (obstruction of os by neoplasm, fibrosis)

24

Chronic endometritis Etiology

(plasma cells) 15% nonspecific
- Chronic PID
- Postpartum/postabortion
- IUCD, retained products
- TB
- Chlamydia

25

Endometrial hyperplasia etiology

• Perimenopausal metrorrhagia
• Obese, PCOD, menopause, estrogen
producing tumors like granulosa cell tumor,
ERT, adrenal disorders
• PTEN tumor suppressor gene

26

Endometrial hyperplasia

• Excess unopposed estrogen effect

27

Tx for endometiral hyperplasia

• Treatment – hysterectomy, progesterone
treatment

28

Which endometrial hyperplasia will put you at high risk for cancer

Complex hyperplasia with atypia (24-48%)

29

Atypia criteria

Nuclear enlargement (2-3 times of RBC)
• Pleomorphism
• Vesicular change
• Chromatin irregularity
• Loss of polarity
• Prominent nucleoli
• Cellular stratification

30

Endometrial polyp associated with

Certain drugs
Tamoxifen

31

What is the most common invasive carcinoma of female genital tract

Endometrial carcinoma

32

Type I endometrial carcinoma

(55 – 65 years, m.c-80%, unopposed estrogen,
obesity, diabetes, hypertension, nulliparous, PTEN, K-ras,
MSI, relatively indolent - ENDOMETRIOID)

33

Type II endometrial carcinoma

Type II (65-75 years, endometrial atrophy and thin physique,
p53, aggressive – SEROUS, CLEAR CELL, MMMT)

34

Spread of endometrial carcinoma

local - myometrium, cervix, vagina, rectum
- peritoneum
- lymphatic – iliac, paraaortic
- blood – lung, liver

35

Stage of endometrial carcinoma

Stage I Carcinoma confined to uterus (corpus)
Stage II Carcinoma involving uterine corpus and cervix
Stage III Carcinoma outside uterus but still within pelvis
Stage IV Carcinoma outside pelvis, involving rectum/bladder

36

Grading of endometrial carcinoma

Grade I: 5% or less nonsquamous solid growth pattern
Grade II: 6%-50% nonsquamous solid growth pattern
Grade III: >50% nonsquamous solid growth pattern

37

>55 years
• Still epithelial, high grade
• Large, fleshy mass, hemorrhage, necrosis
• Epithelial and mesenchymal (leio, rhabdo, chondro,
osteo)
• Metastasis and behaviour defined by epithelial
component
• Poor prognosis

Malignant mixed mullerian tumor

38

Leiomyoma vs leiomyosarcoma

Leiomyoma: No necrosis
Leiomyosarcoma: Necrosis present

39

Clinic-
Asymptomatic
• Menorrhagia, metrorrhagia,
infertility
• Mass effect
• Acute pain – red degeneration
(necrosis) specially in pregnancy

Leiomyoma

40

Tx for leiomyoma

• Laparoscopic resection,
hysterectomy

41

Leiomyoma characteristics

Multiple subserosal, intramural, submucosal
Circumscribed, whorled nodules
Resembles normal smooth muscle (fibroid)

42

Is there malignant potential for leiomyoma?

No

43

Age of Leiomyoma

20-40 yrs
Estrogen dependant growth (regresses with menopause)

44

Age of leiomyosarcoma

Older 40-60 yrs
Postmenopausal bleed

45

Gross-
Large mass, bulky, hemorrhage, necrosis

Lab-
Hypercellular w/ atypia > 10 mitoses
Coagulative necrosis

Poor prog

Leiomyosarcoma

46

Componenet of adenosarcoma

Benign epithelium + malignant stroma

47

Clinic-
Resemble phyllodes tumor of breast
4th-5th decade
Low grad malignancy, local recurrence

Adenosarcoma

48

Stromal tumor components

Benign stromal nodule and endometrial stromal sarcoma

49

Benign stromal nodule component

Endometrial stromal cells, well circumscribed

50

Stromal sarcoma component

Low grade (infiltrative edge+ lymphovascular invasion

51

What is the translocation seen in endometrium w/ stromal differentiation tumors

7;17
Fusion genes JAZF1 and JJAZ1

52

What can cause Uterine bleeding

Abortion
• DUB
• Endometriosis
• Chronic endometritis
• Endometrial hyperplasia, polyp, carcinoma
• Leiomyoma