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Human Reproduction > Week 4: Uterus > Flashcards

Week 4: Uterus Flashcards

1
Q

Types of endometrial pathology

A
  • Endometriosis
  • Pathology with abnormal uterine bleeding
    • adenomyosis
    • endometrial infections
    • uterine neoplasms: Benign and malignant
      • endometrial polyps
      • Endometrial tumors
      • Myometrial tumors
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2
Q

Normal endometrium histology

A
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3
Q

Normal proliferative endometrium histology

A
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4
Q

What is endometriosis?

A

Presence of non-neoplastic endometrial glands and stroma in abnormal locations outside the uterus

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5
Q

Endometriosis epidemiology

A

common in reproductive aged women = 10%

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6
Q

Symptoms of endometriosis

A
  • Cyclic or chronic pelvic pain
  • dysparuenia
  • infertility
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7
Q

Endometriosis locations

A
  • Fallopian tube
  • Ovary
  • Peritoneum
  • Bowel
  • Bladder serosa
  • Among many others
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8
Q

Endometriosis gross histology

A

May form blood-filled “chocolate cysts” in ovary and other sites

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9
Q

Etiology of Endometriosis

A

three theories

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10
Q

OVary gross histology

A
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11
Q

Ovarian endometrioma gross histology

A

Chocolate cyst

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12
Q

Ovarian endometrioma AKA

A

Chocolate cyst

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13
Q

Chocolate cyst AKA

A

Ovarian endometrioma

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14
Q

Endometrial histology

A
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15
Q

Endometriosis in ureter wall histology

A
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16
Q

Endometriosis in bowel wall

A
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17
Q

Question

A

C. Hydronephrosis (urine blocked by endometriosis causing urine build-up upstream)

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18
Q

What is adenomyosis

A
  • Similar to endometriosis but the location differs
  • Presence of ectopic endometrial glands and stroma deep (greater than 2-3 mm) in the myometrium (should be on endometrial cavity surface)
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19
Q

Epidemiology of Adenomyosis

A

Prevalence of 15-25%

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20
Q

Symptoms of Adenomyosis

5 listed

A
  • Pelvic pain
  • Dysmenorrhea
  • Menorrhagia
  • Dyspareunia
  • Uterine enlargement
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21
Q

Adenomyosis etiology

A

Idiopathic

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22
Q

Adenomyosis gross histology

A
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23
Q

Histology of adenomyosis

A
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24
Q

Histology of adenomyosis

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25
Causes of abnormal uterine bleeding
* Dysfunctional uterine bleeding (DUB) * Complications of pregnancy * Organic lesions
26
DUB AKA
Dysfunctional uterine bleeding
27
Causes of DUB
Hormonal imbalances: * anovulatory cycles * inadequate luteal phase * OCPs * peri/postmenopausal changes
28
Complications of pregnancy that can cause abnormal uterine bleeding
* Abortion * trophoblastic disease * ectopic pregnancy
29
Organic lesions of the Endometrium that can cause abnormal uterine bleeding
* Polyps * Endometritis * Hyperplasia * carcinoma
30
Organic lesions of the Myometrium that can cause abnormal uterine bleeding
* Adenomyosis * Leiomyomas * Leiomyosarcoma
31
Organic lesions of the cervix that can cause abnormal uterine bleeding
* Polyps * Carcinoma
32
Causes of Abnormal vaginal bleeding in Adolescence
DUB (hormonal imbalances)
33
Causes of Abnormal vaginal bleeding in Reproductive age
* Complications of pregnancy * DUB * Organic lesions
34
Causes of Abnormal vaginal bleeding in Perimenopause
* DUB * Organic lesions
35
Causes of Abnormal vaginal bleeding in Postmenopausal women
* Atrophy * Organic lesions (cancer \< 10%)
36
What are endometrial polyps?
* Focal overgrowth of glands and stroma * monoclonal proliferation of endometrial stroma with non-neoplastic glands
37
Epidemiology of endometrial polyps
* Age usually \> 40 years old
38
Clinical presentation of endometrial polyps
* irredular vaginal bleeding * rarely infertility
39
Histological features of endometrial polyps
* Thick-walled vessels * altered stroma * Irregular gland architecture
40
Histological features of endometrial polyps
* Thick-walled vessels * altered stroma * Irregular gland architecture
41
Risk factors for endometrial polyps 6 listed
* Age \> 40 years old * HTN * Obesity * Late menopause * endometriosis * Tamoxifen anti-estrogen therapy
42
Gross histology of endometrial polyp
43
What is Endometritis?
* Abnormal inflammation of the uterine lining * may be acute or chronic * usually presents with bleeding, pelvic pain and fever (if acute) * Acute endometritis is typically bacterial infection
44
Endometritis clinical presentation
* bleeding * pelvic pain * fever (if acute)
45
Etiologies of Acute endometritis
Typically caused by a bacterial infection due to * Retained products of conception after delivery * Foreign body such as IUD
46
Histological features of acute endometritis?
Neutrophils in endometrium
47
Histological features of acute endometritis
Neutrophils in endometrium
48
Treatment of acute endometritis
Treated with antibiotics
49
Clinical presentation of chronic endometritis
* Low-grade inflammation * less severe symptoms * bleeding * pelvic pain
50
Histological features of chronic endometritis
* Loss of cervical barrier between vagina and uterine cavity * plasma cells in endometrial stroma
51
Chronic endometritis etiologies
infectious agents may be related to PID * Chlamydia * Ureaplasma * Mycoplasma
52
Pathophysiology of chronic endometritis
loss of cervical barrier between vagina and uterine cavity
53
Treatment of chronic endometritis
can be treated with antibiotics
54
Causes of abnormal bleeding due to reproductive status
* Cycling endometrium * reproductive aged women * Proliferative or secretory phase of menstrual cycle * Non-cycling endometrium * mostly peri or postmenopausal women * increasingly more common in reproductive aged women with obesity epidemic * includes precancers and cancers
55
What are the diagnostic categories of non-cycling endometrium
* Changes reflecting menopause * atrophic endometrium * Changes reflecting hormone therapy * oral contraceptive effect * Hormone Replacement Thearpy (HRT) * Changes reflecting prolonged estrogen exposure unopposed by progesterone * abnormal proliferative endometrium (includes cancer)
56
Risk factors for endometrioid adenocarcinoma with unopposed estrogen
57
Effects of estrogen on the endometrium
58
Effects of progesterone on the endometrium
Anti-proliferation
59
Normal state of hormones in the endometrium
Balance of estrogen and progesterone
60
Imbalance of hormones in the endometrium
imbalance with excess estrogen can lead to abnormal proliferation, endometrial hyperplasia and cancer
61
Series of events from increased estrogen in the endometrium
* Gland crowding * at expense of endometrial stroma (glands increase) * Glandular architecture is abnormal * with irregular gland shapes and sizes * nuclear atypia * from unregulated gland proliferation leads to endometrial hyperplasia (precancer) which can lead to endometrial adenocarcinoma AKA Endometrial intraepithelial neoplasia or EIN
62
Architectural changes in endometrial hyperplasia
* Simple endometrial hyperplasia * Round tubular glands with crowding and dilation * Complex endometrial hyperplasia (EIN) * Crowded complex glands with branching * Nuclear atypia * Nuclei enlarged, irregular, coarse chromatin, prominent nucleoli
63
Diagnostic spectrum of endometrial adenocarcinoma
1. Simple Endometrial Hyperplasia 2. Complex Endometrial Hyperplasia without nuclear atypia 3. Complex endometrial hyperplasia with nuclear atypia (AKA Endometrial Intraepithelial Neoplasia (EIN)) 4. Endometrial adenocarcinoma
64
Risk of progression to endometrial cancer with untreated hyperplasia * Simple hyperplasia without nuclear atypia * Complex hyperplasia without nuclear atypia * Complex hyperplasia with nuclear atypia
* Simple hyperplasia without nuclear atypia: 1-3% * Complex hyperplasia without nuclear atypia: 3% * Complex hyperplasia with nuclear atypia: 23-48%
65
Histological features of normal proliferative endometrium
66
Histological features of simple endometrial hyperplasia
67
Histological features of Complex endometrial hyperplasia
68
Endometrial adenocarcinoma epidemiology
* most common gynecologic tumor in US with approx. 34,900 new cases/year (followed by ovary and cervix) * peak age 55-65+ years * increasingly seen in younger women with high BMI
69
Endometrial adenocarcinoma presentation
Abnormal uterine bleeding, usually preceeded by endometrial hyperplasia
70
Risk factors for endometrial adenocarcinoma
* Unopposed estrogen * obesity * diabetes mellitus * hypertension * nulliparity * late menopause * peak age 55-65+ years * increasingly seen in younger women with high BMI
71
Endometrial adenocarcinoma types
two types * Type 1: Endometrioid (90%) * Type 2: Serous, clear cell, carcinosarcoma (10%)
72
Diagnostic criteria of endometrial adenocarcinoma
* Crowded back-to-back glands with little to no intervening stroma * complex cribiform architecture with glands within glands * Cytologic atypia as described
73
Diagnostic criteria of endometrial adenocarcinoma gross histological features
* initially tumor is present only lining endometrial cavity but may invade into uterine myometrium * then has access to lymphatics and may metastasize * prognosis worsens with depth of invasion
74
Endometrial adenocarcinoma gross histology
75
Endometrial adenocarcinoma gross histology
76
Endometrial adenocarcinoma histological features
77
Endometrial adenocarcinoma histological features
78
Endometrial adenocarcinoma histological features
79
Endometrial adenocarcinoma histological features
80
Endometrial adenocarcinoma histological features
81
Endometrial adenocarcinoma type I
82
Endometrial adenocarcinoma type 2
83
Serous endometrial adenocarcinoma histological features
84
Natural history of endometrial carcinoma
85
Question
C. Biopsy
86
What is Uterine Leiomyoma (fibroid)
Common benign smooth muscle neoplasm that is steroid hormone (estrogen & progesterone) dependent: * Increase in size during pregnancy * Regress after menopause
87
Age of Benign smooth muscle neoplasm
seen in about 75% of women after 30 years, peak age 20-40 years
88
Symptoms of Uterine Leiomyoma
* usually none * abnormal uterine bleeding, may lead to iron deficiency anemia * pelvic pain * Infertility and/or miscarriage
89
Uterine Leiomyoma AKA
Fibroid
90
Symptoms of Uterine Leiomyoma size changes
* Increase in size during pregnancy * Regress after menopause
91
Symptoms of Uterine Leiomyoma
* Usually none * abnormal uterine bleeding, may lead to iron deficiency anemia * pelvic pain * infertility, miscarriage
92
Uterine Leiomyoma gross histology
93
Histological features of Uterine Leiomyoma
94
Histological features of Uterine Leiomyoma
95
What is Uterine Leiomyosarcoma
* Malignant uterine smooth muscle tumor not usually derived from leiomyoma * \***Not** hormonally responsive\*
96
Uterine Leiomyosarcoma histological features for diagnosis
* Increases mitotic rate \> 10/10 HPF * High Cellularity * Nuclear pleomorphism * Tumor necrosis
97
Uterine Leiomyosarcoma common sites of invasion & metastasis
may be Highly aggressive and invade * rectum * bladder * ureters * tends to recur Common sites of metastasis Hematogenous metastasis: lungs
98
Gross histology of Leiomyosarcoma
99
Histological features of Uterine Leiomyosarcoma
100
Histological features of Uterine Leiomyosarcoma
101
Tumors of the endometrial stroma
Low and high grade types Low grade stromal sarcoma High grade stromal sarcoma
102
Low grade stromal sarcoma
103
Low grade stromal sarcoma histological features
104
Histological features of Low grade stromal sarcoma
105
Low grade stromal sarcoma histological features
106
High grade stromal sarcoma
107
High grade stromal sarcoma histological features
108
High grade stromal sarcoma histological features
109
What is the most common type of Endometrial Adenocarcinoma?
Endometrial adenocarcinoma type I
110
Endometrial adenocarcinoma type I etiology
Arises in the setting of endometrial hyperplasia
111
Endometrial adenocarcinoma type I risk factors
* Obesity * DM * HTN * Infertility * Unopposed Estrogen stimulation
112
Endometrial adenocarcinoma type I associated genes
* PTEN mutations (30-80%) * PIK3CA mutations in 40%
113
Endometrial adenocarcinoma type I common sites of metastatsis
* indolent behavior * Lymphatic spread
114
Endometrial adenocarcinoma type II occurs in
older women than type I
115
Endometrial adenocarcinoma type II etiology
Arises in the setting of vaginal atrophy Thin physique no estrogen link
116
Endometrial adenocarcinoma type II genes
P53 mutations seen in 90% of serous carcinoma
117
Endometrial adenocarcinoma type II common sites of metastasis
* Aggressive behavior * Intraperitomeal and lymphatic spread
118
Endometrial carcinoma common sites of metastasis via direct invasion
* Bladder * Rectum * Ureters
119
Endometrial carcinoma common sites of metastasis via lymphatics
* Pelvic/peri-aortic nodes * High risk of pelvic recurrence
120
Endometrial carcinoma common sites of metastasis via hematogenous spread
* Lungs * Liver
121
Common subtypes of Type II Endometrial carcinoma
* Serous carcinoma (most common) * Clear cell carcinoma
122
Common subtypes of Type I Endometrial carcinoma
Endometrioid carcinoma
123
What is Menometrorrhagia?
Menometrorrhagia is a condition in which prolonged or excessive uterine bleeding occurs irregularly and more frequently than normal. It is thus a combination of metrorrhagia and menorrhagia.

Human Reproduction (40 decks)

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