Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
124 Cards in this Set
- Front
- Back
|
What is the embryonic precursor to the upper 1/3 of the vagina and the uterus?
|
Mesonephric ducts
|
|
|
What ducts regress in female embryonic development of the GU tract?
|
Wolffian
|
|
|
What are 2 congenital anomalies of the uterus?
|
-Incomplete fusion of the mesonephric ducts
-Uterine hypoplasia |
|
|
What are the 3 phases of endometrial histology in the menstrual cycle?
|
-Menstrual phase
-Proliferative phase -Secretory phase (milwaukee public schools) |
|
|
What are the 2 ovarian phases of the menstrual cycle and to which endometrial phase does each correspond?
|
-Follicular (proliferative)
-Luteal (secretory) |
|
|
What marks day #1 of the menstrual cycle?
|
The first day of menstruation
|
|
|
What layer of the endometrium is shed during menstruation?
|
The functional layer
|
|
|
What is retained during menstruation? Why?
|
Stratum basalis - it has no response to hormones
|
|
|
Why does the stratum basalis needed to be retained during menstruation?
|
Because that is the layer from which endometrium regenerates
|
|
|
What are the 4 main hormones involved in the menstrual cycle?
|
-FSH
-LH -Estrogen -Progesterone |
|
|
What is the source of FSH/LH?
|
Anterior pituitary
|
|
|
What is the source of Estrogens and Progesterone?
|
Ovary
|
|
|
What are the 2 cell types in the ovaries that make estrogen/progesterone?
|
-Theca cells
-Granulosa cells |
|
|
What hormones stimulate Theca and Granulosa cells?
|
LH - Theca cells
FSH - Granulosa cells |
|
|
What does LH stimulation of Theca cells result in?
|
Increased activity of Desmolase which converts Cholesterol to Androstenedione (RLS)
|
|
|
What happens to the Androstenedione secreted by Theca cells?
|
It diffuses over to the Granulosa cells
|
|
|
What does FSH stimulation of Granulosa cells result in?
|
Increased activity of Aromatase which converts Androstenedione to Estrogen
|
|
|
What type of estrogen do the ovaries produce?
|
17B-Estradiol
|
|
|
What type of estrogen is elevated 1000x in pregnancy and why?
|
Estriol - bc the placenta produces it
|
|
|
What stimulates the anterior pituitary to release FSH/LH?
|
GnRH
|
|
|
What are the 4 main effects of LH and FSH on the ovaries?
|
-Steroid hormone production in the ovarian follicle/c. luteum
-Follicle development beyond the antral stage -Ovulation -Luteinization |
|
|
How is the release of FSH/LH from the anterior pituitary regulated?
|
By feedback from estrogen and progesterone
|
|
|
What hormone has predominent effects on FSH/LH release during the proliferative/follicular phase of the menstrual cycle? What IS the effect that it has?
|
Estrogen - inhibits, neg fb
|
|
|
What hormone predominently affects FSH/LH release at the END proliferative/follicular phase of the menstrual cycle? What IS the effect it has?
|
Estrogen - POSITIVE feedback for more LH release
|
|
|
What hormones affect FSH/LH release during the secretory/luteal phase of the menstrual cycle? What IS the effect that it has?
|
Progesterone - negative on the hypothalamus
Estrogen - negative on ant pit |
|
|
So how is it that as the Proliferative phase goes on and plasma Estrogen levels rise dt ovary secretion, how is LH able to surge to stimulate ovulation?
|
By the fact that Estrogen feedback on the pituitary switches over from neg to pos
|
|
|
What is the main hormone released by the pituitary in the Proliferative phase?
|
FSH
|
|
|
What does FSH do during the Proliferative phase?
|
Stimulates Follicle maturation in the ovary
|
|
|
What does the Follicle maturation result in?
|
Increased estrogen secretion from the granulosa cells
|
|
|
What effect does Estrogen have during the Proliferative phase?
|
Proliferation of endometrial GLANDS (primarily) and stroma.
|
|
|
So what are the 3 histologic features seen in the GLANDS during the proliferative phase?
|
-Straight long tubules
-Nuclei are pseudostratified -Mitotic figures are numerous |
|
|
How do stromal cells appear during the proliferative phase?
|
Compact/spindle-shaped with scant cytoplasm and abundant mitotic activity
|
|
|
What signals the end of the proliferative phase?
|
Ovulation
|
|
|
What happens to endometrial growth and mitotic activity at ovulation?
|
-Endometrial growth slows
-Mitotic activity ceases w/in 1-2 days |
|
|
So what hormone stimulates ovulation?
|
LH surge - in response to pos feedback from estrogen on the pituitary
|
|
|
What phase does the ovary enter after ovulation? Why is it called this?
|
Luteal phase - bc the corpus luteum begins to secrete Progesterone
|
|
|
And what phase does the uterus enter after ovulation?
|
The Secretory phase
|
|
|
What hormone is important for inducing the secretory changes in the endometrium?
|
Progesterone
|
|
|
What is the earliest histologic sign of ovulation seen in the uterine glands?
|
Basal secretory vacuoles
|
|
|
When is secretion maximum during the secretory phase?
|
Day 18-24
|
|
|
What is the histologic appearance of the glands during the secretory phase?
|
-Tortuous and dilated
-NO mitoses |
|
|
Where is the predominant site of histologic changes during the secretory phase?
|
In the STROMA - due to effects of progesterone
|
|
|
So in general each acts on what:
-Estrogen -Progesterone |
Estrogen - on glands
Progesterone - on stroma |
|
|
What are 4 stromal changes seen during the secretory phase?
|
-Stromal edema
-Spiral arterioles prominent -Predecidual changes -Premenstrual changes |
|
|
What are predicidual changes intended for?
|
Preparing a place for conceptus implantation
|
|
|
What do premenstrual changes consist of?
|
A few PMNs and lymphocytes
|
|
|
What do most endometrial problems manifest themselves as?
|
Abnormal vaginal bleeding
|
|
|
What is done to investigate endometrial problems with abnormal vaginal bleeding?
|
Endometrial biopsy
|
|
|
What are 6 conditions that give reason for doing an endometrial biopsy?
|
-Infertility
-DUB (dysfxl uterine bleeding) -Inflammation -Organic cause of bleeding -Pregnancy complication -Exogenous hormone effects |
|
|
Why would you want to do an endometrial biopsy for an infertility workup?
|
To determine if ovulation ever occurred
|
|
|
What is dysfunctional uterine bleeding caused by?
|
Anovulatory cycles
|
|
|
In what age groups is DUB and anovulatory cycles more common?
|
-Adolescence
-Perimenopause |
|
|
What is more commonly a cause of abnormal uterine bleeding in prepubertal girls?
|
Precocious puberty
|
|
|
What is a common cause of abnormal uterine bleeding in adolescent girls?
|
DUB/anovulatory cycles
|
|
|
What are more common causes of abnormal uterine bleeding in women of reproductive age?
|
-Pregnancy complications
-Organic lesions |
|
|
What are 2 causes of abnormal uterine bleeding in postmenopausal women?
|
-Organic lesions
-Endometrial atrophy |
|
|
What is endometrial atrophy?
|
Menopause
|
|
|
What are 3 components in a Fertility Workup?
|
-Dating of endometrium via biopsy
-Assessment of hormone status -Documentation of Ovulation |
|
|
What are 3 histology features that are NECESSARY for documenting ovulation?
|
-Prominent basal vacuolization
-Secretory exhaustion -Predecidual changes |
|
|
What is the term for the histologic appearance of prominent basal vacuolization?
|
Piano key appearance
|
|
|
What is Dysfunctional Uterine Bleeding?
|
Abnormal bleeding during or between menstruation, in the ABSENCE of any other underlying organic lesion.
|
|
|
What is the most common cause of DUB?
|
Anovulatory cycles
|
|
|
What is an Anovulatory Cycle?
|
Prolonged Estrogen stimulation but without progesterone activity
|
|
|
What are 3 disorders that can cause anovulatory cycles?
|
-Endocrinopathies
-Primary ovary lesions -Metabolic deficiencies |
|
|
In what ages are anovulatory cycles seen?
|
Adolescents in menarche
Perimenopause |
|
|
What is the histologic appearance of the endometrium when there are anovulatory cycles?
|
Stuck in the proliferative phase with increased gland size and mitotic activity
|
|
|
What is the 2nd most common cause of DUB?
|
Inadequete luteal phase
|
|
|
What is abnormal in inadequete luteal phases?
|
Corpus luteum doesn't secrete enough progesterone so the ovulatory phase is irregular
|
|
|
What are 3 ways that inadequete luteal phase commonly presents clinically?
|
-Infertility
-Increased bleeding/menorrhagia -Amenorrhea |
|
|
What can be seen on histologic exam of endometrial biopsy in inadequete luteal phase-induced DUB?
|
-Secretory characteristics lag in the endometrium
|
|
|
What is menopause also called?
|
Senile cystic atrophy
|
|
|
What is the reason for Senile cystic atrophy?
|
Lack of estrogen resulting in atrophic endometrium
|
|
|
What change is seen in the endometrial glands in senile cystic atrophy?
|
DILATION (not shrinking) of glands lined by flat epithelial cells
|
|
|
What does Senile cystic atrophy need to be differentiated from?
|
Simple hyperplasia with cystic dilation
|
|
|
How can you differentiate between Senile cystic atrophy vs Simple hyperplasia?
|
The glands do not proliferate in menopause, but do in hyperplasia
|
|
|
What is acute inflammation of the uterine lining called?
|
Acute endometritis
|
|
|
What are the 2 most common scenarios that cause Acute endometritis?
|
Post partum or post abortum
|
|
|
How does endometritis develop?
|
By retention of products of conception that cause ascending bacterial infections
|
|
|
What are the 2 most common infectious agents to cause acute endometritis?
|
Group A strep
Staph (rare) |
|
|
What is the treatment for acute endometritis?
|
D/C and removal of the retained gestational fragments
|
|
|
What are 4 conditions in which endometritis can become chronic?
|
-Chronic PID
-Postpartum/abortum -IUD use -Tuberculous endometritis |
|
|
What agent causes chronic endometritis via IUD use?
|
Actinomyces
|
|
|
What is the histologic presentation of chronic endometritis? (3 cell types)
|
-Plasma cells
-Histiocytes -Lymphocytes |
|
|
How does chronic endometritis manifest itself clinically?
|
-Pain
-Abnormal uterine bleeding -Infertility |
|
|
How is chronic endometritis treated?
|
With antibiotics
|
|
|
What is Adenomyosis?
|
Presence of Endometrial tissue INSIDE the uterine wall myometrium
|
|
|
Where does the myometrium lie with respect to endometrium?
|
Under the stratum basalis
|
|
|
Are glands ever normally seen in myometrium?
|
No - they should stay in endometrium
|
|
|
Why is adenomyosis bad?
|
Because the glands can cause hemorrhage during menstruation and since theres no place for the blood to go, severe pain.
|
|
|
What is more important to remember than adenomyosis?
|
Endometriosis
|
|
|
What is endometriosis?
|
The presence of endometrial glands or stroma in abnormal locations OUTSIDE the uterus
|
|
|
What are 3 ways that endometriosis can present clinically?
|
-Infertility
-Dysmenorrhea/dyspareunia -Pelvic pain |
|
|
At what age is endometriosis usually seen?
|
3rd-4th decades
|
|
|
What is the most likely mechanism by which endometriosis develops?
|
By regurgitation of uterine contents during menstruation through the fallopian tube and implantation in the abdomen
|
|
|
What are 2 other mechanisms of development of endometriosis, though less likely?
|
-Metaplastic
-Vascular/lymphatic dissemination |
|
|
What are 3 gross features of endometriosis?
|
-red-blue nodules on serosal surfaces
-Fibrous adhesions -Chocolate cysts |
|
|
What are chocolate cysts?
|
Cystic masses in the ovaries
|
|
|
What are the 3 cardinal microscopic features of endometriosis?
|
-Endometrial stroma
-Endometrial glands -Hemosiderin pigment adjacent to stroma/glands |
|
|
What is the boston term for endometrial hyperplasia?
|
Endometrial Intraepithelial neoplasia
|
|
|
What is the cause and hallmark defining feature of endometrial hyperplasia?
|
Increased gland:stroma ratio caused by disordered endometrial growth
|
|
|
What does the atypia in endometrial hyperplasia have the potential to develop?
|
Carcinoma
|
|
|
What is all endometrial hyperplasia caused by?
|
Prolonged estrogen stimulation (either exogenous or endogenous) and decreased or absent progesterone activity
|
|
|
What are 7 conditions that promote endometrial hyperplasia?
|
-Menopause
-Polycystic ovarian disease -Functioning Granulosa-Theca cell tumors -Increased adrenocortical function -Obestity -Prolonged ERT |
|
|
What clinical symptom generally results from endometrial hyperplasia?
|
Abnormal vaginal bleeding - spotting menorrhagia
|
|
|
What gene is inactivated in 64% of cases of endometrial hyperplasia?
|
PTEN Tumor suppressor gene
|
|
|
What is the inactivation of the PTEN gene related to?
|
Malignant potential and transformation to endometrial cancer
|
|
|
What is it called when there is Endometrial proliferation w/ increased density of abnormal glands and stroma but NO cytologic atypia?
|
SIMPLE hyperplasia
|
|
|
And what must simple hyperplasia be differentiated from?
|
Senile cystic atrophy
|
|
|
How is simple hyperplasia differentiated from senile cystic atrophy?
|
Simple hyperplasia shows pseudostratified nuclei in epithelial cells; none in atrophy
|
|
|
What is the treatment for simple hyperplasia?
|
Removal of the source of estrogen
|
|
|
What is it called when there is increased #/size of glands, and complex glandular structures, but DECREASED stroma?
|
Complex hyperplasia
|
|
|
What else is often abnormal in complex hyperplasia?
|
Cytogenetics - PTEN gene loss
|
|
|
What is the histologic picture of complex hyperplasia?
|
Many animals with outpouching of glands and intraluminal buds
|
|
|
What is more likely to develop into endometrial carcinoma even if atypia is absent; complex or simple hyperplasia?
|
Complex - though still rare <5%
|
|
|
What is the treatment for complex hyperplasia?
-young women -old women |
-Removal of estrogen source
Young: hi-dose progestin therapy Old: consider hysterectomy |
|
|
What is atypical hyperplasia defined as?
|
Either simple or complex hyperplasia WITH atypia
|
|
|
With which hyperplasia is atypia more frequent?
|
Complex
|
|
|
What is atypical endometrial hyperplasia considered to be really?
|
Premalignancy
|
|
|
What % of atypical EM hyperplasia progresses to cancer?
|
23%
|
|
|
What confers greater risk of transformation to cancer from atypical hyperplasia?
|
Degree of atypia - loss of PTEN
|
|
|
What is the treatment for atypical EM hyperplasia?
|
Same as for complex hyperplasia
Young: hi-dose progestin Old: hysterectomy |
|
|
What are benign tumors of the endometrium called?
|
Polyps
|
|
|
At what age are endometrial polyps generally seen?
|
Perimenopause
|
|
|
What is NOT generally seen with endometrial polyps?
|
Transformation to malignancy
|
