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19 Cards in this Set

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What is endometriosis? Is it common or rare? What age group is it seen in? What are the SSx?
Presence of endometrial glands & stroma outside the uterus (fallopian tube, ovary, peritoneum, bowel & bladder serosa); Common in reproductive aged women; SSx: pelvic pain, infertility
What are the 3 theories as to etiology of endometriosis?
Retrograde menstruation, Metastasis, Metaplasia
List 6 causes of irregular vaginal bleeding.
Adenomyosis, Endometrial polyps, Chronic endometritis, Anovulatory menses, Leiomyoma, Abn endometrial proliferations (endometrial hyperplasia (precancers), endometrial carcinoma)
What is adenomyosis? What is it similar to? How common is it? What are the SSx?
Presence of endometrial glands & stroma in the myometrium (should be on surface); Similar to endometriosis; Prevalence 5-70%. SSx: Pelvic pain, Dysmenorrhea, Menorrhagia
What is an endometrial polyp? Is it malignant or benign? What age group is it commonly seen in? What are the SSx?
Focal overgrowth of glands & stroma; Probably a benign tumor of the stroma; Age usually >40yo; SSx: irreg vaginal bleeding, rarely infertility
What is chronic endometritis?
Loss of cervical barrier between vagina & uterine cavity; Plasma cells in endometrial stroma
What are the causes of chronic endometritis? What else do these agents cause?
Infectious agents; Generally those that cause salpingitis; N. gonorrhea, Chlamydia, Mycoplasmas
List 6 causes of anovulatory endometrial cycles. What is the effect of these cycles, regardless of cause?
Menarche/Menopause, Physiologic stress, Estrogen replacememt, Obesity +/- PCOS, Estrogen-secreting ovarian tumors, Endocrine dz (thyroid, adrenal, pituitary). Effect: irreg vaginal bleeding
What is the effect of estrogen & progesterone on the glandular epithelium & stroma of the endometrium?
Estrogen causes proliferation of both the glandular epithelium & endometrial stroma. Progesterone is anti-proliferative on the glandular epithelium & causes a decidual change in the endometrial stroma
What is the pathogenesis of Abnormal Proliferative Endometrium and how does this lead to CA?
Failure to ovulate on schedule -> Sustained glandular stimulation by E, unopposed by P -> Abn glandular architecture -> Increasing density of glands at expense of endometrial stroma -> Unregulated glandular proliferation -> Invasion of endometrium, lymphatic, bv's (= carcinoma)
As the endometrium becomes more abnormal (from disordered proliferative to low-grade carcinoma), what histological factors increase?
Glandular complexity -> Gland: sroma ratio -> Epithelial stratification -> Nuclear enlargement & pleomorphism
What is the difference between low- & high-grade hyperplasia in terms of mean age, hyperplastic v atrophic endometrium, ER/PR, p53 mutation, & prognosis
Low grade: Age: 59, hyperplastic endometrium, +ER/PR, No or late p53 mutation, Favorable prognosis. High grade: 68y, Atrophic endometrium, -ER/PR, p53 mutation, Poor prognosis
Endometrial carcinoma can spread by direct invasion to the __, __, & __, through lymphatic metastasis to the __/__ nodes (with a high risk of pelvic recurrence), and through hematogenous metastasis to the __ & __.
Bladder, Rectum, Ureters; Pelvic/Peri-aortic nodes; Lungs, Liver
How common are uterine leiomyomas? What are they also known as? What are the SSx?
75% of women >30yo; Fibroids; Usually asymptomatic, but can present w/ vaginal bleeding, pelvic pain, & infertility
Explain the steroid hormone dependence of leiomyomas?
+ER/PR; Regress after menopause
Are uterine leiomyosarcomas derived from leiomyomas?
No
What 4 histological features are required for a dx of leiomyosarcoma?
Increased mitotic rate (>10/hpf), High cellularity, Nuclear pleomorphism, Tumor necrosis
Where can leiomyosarcomas spread to via local invasion? via hematogenous metastasis?
Local invasion: rectum, bladder, ureters. Hematogenous metastasis: lungs
What is the difference between endometrial stromal nodules, low grade stromal sarcomas, and high grade sarcomas.
Stromal nodule: completely circumscribed & benign. LG: cells resemble benign endometrial stroma; has infiltrative and/or vasoinvasive margins. HG: very pleomorphic cells that are not readily recognized as endometrial; rapid growth & metastasis; poor prognosis