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19 Cards in this Set
- Front
- Back
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What is endometriosis? Is it common or rare? What age group is it seen in? What are the SSx?
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Presence of endometrial glands & stroma outside the uterus (fallopian tube, ovary, peritoneum, bowel & bladder serosa); Common in reproductive aged women; SSx: pelvic pain, infertility
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What are the 3 theories as to etiology of endometriosis?
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Retrograde menstruation, Metastasis, Metaplasia
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List 6 causes of irregular vaginal bleeding.
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Adenomyosis, Endometrial polyps, Chronic endometritis, Anovulatory menses, Leiomyoma, Abn endometrial proliferations (endometrial hyperplasia (precancers), endometrial carcinoma)
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What is adenomyosis? What is it similar to? How common is it? What are the SSx?
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Presence of endometrial glands & stroma in the myometrium (should be on surface); Similar to endometriosis; Prevalence 5-70%. SSx: Pelvic pain, Dysmenorrhea, Menorrhagia
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What is an endometrial polyp? Is it malignant or benign? What age group is it commonly seen in? What are the SSx?
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Focal overgrowth of glands & stroma; Probably a benign tumor of the stroma; Age usually >40yo; SSx: irreg vaginal bleeding, rarely infertility
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What is chronic endometritis?
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Loss of cervical barrier between vagina & uterine cavity; Plasma cells in endometrial stroma
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What are the causes of chronic endometritis? What else do these agents cause?
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Infectious agents; Generally those that cause salpingitis; N. gonorrhea, Chlamydia, Mycoplasmas
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List 6 causes of anovulatory endometrial cycles. What is the effect of these cycles, regardless of cause?
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Menarche/Menopause, Physiologic stress, Estrogen replacememt, Obesity +/- PCOS, Estrogen-secreting ovarian tumors, Endocrine dz (thyroid, adrenal, pituitary). Effect: irreg vaginal bleeding
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What is the effect of estrogen & progesterone on the glandular epithelium & stroma of the endometrium?
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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
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What is the pathogenesis of Abnormal Proliferative Endometrium and how does this lead to CA?
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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)
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As the endometrium becomes more abnormal (from disordered proliferative to low-grade carcinoma), what histological factors increase?
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Glandular complexity -> Gland: sroma ratio -> Epithelial stratification -> Nuclear enlargement & pleomorphism
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What is the difference between low- & high-grade hyperplasia in terms of mean age, hyperplastic v atrophic endometrium, ER/PR, p53 mutation, & prognosis
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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
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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 __ & __.
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Bladder, Rectum, Ureters; Pelvic/Peri-aortic nodes; Lungs, Liver
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How common are uterine leiomyomas? What are they also known as? What are the SSx?
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75% of women >30yo; Fibroids; Usually asymptomatic, but can present w/ vaginal bleeding, pelvic pain, & infertility
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Explain the steroid hormone dependence of leiomyomas?
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+ER/PR; Regress after menopause
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Are uterine leiomyosarcomas derived from leiomyomas?
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No
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What 4 histological features are required for a dx of leiomyosarcoma?
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Increased mitotic rate (>10/hpf), High cellularity, Nuclear pleomorphism, Tumor necrosis
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Where can leiomyosarcomas spread to via local invasion? via hematogenous metastasis?
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Local invasion: rectum, bladder, ureters. Hematogenous metastasis: lungs
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What is the difference between endometrial stromal nodules, low grade stromal sarcomas, and high grade sarcomas.
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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
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