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43 Cards in this Set
- Front
- Back
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what does the uterus look like in these different stages |
1. proliforative: rapid growth, straight tubular glands with regular tall pseudostrat epithelium, lots of mitoses,
2. secretory: glands dilated, tourtous, spiral srterioles, **the basal layer is retained |
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when does acute endometritis occur, whats the tx
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retained products of conception
bacterial infections after delivery/miscarriage **its not super common, we have that cervix to block things out *contrast that to chronic: PID, POC, IUD, TB. see plasma cells |
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what are the 4 settings in which chronic inflammation of the endometrium occurs. what cell is the morphologic hallmark
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1. chronic PID
2. Retained POC 3. IUD 4 TB PLASMA CELLS |
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what does it mean when a plasma cell is seen in the endometrium
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chronic inflammation
seen with 1. chronic PID 2. retained POC 3. IUD 4. TB |
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whats adenomyosis
what does it look like on histo when does it make sx |
1. adenomyosis is when basal layer of endometrial glands dig deep into myometrium
2. irregular nest of endometrial stroma +/- glands 3. the cysts can hemorrhage and cause problems |
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adenomyosis
endometriosis |
adeno- the myometrium is full of endo
endo- the areas outside of the uterus are full of endo |
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where does endometriosis occur
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all sorts of places. the KEY is that its NOT in the uterus
1. ovary- chocolate cyst 2. uterine lig etc etc |
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how old are ppl who develop endometriosis
sx |
seen in 40-50's
**infertile, dysmenorrhea, pelvic pain, hurts to poop |
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what 3 things do they think causes endometriosis
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regurg
metaplastic vascular/lymph |
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does endometriosis respond to hormones
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yep! cyclic menstrual changes
red/blue nodules below serosal surface lots of sdhesions |
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whats a chocolate cyst
what 2-3 features are required for chocolate cyst dx |
ovarian endometriosis
1. endometrial glands 2. stroma 3. hemosiderin pigment |
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what are hte clinical sx for endometriosis
what can develop in endometrial lesions |
sx: dysmenorrhea, pelvic pain, hurts to poo, dysparenuia, intestinal problems, infertile
2. DUB- dysfx uterine bleeding excess estrogen so anovulatory |
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what are the 2 entities of endometrial hyperplasia
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1. estrogen field effects of BENIGN endo hyperplasia. unopposed estrogen
2. EIN- endometrial INTRALEPITHELIAL neoplasia. monoclonal neoplastic growth that progresses to endometroid endometrial carcinoma |
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why treat endometrial hyperplasia
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bc it can lead to cancer
the EIN hyperplasia --> endometroid endometrial carcinoma MONOCLONAL NEOPLASTIC GROWTH |
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what hormone drives endometrial hyperplasia
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estrogen
**hyperplasia caused by anything that cayses hyperplasia |
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what conditions promote endometrial hyperplasia
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anything that prolongs estrogen stimulation
late estrogen PCOD granulosa cell tumor estrogen replacemnt tx excessive cortical fx |
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whats a presentation of a woman with endometrial hyperplasia
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most common- postmenopausal bleeding
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ok so endometrial hyperplasia is divided into
1. benign 2. EIN tell me waht kinds of benign there are |
benign:
1. simple 2. complex 3. atypical- 25% progress to CA. GET IT TREATED!!!! EIN --> endometroid endometriala carcinoma |
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what tumor suppressor gene is inactivated in EIN sequence (this is the endometroid intraepithelial neoplasia)
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PTEN
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PTEN is associated with whatr
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endometrial hyperplasia, when you have this its HUGE in the switch from benign hyperplasia to precancerous
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whats endometrial polyp
what are the 2 histo types of polyps |
1. functional endometrium
2. hyperplastic endometrim- cystic **associated with tamoxifen |
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whats the most common tumor in women
is it benign? what are the gross and micro sx |
leiomyoma "fibroids"
benign arise from SM cells: sharply circumscribed, discrete, round, firm, gray white. can be intra/sub/se. whorled SM cells sx: bleeding, frequency, pain, infertile, asx. |
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a lady comes in with abnormal bleeding, pain and infertility, after taking a biopsy it comes back with whorl of SM. you assure her its benign. whats the deal
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uterine leiomyoma "fibroids" super common
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whats more common. whats more deadly
endometrium ovary |
endo is more common for tumors
ovarian tumors is more deadly |
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what is the most common INVASIVE cancer of female genital tracct
who gets it, how do they present |
endometrial adenocarcinoma (invasive, not cervical bc of paps)
seen in post menopausal women (55-65) present with abnormal bleeding - this is good bc we know there is a problem. contrast to the ovarian that dont have as obvious presentations |
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we learned htat endometrial adenocarcinoma is the most common invasive female cancer. why is it not cervical
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bc pap smears are detecting cervicals before tehy get INVASIVE
endometrial adenocarcinoma presents with bleeding so we know there is a problem that needs to be addresses seen in 55-65 yo |
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what are the 2 categories of carcinoma of the endometrium. whats more common
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Type I: endometroid. PTEN, unopposed estrogen. hyperplastic precoursor. stable growth. seen before menopause. more common
Type II: serous: seen post menopause, no estrogen, no hyperplastic precursor, high grade, DEEP invasion, progressive |
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is PTEN seen in type I (endometroid) or type II (serous) carcinoma
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type I- most common
unopposed estrogen, obsesm HTN, DM, hyperplastic precursor. |
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type I endometiral CA looks like what?
what is it assocaited with (5) what gene is mutated |
MOST COMMON
Looks like: well differentiated, mimic proliforative endometrial glands= endometroid carcinoma there is an endometrial hyperplasia precursor PTEN mutation associated with: obesity, DM, HTN, infertile, unopposed estrogen |
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RISK factors for endometrial carcinoma I
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1. obese
2. DM 3. HTN 4. infertility 5. unopposed estrogen stimulation PTEN mutation |
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endometrial carcinoma, morph is it a glandular
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yep- adenocarcinoma
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what are the GRADES Of endometrial carcinoma
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recall grade is determined by that pathologist and its differnt than stage
1 well differentiated 2. moderatly differentiated 3. poorly differentiated |
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what age gets Type II endometrial CA
what is most common subtype what mutation |
occurs LATER than type I
p53 mutation no endometrial hyperplasia precursor, the precursor is EIC (endometrial intraepithelia, carcinoma) |
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can we screen for endometrial CA
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nope
**post menopausal bleed usually is presenting factor and this requires a work up |
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type I and type II endometrial carcinoma prognosis
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I: better
II: worse depends on stage Stage- I is a 90% survivial Stage II and III is 50% |
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what are the 2 familial CA syndromes with increased risk of endometroid CA
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1. HNPPC: DNA mismatch repair
2. Cowdens Syndrome- PTEN mutation- (type I) |
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whats MMMT? prognosis?
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Malignant mixed mulerian tumors (carcinosarcoma)
endometrial adenocarcinoma with malignant stromal differentiaion BAD PROGNOSIS!!!!! |
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what is the super malignant endometrial cancer that is adenocarcinoma with malignant stromal differentiation
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mixed malignant mullerian tumor
super bad prognosis |
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what are the 2 groups of endometrial CA with stromal differentiation
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stroma is sarcoma
1. Adenosarcomas |
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adenocarcinoma are composed of what tissue, wahts the prognosis
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BAD
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what do leiomyosarcomas arise from
what are the gross adn morph features |
leiomyosarcoma is de novo, its common in 40-60 yo. recurr after removal
mitoses, nuclear atypia, necrosis |
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whats the diff btwn a leiomyoma and leiomyosarcoma
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leiomyoma- benign
leiomyosarcoma- no necrosis, no nuclear atypia, no mitoses. arises de novo. seen in pre and post menopausal RECUR after removal |
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what age ppl get leiomyosarcoma
what happens after they get them removed |
40-60 yo
RECUR after removal |
