Repro: Uterus Pathology

Front 1

Layers of Uterus

Back 1

Endometrium
Myometrium
Serosa

Front 2

Acute Endometritis vs Chronic Endometritis Symptoms and causes and treatment. Types

Back 2

Acute Endometritis - uncommon, can occur post-abortion or post-partum. Treat with Abx and has acute inflammatory cells (NEUTROPHILS)

Chronic endometritis - Chronic inflammation of the endometrium. Can present like tumors so must distinguish.

Symptoms - uterine bleeding, chronic pain, vaginal discharge, infertility

Tx - Abx to prevent uterus loss

Causes/Types
a) Plasma Cell Endometritis - most common, pts of mid-reproductive age, PLASMA cells in endometrium (not normal)
b) Actinomyces - associated with IUD, FILAMETNOUS BACTERIA aggregate into SULFUR granules with acute inflammatory cells around
c) Endometrial Tuberculosis - CASEATING GRANULOMA, lymphocytes and chronic inflammatory cells. Treat like TB

Front 3

Endometrial polyps and Histology

Back 3

Sessile masses of variable size and number.

Histology: Irregular BENIGN endometrial glands, fibrous stroma and thick-wall vessels. Asymptomatic or may ulcerate and cause bleeding

RARELY can lead to adenocarcinoma

Necrosis (often at tip) can lead to endometrial bleeding

Front 4

Endometrial Hyperplasia Cause (and Source), Classification

Back 4

Cause
a) Endogenous estrogen production - perimenopausal status, persistent anovulation in younger women, estrogen producing ovarian tumors such as granulosa cell tumor and fibrothecoma. Polycystic ovarian syndrome, obesity

b) Exogenous estrogen administration (HRT ex)

Classification
1) Simple Hyperplasia - NO architecture or cytologic atypia, CROWDED glands. VERY LOW progression to carcinoma
2) Complex Hyperplasia - budding, irregular, more crowded proliferating glands. Abnormal architecture but NO cytologic atypia
3) Atypical Hyperplasia - crowded, irregular glands, CYTOLOGIC ATYPIA with larger, darker nuclei and no polarization of the cells within the glands. As high as 30% progress to carcinoma

CYTOLOGIC ATYPIA is MOST IMPT predictive feature for progression to carcinoma

Front 5

Endometrial Cancer Histologic Types, Age breakdown and Presentation

Back 5

Endometroid
Papillary Serous
Clear Cell Adenocarcinoma
Malignant Mullerian tumor

Younger women (45-65) - endometroid - likely estrogen dependent
Older women (70-80) - papillary serous, clear cell adenocarcinoma, malignant mullerian tumor - not estrogen dependent

Presentation - abnormal uterine bleeding, often postmenopausally

Evaluated with biopsy in office, curretage to confirm diagnosis

Front 6

Endometrial Adenocarcinoma Presentation, Histology, Grading, Age difference

Back 6

Mostly younger women due to UNOPPOSED ESTROGEN and begins with endometrial hyperplasia

Histology - on biopsy or curretage see atypical, crowded glands that can represent either hyperplasia or carcinoma. If invades into myometrium can diagnose carcinoma

Less aggressive than others

Grade I - looks just like endometrial hyperplasia
as move up to Grade III get more atypia, lots of mitoses and cytologic atypia

In Older Women (70-80) - endometrial cancer is poorly differentiated, more aggressive, poor prognosis

Front 7

Papillary Serous Carcinoma Presentation, Histology,

Back 7

Same type of malignancy, often from Fallopian tube. VERY vascular papillae lined by epithelium, lots of mitoses, large nuclei and papillary proliferation

VERY AGGRESSIVE

Front 8

Clear Cell Adenocarcinoma Presentation, Histology

Back 8

SMALL nuclei with clear cytoplasm

Most commonly solid type

Front 9

Malignant Mixed Mullerian Tumor (MMMT) Presentation, Histology, Subtypes

Back 9

Tumor with components of both carcinoma and sarcoma

VERY fast growing, malignant tumor, often prolapse through cervix

Subtypes
a) Homologous - sarcoma originates from uterus (leiomyosarcoma, endometrial stromal sarcoma)
b) Heterologous - sarcoma originates OUTSIDE of uterus (rhabdomyosarcoma, chondrosarcoma)

Front 10

Endometrial Stromal Sarcoma, Types

Back 10

Derived from endometrial stroma, occurs in young and old women

Hardest to diagnose because it looks somewhat normal, malignant because invades myometrium though. Normal mitoses rate

Low Grade vs High grade (more cellularity, cytologic atypia and mitoses)

Needs IMMUNOHISTOLOGIC STAIN to diagnose

Front 11

Adenomyosis

Back 11

Endometrial implants within thickened uterine wall

Front 12

Benign and Malignant Myometrial Neoplasms

Back 12

Benign - Leiomyoma - can be in submucosal, myometrial or in serosa. Can cause infertility if tumor fills cavity and acts as IUD. White, firm, well circumscribed lesions. Smooth muscle with well defined borders

Malignant - Leiomyosarcoma - DOES NOT arrive from a leiomyoma. Malignant tumor that grows aggressively and either fills endometrial cavity or growing into myometrium. Discoloration due to bleeding, necrosis or lack of borders. Malignant, invasive lesions without borders

Front 13

Benign Paratubal Cyst

Back 13

Thin, translucent cyst filled with fluid, can obstruct fallopian tube

Front 14

Pelvic Inflammatory Disease

Back 14

Acute salpingitis - acute infiltration of tube with neutrophils that can lead to hemorrage and fibrous tissue stuck to surroundings

Once treated can get hydrosalpinx (tube filled with fluid and dilated) OR can become narrowed/occluded or form adhesions

Acute Salpingitis is MOST COMMON cause of ectopic pregnancy

Front 15

Ectopic Tubal Pregnancy

Back 15

Tube implants in a place other than uterus, usually fallopian tube or ovary, can rupture and cause bleeding

Ovary will have a corpus luteum

Front 16

Fallopian Tube Carcinoma

Back 16

Serous epithelium in fallopian tube can be transformed

Usually discovered once really advanced. Usually Papillary Serous Carcinomas