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35 Cards in this Set

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What are the cyclic changes of the endometrium?
1. Proliferative phase (estrogen phase)
2. Secretory phase (progesterone phase)
3. Menstruation
4. Microscopic changes.
Describe the early, mid, and late phases of the proliferative phase (pre-ovulatory phase.
-Early: thin regeneration surface epithelium, straight narrow glands w/ mitosis, compact stroma w/ some mitosis.
-Mid: columnar surface epithelium, longer curving glands, variable stromal edema, numerous mitosis.
-Late: undulent (up & down) surface, tortuous glands w/ active pseudo-stratified epithelium, moderately dense stroma.
Describe the characteristics of interphase.
-scattered sub-nuclear vacuoles (<50% of glands)
-overlaps into POD 1&2 (day 15 or 16 of cycle); pattern isn't necessarily indicative of ovulation;
Describe the secretory phase POD 2-POD 15
POD 2: >50% glands w/ uniform sub-nuclear vaculolization, mitosis present.
POD 3: Sub-nuclear vacuoles & nuclei uniformly aligned; scattered mitosis;
POD 4: vacuoles in luminal position.
POD 5: vacuoles infrequent, secretions are luminal
POD 6: secretions are prominent;
POD 7: beginning stromal edema;
POD 8: Maximal stromal edema.
POD 9: spiral arteries are prominent--see lots of bv's.
POD 10: thick periarterial cuffs of predecidua.
POD 11: islands of predecudua in superficial compactum.
POD 12: beginning coalescence of surface islands of predeciduea.
POD 13: confluence of surface islands; stromal granulocytes prominent.
POD 13: extravasation of RBC's in stroma; stromal PMNs prominent.
Describe the characteristics of microscopy of menstrual phase?
Tissue shredding, regeneration, dilated exhausted glands w/ adjacent decidualized stroma w/ fragmentation, fibrin thrombi in vessels & stroma.
What are the causes of acute endometritis?
Ascending gonococcal, postpartum streptococcal (puerperal sepsis), chemical or irritant.
What are the causes of chronic endometritis?
Silent gonococcal, IUD (actinomycosis), Others-TB, chlamydia.
What is dysfxnal uterine bleeding & what can be used for diagnostic purposes or therapy?
-Irregular, excessive, inappropriate menstrual bleeding b/c of hormonal imbalance & w/o organic lesion;
-D&C-->1/2 who do this have no abnl findings on tissue exam, but this helps start them back w/ nl menses.
What is an anovulatory cycle?
-No ovulation b/c progesterone is normally low during this time, but here you get prolonged estrogen stimulation w/no secretory phase.
-Most common around menarche (immaturity) & menopause (atrophy)
-may see proliferative phase glands w/ individual cell necrosis & stromal cell breakdown.
Describe the inadequate luteal phase or luteal phase defect.
-Corpus luteum fails to secrete adequate progesterone level.
-Get infertility w/ inc bleeding or amenorrhea
-w/ bx: endometrium has features that lag behind nl dates.
Describe irregular shedding.
Glands @ different states of development. Prolonged menses.
What is the most common cause of DUB (dyzfxn'al uterine bleeding) in postmenopausal females?
Atrophic endometrium (must rule out endometriual CA).
-Thinned endometrial mucosa.
-Dec in glands & stromal volume.
-Surface: low columnar-cuboidal
-Collagenized stroma (no longer responsive to edema)
-cystically dilated glands often present.
What is the Arias-Stella reaction?
During pregnancy, voluminous cells w/ lg hyperchromatic nuclei w/ hobnail appearance & clear vacuolated cytoplasm. -Nuclear atypia is striking, but N/C ratio intact; mitosis are rare. (if you see mitosis, think malignancy, not preg)
-May also be seen w/ progestins, IUP, EUP, trophoblastic dz.
What is the differential diagnosis for Arias Stella rxn in pregnancy?
Adenocarcinoma--more focal, more mitosis.
When do endometrial polyps tend to show up? They are associated w/ what?
-Common around menopause
-May cause uterine bleeding;
-Usually .5-3 cm in diameter.
-May protrude thru external os.
-Have been assoc w/ tamoxifen.
What is Adenomyosis & what are the sx's?
-Adenomyosis: endometrial GLANDS & STROMA deep in myometrium assoc w/ hypertrophied myometrium.
-Common cause of menstrual irregularities & enlarged uterus;
-Sxs: cramping, pain, prolonged & inc menstrual periods & assoc w/ uterine rupture during preg.
What is Endometriosis?
-Misplaced endometrial glands & stroma seen in vulva, vagina, cervix, ovaries, bladder, bowel.
-Cause: controversial if developmental defect or acquired (implantation), maybe implantation of viable menstrual endometrium.
Sx: abdominal pain, maybe infertility; If extensive, can coat pelvic organs leading to bowel obstruction.
What is the most common gynecological malignancy and is primarily a dz of older women? How does it present?
Adenocarcinoma; Post-menopausal bleeding
Adenocaricoma's etiology is most likely related to what?
unopposed estrogen
What is the protective effect for adenocarcinoma and what are the risk factors associated with it?
Protective: pregnancy;
Risk factors: obesity, HTN, DM, infertility, estrogen producing tumors.
What is the tx for adenocarcinoma?
-cystic hyperplasia & adenomatous hyperplasia: treated hormonally;
-Atypical adenomatous hyperplasia & CA treated by hysterectomy (can use for staging-->if deeply invasive or >50% of wall thickness follow surgery w/ radiation.
What is the most common uterine neoplasm? What age group? Race?
Leiomyoma (Fibroids), 40-50, blacks
Leiomyomas are stimulated by what?
hormones & pregnancy, regress post menopause
Describe the appearance of leiomyomas?
multiple, vary in size, well circumscribed, consist of interlacing bundles of smooth muscle w/ gross woven pattern
How do we classify leiomyomas?
1) Submucosal, 2) intramucosal, 3) subserosal
What are the sx's of leiomyomas?
depends on location, but can be bleeding, impaired fertility, obstetrical complications, bowel, GU problems
What do leiomyomas look like macro and microscopically?
macro: spherical, firm, well circumscribed, bulge from myometrium. White-tan, whorled trabecular pattern, calcified.
Micro: whorled anastamosing fascicles of uniform fusiform smc's. Nuclei are uniform, elongated w/ blunt, tapered ends (cigar shaped); well circumscribed. rare mitosis.
What is a STUMP?
smooth muscle tumor of uncertain potential. Can't dx benign or malignant based on just histo.
Describe the characteristics of a leiomyosarcoma.
Rare, older women, single, necrotic, benign doesn't turn to malignant, atypical cells, mitosis, >10/HPF
How does atpyia help you determine if its an ovarian myometrium pathology is benign, malignant or a STUMP?
-if atypia is present but only a little mitosis, its still malignant;
-if atypia is focal, moderate-severe, but mitosis is <15/HPF, then its a leiomyoma;
-if >15 HPF, then STUMP.
75% of endometrial stomal nodules occur in which age group?
premenopausal.
Describe the appearance of an endometrial stromal nodule?
fleshy yellow tumor, usually single, bulges from myometrium, circumscribed contour.
Micro: uniform cell, inconspicuous nuclei, low mitosis, non-infiltrative borders.
-similar to cellular leiomyoma appearance but stromal nodules are CD10 negative.
Pts w/ endometrial stromal nodules usually present with what?
abnl vaginal bleeding
which female malignancy occurs in younger females than other uterine malignancies (42-58), presents w/ ab pain & abnl bleeding?
endometrial stromal sarcoma.
What are the differences b/w endometrial stromal sarcomas that are low grade and those that are high-grade?
Low grade: indolent growth pattern, late recurrences, RESPOND to PROGESTIN therapy, t(7,17) translocation (zinc finger genes), IRREGULAR TONGUES, lymphatic vascular invasion, low mitosis.
High grade: aggressive, hi mortality, DOESN"T respond to progestin, necrotic, hemorrhagic, lots of atypia, mitosis, NO TONGUE, but they displace myometrium