Repro Zaman - Uterus; Kct

Front 1

What are the cyclic changes of the endometrium?

Back 1

1. Proliferative phase (estrogen phase)
2. Secretory phase (progesterone phase)
3. Menstruation
4. Microscopic changes.

Front 2

Describe the early, mid, and late phases of the proliferative phase (pre-ovulatory phase.

Back 2

-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.

Front 3

Describe the characteristics of interphase.

Back 3

-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;

Front 4

Describe the secretory phase POD 2-POD 15

Back 4

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.

Front 5

Describe the characteristics of microscopy of menstrual phase?

Back 5

Tissue shredding, regeneration, dilated exhausted glands w/ adjacent decidualized stroma w/ fragmentation, fibrin thrombi in vessels & stroma.

Front 6

What are the causes of acute endometritis?

Back 6

Ascending gonococcal, postpartum streptococcal (puerperal sepsis), chemical or irritant.

Front 7

What are the causes of chronic endometritis?

Back 7

Silent gonococcal, IUD (actinomycosis), Others-TB, chlamydia.

Front 8

What is dysfxnal uterine bleeding & what can be used for diagnostic purposes or therapy?

Back 8

-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.

Front 9

What is an anovulatory cycle?

Back 9

-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.

Front 10

Describe the inadequate luteal phase or luteal phase defect.

Back 10

-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.

Front 11

Describe irregular shedding.

Back 11

Glands @ different states of development. Prolonged menses.

Front 12

What is the most common cause of DUB (dyzfxn'al uterine bleeding) in postmenopausal females?

Back 12

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.

Front 13

What is the Arias-Stella reaction?

Back 13

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.

Front 14

What is the differential diagnosis for Arias Stella rxn in pregnancy?

Back 14

Adenocarcinoma--more focal, more mitosis.

Front 15

When do endometrial polyps tend to show up? They are associated w/ what?

Back 15

-Common around menopause
-May cause uterine bleeding;
-Usually .5-3 cm in diameter.
-May protrude thru external os.
-Have been assoc w/ tamoxifen.

Front 16

What is Adenomyosis & what are the sx's?

Back 16

-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.

Front 17

What is Endometriosis?

Back 17

-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.

Front 18

What is the most common gynecological malignancy and is primarily a dz of older women? How does it present?

Back 18

Adenocarcinoma; Post-menopausal bleeding

Front 19

Adenocaricoma's etiology is most likely related to what?

Back 19

unopposed estrogen

Front 20

What is the protective effect for adenocarcinoma and what are the risk factors associated with it?

Back 20

Protective: pregnancy;
Risk factors: obesity, HTN, DM, infertility, estrogen producing tumors.

Front 21

What is the tx for adenocarcinoma?

Back 21

-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.

Front 22

What is the most common uterine neoplasm? What age group? Race?

Back 22

Leiomyoma (Fibroids), 40-50, blacks

Front 23

Leiomyomas are stimulated by what?

Back 23

hormones & pregnancy, regress post menopause

Front 24

Describe the appearance of leiomyomas?

Back 24

multiple, vary in size, well circumscribed, consist of interlacing bundles of smooth muscle w/ gross woven pattern

Front 25

How do we classify leiomyomas?

Back 25

1) Submucosal, 2) intramucosal, 3) subserosal

Front 26

What are the sx's of leiomyomas?

Back 26

depends on location, but can be bleeding, impaired fertility, obstetrical complications, bowel, GU problems

Front 27

What do leiomyomas look like macro and microscopically?

Back 27

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.

Front 28

What is a STUMP?

Back 28

smooth muscle tumor of uncertain potential. Can't dx benign or malignant based on just histo.

Front 29

Describe the characteristics of a leiomyosarcoma.

Back 29

Rare, older women, single, necrotic, benign doesn't turn to malignant, atypical cells, mitosis, >10/HPF

Front 30

How does atpyia help you determine if its an ovarian myometrium pathology is benign, malignant or a STUMP?

Back 30

-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.

Front 31

75% of endometrial stomal nodules occur in which age group?

Back 31

premenopausal.

Front 32

Describe the appearance of an endometrial stromal nodule?

Back 32

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.

Front 33

Pts w/ endometrial stromal nodules usually present with what?

Back 33

abnl vaginal bleeding

Front 34

which female malignancy occurs in younger females than other uterine malignancies (42-58), presents w/ ab pain & abnl bleeding?

Back 34

endometrial stromal sarcoma.

Front 35

What are the differences b/w endometrial stromal sarcomas that are low grade and those that are high-grade?

Back 35

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