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45 Cards in this Set

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What is endometrial hyperplasia?
Non-physiologic, non-invasive proliferation of endometrium
What is the cause of endometrial hyperplasia?
Increased, unopposed estrogen effect
What is the clinical presentation of endometrial hyperplasia?
Abnormal bleeding
What is the main protective factor from endometrial hyperplasia?
Progesterone
What is seen on an ultrasound in endometrial hyperplasia?
Increased size of endometrial stripe
What are the 4 main histologic features of hyperplasia?
1. Increased gland-to-stroma ratio (more glands)

2. Irregularities in gland shape

3. Variation in gland size

4. Mitotic Activity
What are the 2 classifications of endometrial hyperplasia?
1. Hyperplasia W/O atypia

2. Hyperplasia W/ atypia
Within the 2 main classifications, what are the 2 sub-classifications?
1. Simple

2. Complex
What are the 3 features of simple hyperplasia?
1. More glands

2. Variable size/shape of glands

3. Normal nuclei
What are the 4 features of compelx hyperplasia?
1. More glands

2. Decreased stroma

3. Branching, irregular glands

4. Normal nuclei
What are 3 histoligical characteristics of hyperplasia with atypia?
1. Loss of normal nuclear polarity

2. Enlarged, rounded nuclei with coarse chromatin

3. Prominent nucleoli
What there an observed benefit to having a hysterextomy right after being diagnosed with hyperplasia?
NO
Is it easy to differentiate between hyperplasia and carcinoma?
No, grey zone in between which can make diagnosis difficult
What characteristic is definite for cancer?
Myometrial invasion
What are 3 criteria seen in terms of "invasion of endometrial stroma" in carcinoma?
1. Irregular infiltration of glands associated with altered fibroblastic stroma

2. Confluent glandular pattern uniterrupted by stroma (like honeycomb cereal)

3. Extensive papillary pattern
What is seen wrt to stromal cells in endometrial carcinoma?
Stromal cells get more elongated

No stroma seen between the glands

Extensive papillary growth pattern
Is endometrial carcinoma relatively common?
Yes, most common malignant tumor of the female genital tract
What is most deadly pelvic cancer?
Ovarian cancer
How do patients often present with endometrial carcinoma?
Abnormal bleeding
What are the risk factors for endometrial carcinoma?
Same as hyperplasia

Biggest: Increased estrogen
What are the types of endometrial carcinoma?
Type I - estrogen dependent

Type II - not estrogen dependent
Which type is more common?

More deadly?
Type I - 80-85%

Type II - more deadly
What 3 genetic mutations are seen in Type I carcinoma?
1. PTEN mutation

2. K-ras mutation

3. Microsatellite instability
What genetic mutation is associated with Type II carcinoma?
P53 mutation
The endometrioid type of carcinoma is what type?
Type I
What describes endometrial carcinoma, Endometrioid type (Type I), histologically?
1. Way too many glands

2. Looks like hyperplasia but has cribiforming
What 3 items are seen in endometrial carcinoma, Type II?
1. Complex papillaie or irregular gaping glands

2. Marked nuclear atypic

3. Calcifications
How many stages are there for endometrial carcinoma?
I-IV
What characterizes stage I?
Confined to uterus
What characterizes stage II?
Cervical involvement
What describes stage III?
Uterine serosa, adnexa, positive cytology, vaginal or pelvic LN metastases
What describes stage IV?
Invasion of bladder or bowel muscosa or distant metastases
What is the overall survival for endometrial carcinoma?
75-80%
What is the main type of cervical cancer?
90% squamous

5% adenocarcinoma
What is the main risk factor for cervical cancer?
HPV infection
What HPV strains cause warts?
6&11
What is a typical cell characteristic seen in HPV infection?
"Halo cells" with clear cytoplasm surrounding them
Where does HPV infection usually happen within the cervix?
At the transformation zone, infects squamous epithelial
What specific types of HPV are associated with cancer?
16 and 18
What viral genes cause high risk HPV?
Viral E6 and E7 genes
What is needed in terms of HPV infection to progress to cancer?
HPV persistence
What is required for HPV infection persistence?
Viral genome integration

But more changes needed to progress to cancer
What is the site of first preneoplastic lesions?
Squamocolumnar junction (transformation zone)
What is the second leading cause of women death (20-39 yrs)?
Invasive cervical cancer
What is the classical gross appearance of cervical cancer?
"Barrel Cervix"