Reproductive Uterus And Cervix

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histo a few days after ovulation

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subnuclear vacuoles that look like piano keys (early secretory endometrium)

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3 days after ovulation endometrium changes into

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mid secrotory endometrium (glands more irregular and complex)

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epithelium differenc ein early vs. mid secretory

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early - stratified cigar shpaed
mid- rounded

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main change in late secretory endometrium

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decidualized change where stromal cells appear bigger (appearance of pregnant endometrium)

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differences in early, mid, late secretory

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Es-subnuclear vacuoles
MS-complex glands and stromal edema
LS-decidualized changes

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glands become more tortuous in what phase

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secretory

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when is basal vacuolization seen?

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directly after ovulation

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edema is seen most in

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mid secretory phase

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inflammation of the endometrium

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chronic endometritis

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symptoms of chronic endometritis

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abnormal uterine bleeding, chronic uterine pain, vaginal discharge

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treatment for chronic endometritis

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antibiotics

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ways to get chronic endometritis

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pelvic inflammatory
IUD
TB
sometimes no cause

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3 types of chronic endometritis

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1. plasma cell
2. actinomyces
3. tuberculosis

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most common type of endometritis

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plasma cell

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uaual cause of plasma cell endometritis

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chlamydia

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cause of chronic endometritis associated with actinomyces

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IUD

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endometrial polyps benign?

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yep

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3 key features of endometrial polyps

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benign endometrial glands
fibrotic stroma
prominent vessels

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why does atrophic endometrium occur?

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you get old

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endometrial hyperplasia is bad because

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these are precancerous lesions which can lead to tumors

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main factor in hyperplastic endometrium is

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estrogen

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genes in hyperplasia

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PTEN (sumor supressor)

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3 types of endometrial hyperplasia

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1. simple
2. complex
3. atypical

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simple hyper plasia

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increase in number of normal appearing glands

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complex hyperplasia

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glands appear distorted with complex architecture

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difference in complex and atypical hyperplasia

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complex has NO cytologic atypia

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treatment for complex endometrial hyperplasia

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progesterone

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atypical hyperplasia

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architectural atypia of glands and cellular atypia as well

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pts with atypical hyperplasia are treated

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as if they have cancer

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treatment for atypical hyperplasia

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progesterone

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highest risk of the endometrial hyperplasias to become cancer

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atypical

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most common cancer of female genital tract

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endometrial cancer

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most common presenting symptom of endometrial cancer

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abnormal uterine bleeding

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2 subsets of women that get endometrial cancer

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45-65 b/c estrogen (HT), usually opese with diabetes and hypertension (better prognosis)
70-80
no history of reproductive problems (poor prognosis)

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types of endometrial cancer

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endometriod adenocarcinoma
papillary serous carcinoma
clear cell adenocarcinoma
endometrial stromal sarcoma
malignant mixed mullerian tumor

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endometrioid adenocarcinoma resembles

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endometrium

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age of endometroid adenocarcinoma

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young

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agressiveness of endometroid adenocarcinoma

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not that agressive
pts survive nicely

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grading of endometroid tumor is based on

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amount of solid area in the tumor (solid=bad, fewer glands)

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pepillary serous carcinoma age

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older women

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papillary serous carcinoma epithelium

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serous epithelium in atypical epithelium in carcinomas and is normally present in fallopian tubes

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papillary serous carcinoma agressiveness

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agressive in lymph nodes

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clear cell adenocarcinoma age

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older women

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agressiveness of clear cell adenocarcinoma

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very agressive and invasive

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endometrial stromal sarcoma age

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no predilication for age

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endometrial stromal sarcoma arises from

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endometrial stroma

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types of endometrial stromal sarcoma

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1. low grade that resembles normal endometrial stroma that is hypercellular. It has a tendency to grow into the lymph vessel spaces and make big nodules. Also grows into myometrium
2. high grade with sheets of atypical cells

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Malignant Mixed Mullerian Tumor age

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usually older women but seen in younger 50-60 as well

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what is a malignant mixed mullerian tumor?

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mixture between carcinoma and sarcoma

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agressiveness of malignant mixed mullerian tumore

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very agressive

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malignant mixed mullerian tumors are graded on sarcoma distortion because

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sarcomas arising from native uterus tissues (homologous) have a better prognosis