Reproductive Pathology

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  1. Adenomyosis
    • down growth of endometrial tissue into and between the smooth muscle fascicles of the uterus 
    • grossly the uterus may be enlarged and may have a rounded appearance
    • patients may be asymptomatic or may present with menorrhagia or pelvic pain
  2. Microscopically what do we seen in adenomyosis?
    endometrial glands and stroma in the myometrium
  3. What is endometrial hyperplasia? why do we get it? what is it due to?
    • it is increased proliferation of the endometrial glands relative to the stroma resulting in increased gland to stroma ratio and abnormalities in the epithelial growth. 
    • It is linked to prolonged and unopposed estrogen stimulation of the endometrium such as anovulation, increased estrogen production or exogenous estrogen administration. 
    • It can culminate in endometrial carcinoma. 
    • Linked to PTEN inactivation
  4. PTEN is linked with
    Endometrial hyperplasia and endometrial cancer
  5. In which disease do we see different histology that actually has a name and what are they? Which ones are worse than others and why?
    • Endometrial hyperplasia
    • simple endometrial hyperplasia w and w/o atypia
    • complex endometrial hyperplasia w and w/o atypia
    • Complex hyperplasia with atypia is worse because there is a 20% probability of endometrial carcinoma vs 1-2% in others
  6. What is the difference histologically between complex and simple w and w/o atresia in endometrial hyperplasia?
    • Simple: round or tubular contours that are mystically dilated
    • complex: crowded with branching and budding
    • with atypia: prominent nucleoli, vesicular nuclei and loss of nuclear polarity
    • w.o atypia: uniform cells similar to those of the proliferative endometrium of the menstrual cycle
  7. What is the treatment for endometrial hyperplasia?
    • cyclic progestin therapy
    • high dose progestin therapy
    • hysterectomy
  8. What is the most common invasive cancer of the female reproductive tract in the USA?
    endometrial carcinoma
  9. When is the peak incidence for endometrial carcinoma?
    post menopausal
  10. What are the risk factors to endometrial carcinoma?
    basically unopposed estrogen like: obesity. DM, high fat diet, high socioeconomic status, tamoxifen use, unopposed estrogen replacement therapy
  11. What are the types of endometrial carcinomas and what makes them different?
    • Type 1: group associated with increase estrogen levels and endometrial hyperplasia and these patients can have increased levels of estrogen due to obesity. anovulatroy cycles, ovarian estrogen secreting tumors and estrogen replacing therapy.
    • Well differentiated and of endometrium type: better prognosis
    • Type 2: associated with normal estrogen levels.
    • develop at an older age.
    • they are less differentiated and more aggressive
    • arise in background of atrophy rather than hypertrophy such as type 1.
  12. Kras associated with
    type 1 endometrial carcinoma
  13. P53 associated with
    • type 2 endometrial carcinoma
    • serous carcinoma
  14. ERBB2
    oncogene associated with type 2 endometrial carcinoma
  15. Most common carcinoma cell type of the cervix? endometrium? ovary?
    • cervix: squamois
    • endometrium: endometriod but clear can occur
    • ovary: serous
  16. What histological criteria needs to be there for endometrial adenocarcinoma?
    • confluent glands with ctibform growth
    • extensive intraglanduar papillary growth
    • despoplastic stromal response- rx of tissue to tumor
  17. You hear a patient has serous or clear cell endometrial carcinoma. What grade is she
    auto 3.
  18. What is the grading of endometrial cancer?
    • FIGO
    • G1: 95% of tumor forms glands
    • 2: 50-95
    • 3: less than 50
  19. What is the treatment for endometrial cancer?
    • sx
    • chemo
    • radiation
  20. What is the most common type of uterine tumor?
    Leiomyoma (fibroid)
  21. How do leiomyomas present?
    • asymptomatic
    • pelvic discomfort
    • abnormal uterine bleeding
    • urinary frequency
    • can cause problems during pregnancy
  22. What causes leyoimiomas?
    chromosomal abnormalities
  23. Patient hears leyoimyoma and asks if she is going to die? What do you tell her?
    it is benign and rarely if ever transforms
  24. What happens to large leiomyomas?
    large tumors may degenerate and develop sod yellow or red areas
  25. What is the microscopic appearance of leiomyomas?
    fascicles of spindled cells with oval nucleus and infrequent mitoses that resemble the normal myometrium but are more numerous
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Reproductive Pathology
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