Home > Flashcards > Women's & Gender Studies > gyn path 1

Details Title: gyn path 1 Description: 4.27.07 Total Flash Cards: 54 Created: 04/29/2007 15:12:24	To study from this set of flash cards, or to create your own your own study flash cards, register HERE. If you are already a registered user, CLICK HERE.
Cards Term these flash cards will cover: Definition abnormal uterine bleeding, fibroids (leiomyoma), endometriosis) Term what is endometriosis? Definition In endometriosis, the tissue that lines the uterus (the endometrium, from endo, "inside", and metra, "womb") is found to be growing outside the uterus, on or in other areas of the body. Normally, the endometrium is shed each month during the menstrual cycle; however, in endometriosis, the misplaced endometrium is usually unable to exit the body. The endometriotic tissues still detach and bleed, but the result is far different: internal bleeding, degenerated blood and tissue shedding, inflammation of the surrounding areas, pain, and formation of scar tissue may result. In addition, depending on the location of the growths, interference with the normal function of the bowel, bladder, small intestines and other organs within the pelvic cavity can occur. In very rare cases, endometriosis has also been found in the skin, the lungs, the diaphragm, and the brain. Term what horomone is needed in the prolif phase? Definition estrogens Term what horomones are needed during the secretion phase Definition estrogens and progesterone Term what are reasons for endometrial biopsy? Definition Determine the cause of abnormal uterine bleeding Evaluate endometrium in infertile patients (histologic dating) Evacuation of products of conception(work-up of patient with suspected ectopic pregnancy) Assess the response of endometrium to hormonal therapy (estrogen replacement, tamoxifen, high dose gestogen) Term what are 2 things you should look for in an infertility biopsy? Definition Is there morphologic evidence of ovulation Interval phase – 36 to 48 hrs between ovulation and first histologic changes due to ovulation First histologic evidence: Abundant subnuclear vacuoles Histologic date Glandular changes (tortuosity, mitoses, orientation of nuclei, sub- and supranuclear cytoplasmic vacuoles, luminal secretions) Stromal changes (edema, mitoses, predecidua, granular lymphocyte infiltrate) Term what is the first evidence (histological) of ovulation? Definition abundant subnuclear vacuoles Term how can you tell histological date? Definition the histo date is related to: Glandular changes (tortuosity, mitoses, orientation of nuclei, sub- and supranuclear cytoplasmic vacuoles, luminal secretions) Stromal changes (edema, mitoses, predecidua, granular lymphocyte infiltrate) Term what are 3 signs of prolif endometrium? Definition 1. stratified nuclei, 2, round, regular glands, 3. mitosis Term what are 2 signs of early secretory endometrium? Definition uniform, subnuclear vaculose, single row of nuclei Term what are 4 later signs of secretory endo (days 20-21) Definition intraluminal secretions, marked stroma edema ("naked nuclei"), prominent spiral arteries, and predecidual changes around the spiral arteries Term what are 2 very late signs of secretory endometrium? Definition Confluent sheets of predecidua (cells with prominent pink cytoplasm), and Granular lymphocytes (little dark nuclei) Term what are causes of abnormal uterine bleeding? Definition Any non-physiologic uterine bleeding Common sign of a number of different uterine disorders Causes Dysfunctional bleeding (anovulatory cycles) Complications of pregnancy (spontaneous abortion, ectopic pregnancy) Organic lesions Leiomyomas (fibroids) Polyps Infection (endometritis) Atrophy Hyperplasia Neoplasia (endometrial or cervical cancer) Clotting disorders Term what are 3 organic lesions which may cause abnormal uterine bleeding? Definition Organic lesions Leiomyomas (fibroids) Polyps Infection (endometritis) Term what are reasons for abnormal vaginal bleeding? Definition Extrauterine causes Non-physiologic uterine bleeding Menorrhagia (Excessive bleeding in both amount and duration of flow occurring at regular intervals) Metrorrhagia(Bleeding, usually not heavy, occurring at irregular intervals) Menometrorrhagia(Excessive bleeding with prolonged period of flow occurring at frequent and irregular intervals) Dysmenorrhea(Painful menses) Postmenopausal bleeding(Abnormal bleeding that occurs at least one year after the menopause) Term in adolescents, what are causes for abnormal bleeding? Definition Adolescents Dysfunctional (anovulatory) bleeding Complications of pregnancy Term In the reproductive years? Definition Reproductive years Complications of pregnancy Endometritis Dysfunctional bleeding Organic lesions (leiomyomas, polyps) Term In the perimenopausal years? Definition Perimenopausal years Dysfunctional bleeding Organic lesions (hyperplasia, polyps) Exogenous hormones (estrogen replacement, progestin therapy) Term In the post menopausal years? Definition Postmenopausal years Atrophy Organic lesions (hyperplasia, polyps) Carcinoma Term What is dysfunctional uterine bleeding? Definition Alteration of the normal cyclical hormonal stimulation of the endometrium No underlying organic disorder Term what does DUB indicate? Definition Clinically DUB indicates ovulatory dysfunction Term by definition, what does it exclude? Definition By definition excludes Postmenopausal bleeding Presence of specific pathological processes (inflammation, polyps, hyperplasia, carcinoma, exogenous hormones, complications of pregnancy) Term what are common histo findings of DUB? Definition Common histologic finding: stromal and glandular breakdown Term what is the common pathway for glandular breakdown and stromal breakdown leading to bleeding? Definition Estrogen stimulation --> Proliferation --> No ovulation – No progesterone --> Continued proliferation Glands become enlarged, irregular, disordered --> Vascular support insufficient for continued proliferation --> Breakdown and bleeding Term what are stromal blue balls? Definition Collapse of stroma into aggregates (stromal balls) Nuclear debris and reparative epithelial changes Evidence of bleeding Term what will you see histologically with glandular and stromal breakdown? Definition blood, aggregates of stromal cells, reparative epithelial change with nuclear debris Term histo, what will you see with stromal blue balls? Definition collasped, condensed small blue stromal cells, and attenuated epithelial cells on the surface of the balls. Term what are SBBs evidence of? Definition an anovulatory cycle Term what causes endometrial atrophy? Definition Cause of 25-50% of abnormal uterine bleeding in postmenopausal women Lack of estrogen stimulation Cystic change of glands is common(may result in thickened endometrial stripe) Term what are endometrial polyps? Definition Originate from localized hyperplasia of the basal endometrium – focal lesion Most common in 4th and 5th decades Present with abnormal bleeding No malignant potential, but carcinoma may be found within them Term what do you see grossly with endometrial polyps? Definition Gross Vary greatly in size Sessile or pedunculated Term what do you see histologically with endometrial polyps? Definition Histology: Larger tissue fragments with dense stroma and thick-walled arteries Glands irregular, dilated, may be crowded focally Separate fragments of normal endometrium Term what is a leiomyoma? Definition Benign smooth muscle tumor Corpus Cervix Uterine ligaments Ovaries Incidence uncertain - most frequent tumor of female genital tract 20-30% of women over age 30 yrs More than 40% of women over 40 yrs More common in African Americans Younger age Larger tumors More often symptomatic (anemia, pain) Term what is the etiology of leios? Definition Etiology Pivotal effects of hormones – tumors of reproductive period Enlarge during pregnancy, regress after menopause Abnormal gene expression compared to normal myometrium to maintain high sensitivity to estrogen Accelerated growth with tamoxifen Term How do you classify leio? Definition by location: intramural, submural, subserosal Term what are possible complications of subserosal? Definition Large, pedunculated subserosal leiomyoma Complications: torsion infarction separation from uterus – parasitic leiomyoma Term what are the symptoms of subserosal? Definition Symptoms: Pelvic mass Pelvic/abdominal pain Term what are the symptoms of submucosal? Definition Symptoms: Abnormal bleeding Painful menses Infertility Spontaneous abortions Term what happens to the endometrium in leios? Definition it thins Term what is the leio typical cut surface? Definition Leiomyoma typical cut surface: Well circumscribed Bulges from myometrium Solid, white/tan Whirled appearance No necrosis or hemorrhage Term what do you see histologically? Definition Uniform, bland spindled cells Fascicular arrangement , Spindled cells Abundant eosinophilic (pink) cytoplasm Uniform, oval, cigar-shaped nuclei Fine chromatin pattern Only rare mitoses Term what is a leiomyosarcoma? Definition Malignant counterpart of leiomyoma Most common pure sarcoma of uterus Incidence: Rare 2-3 of 1000 women with smooth muscle tumors of uterus Age over 40 More common in African Americans and patients on tamoxifen Term what are the gross features of a Leiosar Definition Gross features suspicious for malignancy Loss of whorled pattern Homogenous Margin not well defined, irregular Yellow color Necrosis, hemorrhage Softer, less rubbery, less resilient Absence of a bulging surface Term what are the histo dx for leisar Definition Diagnostic features Invasion of surrounding myometrium Vascular invasion Increased cellularity Nuclear atypia Increased mitotic activity Coagulative necrosis Term what do you see histologically? Definition cellular tumor, atypical nuclei, necrosis, mitotic activity, marked nuclear atypia, bizarre giant cells Term what is endometriosis? Definition Endometrial tissue (both glands and stroma) outside the uterine cavity Women in reproductive years True incidence unknown 4-10% of women in reproductive years 25-50% of infertile women 5-25% of women with pelvic pain Term where are most frequent sites of Endo? Definition Most frequent sites Pelvic peritoneum Ovaries Term what are risk factors of Endo? Definition Risk factors Genetic basis Far more common in monozygotic than dizygotic twins Increased exposure to menstruation Longer duration of flow Higher volumes of retrograde menstruation Cervical stenosis Reduced risk Multiparous women Oral contraceptive use Term what are 3 theories on the pathogenesis of endo? Definition Transplantation of endometrial fragments to ectopic sites Metaplasia of peritoneum Induction of undifferentiated mesenchyme in ectopic sites to form endometriotic tissue Term describe the transplant theory: Definition blood in pelvis from retrograde flow during menses. Transplantation theory: Some of the menstrual products flow in a retrograde fashion through the tubes into the peritoneal cavity Over 90% of women have blood in their pelvis at the time of menstruation Explains most common sites of endometriosis Uncommon sites are explained by vascular or lymphatic spread (lungs, lymph nodes) or direct implantation (surgical scars) Term Gross appearance of endometriosis is variable reflecting the functional state Definition Black nodule (advanced lesion with some resolved bleeding) , Vesicle formation (early lesions), Red/blue nodules (fresh blood, active growth), Yellow/brown nodules (blood breakdown products) Term what are unusual sites of endometriosos? Definition episiotomy scar, umbilicus, colon Term what are classic symptoms of endo? Definition Classic symptoms Secondary dysmenorrhea, dyspareunia, pelvic pain, infertility Pelvic mass, ascites No correlation between severity of symptoms and extent of disease Unusual locations Hemoptysis, rectal bleeding, hematuria Usually symptoms correlate with menstrual cycle Bowel obstruction, ureteral obstruction Term Endometriosis in colon causing bowel obstruction? Definition yes,