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Details Title: Gyn Path II Description: 4.27.07 Total Flash Cards: 49 Created: 04/30/2007 14:41:43	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 This lecture will cover: Definition endometrial hyperplasia and cancer, and cervical cancer Term What is endometrial hyperplasia Definition Non-physiologic, non-invasive proliferation of endometrium Term what causes EH? Definition Cause: Increased, unopposed estrogen effect Term what are the 2 clinical presentations? Definition Clinical presentation: abnormal bleeding Perimenopausal years (frequent anovulatory cycles) Term what are the risk factors? Definition Risk factors Exogenous Estrogens (Tamoxifen) Endogenous Ovarian lesions (stromal tumors, PCOD, stromal hyperplasia) Obesity Hypertension Diabetes Reproductive factors (nulliparity, early age at menarche, late menopause) Cigarette smoking Term what are protective factors? Definition Protective factors – progesterone Large number of births Old age at first birth Long birth period Short premenopausal delivery-free period Term what will you see histologically? Definition Abundant, fleshy endometrium Diffuse process, Increased gland-to-stroma ratio (more glands) Irregularities in gland shape Variation in gland size Mitotic activity Term what are the classifications? Definition Hyperplasia without atypia Simple Complex Hyperplasia with atypia (atypical hyperplasia) Simple Complex (adenomatous) Term what is atypia? Definition Atypia is a clinical term for abnormality in a cell. The term is medical jargon for an atypical cell. It may or may not be a precancerous indication associated with later malignancy, but the level of appropriate concern is highly dependent on the context with which it is diagnosed. Term what do you see with simple hyperplasia? Definition More glands than normal Size and shape of glands variable Nuclei similar to normal proliferative – no atypia Term what is stroma? Definition Stroma (animal tissue), the connective, non-functional supportive framework of a biological cell, tissue, or organ Term what will you see with complex hyperplasia? Definition Much more glands than normal Markedly decreased stroma Branching, very irregular glands Nuclei similar to normal proliferative – no atypia. No more doughnut cells. Term what will you see with hyperplasia with atypia? Definition Loss of normal nuclear polarity Enlarged, rounded nuclei with coarse chromatin Prominent nucleoli (Nuclei similar to those of carcinoma) Term what is the risk of cancer Definition 29% risk with complex with atypia Term What is the risk of cancer if hysterectomy is done right after hyperplasia is diagnosed? Definition 29% Term Is there a grey zone distinguishing btw hyperplasia and carcinoma? Definition yes--in the architectual complexity--there is a big overlap Term How do you distinguish hyperplasia from carcinoma? Definition Myometrial invasion Invasion of endometrial stroma – any of three criteria Irregular infiltration of glands associated with altered fibroblastic stroma (desmoplastic response) Confluent glandular pattern uninterrupted by stroma (cribriform glands) Extensive papillary pattern Term what is the myometrium? Definition The myometrium is the middle layer of the uterine wall consisting of smooth muscle cells and supporting stromal and vascular tissue. The inner layer of the uterine wall is the endometrium or uterine lining, and the outer layer the serosa or peritoneum. The myometrium stretches (the smooth muscle cells expand in size, rather than number) during pregnancy to allow for the harboring of the pregnancy, and contracts in a coordinated fashion during the process of labor. After delivery the myometrium contracts to expel the placenta and reduce blood loss. Lack of contraction at this stage is termed uterine atony. After pregnancy the uterus returns to its nonpregnant size by a process of myometrial involution. Pathology: Neoplasms of the myometrium are very common, termed uterine leiomyomata or fibroids. Their malignant version, leiomyosarcoma, is rare. Term what is the most common malignant tumor of the female genital tract? Definition endometrial carcinoma Term what are the 2 groups of endometrial carcinoma? Definition Type I (estrogen dependent) – 80-85% endometrioid type; Type II (non-estrogen dependent) – 15-20% Serous type Clear cell type Term How is estrogen relevant to endo carcinoma? Definition Most women with endometrial cancer have a history of unopposed and increased levels of estrogen. One of estrogen's normal functions is to stimulate the buildup of the endometrial lining of the uterus. Excess estrogen administered to laboratory animals, especially in the absence of any progesterone, can produce endometrial hyperplasia, which is a precursor for cancer. Term What is the histopathology of ec? Definition Histopathology is usually an endometrioid adenocarcinoma. Endometrial adenocarcinoma Endometrial adenocarcinoma It appears on a background of endometrial hyperplasia. Tumor cells are atypical and form irregular glands, with multiple lumens, pluristratification. The stroma is reduced, producing the "back to back" aspect. With evolution of the disease, the myometrium is infiltrated. Term Why type of EC has unopposed estrogen? Definition Type1, which is indolent Term Is type 2 aggressive? Definition yes. Term Are type 1 and 2 different genetically? Definition yes Term What's the histopath of Type 1? Definition Endometrioid type (Type I) Glands and tumor cells are similar to those of atypical hyperplasia of endometrium More complex proliferation Confluent proliferation of cell Term What's the histopath of type 2, serous? Definition Serous type (Type II) Complex papillae or irregular gaping glands Serous type (Type II) Marked nuclear atypia Macronucleoli Numerous abnormal mitoses Calcifications (Psammoma bodies) Term what is a precursor to Type 2? Definition intraepithelial carcinoma Term what do you see in clear cell type (type ii) Definition Clear cell type (Type II) Clear, vacuolated cytoplasm Markedly atypical nuclei May be admixed with serous carcinoma Term what are the 2 types of cervical cancer? Definition 90+% Squamous; 5+% Adenocarcinoma; Other rare subtypes Term what are the risk factors? Definition Risk Factors: Strong evidence: HPV infection Moderate evidence Multiple sexual partners (>6) Cigarette smoking Early age at first sexual intercourse Immunosuppression Term what are the precursor lesions? Definition Precursor lesions Dysplasia of increasing severity (CIN 1-3) Detection by Pap smear and histology Screening – Pap smear Term what type of HPV are associated with warts? Definition 6, 11 Term what type of HPV is associated with cervical cancer? Definition 16 and 18 Term what causes cellular transformation? Definition Viral E6 and E7 genes of high risk HPVs are introduced into the epithelium and can cause cellular transformation: Term what is necessary for progression to cancer? Definition HPV persistence Term LSIL? Definition get infected, virus gets into endometrium Term HSIL Definition virus gets integrated into genome Term squamous cellular cancer: Definition HSIL+ other adverse events Term Where do lesions occur? Definition Squamocolumnar junction (transformation zone) is the site of first preneoplastic lesions Term what is the gradual progression? Definition Gradual progression from low grade to high grade dysplasia (CIN 1 to CIN 3) Low grade lesions are often reversible (regress) Takes months to years for neoplastic cells to acquire invasive potential Term what is the histology of the cervix? Definition The epithelium of the cervix is nonkeratinized stratified squamous epithelium at the ectocervix, and simple columnar epithelium at the cervix proper.[2][3] Term AS YOU head to SCC, Definition cell size decreases and N:C ratio increases Term scc cells look like Definition sperm. Term LSIL Definition HPV, condyloma CIN I Term HSIL Definition CIN II CIN III CIS Term HPV cells Definition have halos Term Where do you do a pap on a youth? Definition Majority of precancerous lesions arise at or near the squamocolumnar junction or transformation zone (TZ) where squamous metaplasia occurs Young pts: TZ at or near cervical os Term where do you do a pap on an adult? Definition Older pts (or post cone): TZ moves higher into endocervical canal Pap smear needs to sample this area to be adequate/optimal for evaluation