Path Block 3 (Uterus)

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Path Block 3 (Uterus)
2010-11-05 19:54:48
Path Block Uterus

Path Block 3 (Uterus)
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  1. Know the phases of Menstration
  2. What are the Major causes of abnormal bleeding in?
    Post menopausal?
    - Anovulatory phase

    -Anovulatory phase, Irrecular chedding, organic lesions (carcinoma or hyperplasia or polyps_

    - Organic lesions, Endometrial atrophy
  3. DUB
    This is a premenopausal term
  4. When is anovulatory phase common? What is the cause?
    What could it cause?
    • •Most common at menarche & perimenopausal
    • - might be due to prolonged estrogen stimulation, but as of now no obvious cuase

    -may produce hyperplasia and cystic atrophy when complete ovarian atrophy
  5. Inadequte corpus luteum. What is it do to?
    Low progesterone--> early menses
  6. What is endometritis?
    What causes it?
    What will it presend as clinically?
    What will you see?
    • Chronic Endometritis is inflamation of the endometrium.
    • -Caused by: PID, IUD, Retained products of conception.
    • -Symptons include: Bleeding, Pain and Infertility.
  7. What is going on here? What will you see?
    • This is Chronic Endometritis.
    • See Plasma cells
  8. What is this? What might this patient get as a result?
    This is IUD with Actinomycies infection. See Sulfur granules. Could cause Chronic Endometritis.
  9. What is Adenomyosis?
    is it functional tissue?
    –Endometrial glands and stroma within the myometrium

    - Usually not but can be functional
  10. This is a pic of a patients Myometrium. What does this patient have?
  11. What is Endometriosis?
    Is it functional tissue?
    What does the patient present with clinically?
    What do you see?
    –Displaced endometrial glands & stroma,outside of the uterine corpus

    • - Usually IS Functional
    • - Pelvic pain, Dysmenorrhea and infertility
  12. What does this patient have? What do you see?

    See Gunpowder burns
    • Endometriosis
    • See Chocolate Cysts
  13. Endometrial Polyps

    What can they cause?
    What is its reaction to estrogen?
    What do you see histologically?
    • Common cause of uterine bleeding
    • Anti estrogenic (tamoxifen)

    –Disordered endometrial tissue with central thick walled vessels in stroma
  14. What is seen here?
    See a thick walled vessel. Associated with Endometrial polyp
  15. What can endometrial Hyperplasia cause? In who?

    What causes it?
    Treat it?
    It is a common cause of DUB in peri and postmenopausal women.

    Condition of prolonged, unopposed estrogen stimulation

    • Progesterone agents with follow up or hysterectomy
  16. This is Endometrial Hyperplasia
  17. Endometrial Intraepithelial Neoplasia (EIN)

    What is it?
    What mutation?
    What do you see?
    It is Atypical hyperplasia that is not reproducable

    PTEN(tumor supressor) associated

    Gland to stroma ration is increased
  18. What is the most common malignancy of the female genital tract, bypassing cervical?

    What ages?
    Risk factors?
    Endometrial Adenocarcinoma

    Postmenopausal(55+) women with PID/DUB

    Obesity, DM, hypertension, interfility, Nulliparity, late menopause
  19. Endometrial Adenocarcinoma
    What are the clinical finding?
    see Uterine enlargement and Pelvic discomfort

  20. See increase in Gland to stroma ratio as you move from left to right

    = EIN
  21. What are the Types of Endometrial Adenocarcinoma? Which is most common?
    Type 1: Endometriold (Most common 80%)

    Type 2: Serous Carcinoma (clear cells carcinoma)
  22. Endometrial Adenocarcinoma Type one:

    Age? Histology?
    Perimenopausal Women

    Squamus metaplasia my be present

    Good Prognosis
  23. Endometrial Adenocarcinoma Type 2:

    Post menopausal women

    Not associated with prolonged unopposed estrogen stimulation

    Automatically a grade 3, More aggressive
  24. Endometrial Adenocarcinoma types?

    • Type 1:
    • -Endometriod
    • -PTEN & p53
    • -Indolent (non aggressive)
    • -EIN

    • Type 2:
    • -Serous,clear cell
    • -p53
    • -agressive
    • -EIC
    • Endometrial Adenocarcinoma type 1
    • Endometrioid
  25. This is a p53 stain
    • Endometrial Adenocarcinoma type 2
    • Serrpus type
  26. What are the Endometrial Tumors with stromal elements?


    Pure stromal tumors
  27. What is Carinosarcoma?

    What are the two types?
    Age? Prog?
    • It is a tumor of unterine corpus of MIXED
    • epithelial and mesenchymal cell origen.

    • 1. Homologous
    • 2.Heterologous

    Seen in elderly patients, poor prognosis
  28. What is this? what is another name for it?
    This is a carniosarcoma

    or Malignant mixed mullerian tumor
  29. Endometrial Stromal Lesions

    What are the two types?
    • Adenosarcoma
    • -Low grad
    • - present as a polyp
    • Stromal tumors
    • Benign verse malignant
    • Relapses 80% or the time
  30. Myometrium: Smooth Muscle Neoplasms

    What are the types?

    Which is the most common type?
    –Benign (Leiomyoma (“Fibroid”))-- Most common type

    STUMP (Smooth Muscle Tumor of Uncertain Malignant Potential)

    –Malignant (Leiomyosarcoma)
  31. Leiomyoma presents as?
    Where is it usually located?
    • Well circumscribed white-tan nodules
    • –Variable sizes, usually multiple

    • - usually in the uterine corpus
    • –Pushing, non-infiltrating borders
  32. Leiomyoma
  33. Leiomyosarcoma

    Clinical presentation?
    How does it arise?
    Gross distription?
    - Histological discription?
    • •Peri- and postmenopausal females
    • Vaginal bleeding, enlarging pelvic mass

    usually arises de novo

    –Large, soft, hemorrhagic tumors with areas of necrosis

    • –Infiltrating borders
    • –Increased mitotic activity & cellular atypia
  34. This is a Leiomyosarcoma

    See Mitotic figues (increased replication)

    Large, soft looking tumor with an area of necrosis.