lecture 1 / 2 of the pathology of the uterus.
questions
overview...
1. the uterus is composed mostly of...
2. what are menorrhagia and metrorrhagia?
3. what are anovulatory cycles generally caused by?
4. what can anovulatory cycles also be caused by?
5. when do anovulatory cycles most commonly occur?
6. what is an "inadequate luteal phase"
7. what are some symptoms that often accompany an inadequate luteal phase?
8. what is the test used to diagnose inadequate luteal phase? what does it show? when is it performed?
endometritis...
9. acute endometritis is associated with...
10. what are the etiologies of chronic endometritis?
11. what is seen in endometrial tissue in acute and chronic endometritis?
endometriosis and adenomyosis...
12. what is endometriosis?
13. what age does endometriosis generally occur?
14. where in the body does endometriosis commonly affect?
15. what is adenomyosis?
16. what are the histological characteristics of adenomyosis?
17. how common is adenomyosis?
18. what are the clinical symptoms of adenomysosis?
19. what are the signs/symptoms of endometriosis?
20. what is "retrograde/implantation" etiology theory for endometriosis?
21. what is the "metaplastic" theory for endometriosis?
22. what is the "vascular or lymphatic" theory for endometriosis?
23. the vascular/lymphatic theory could explain...
24. what are three "non standard" theories of etiology for endometriosis?
25. what is the morphology of endometriosis implants?
26. what is a "chocolate cyst"?
endometrial polyps...
27. what is an endometrial polyp?
28. how big are endometrial polyps?
29. what are the two histological types of polyps? which one does not respond to progesterone?
30. what is a serious potential complication of endometrial polyps?
endometrial hyperplasia...
31. endometrial hyperplasia is related to...
32. what is the general cause of endometrial hyperplasia?
33. what are estrogen producing factors implicated in the pathogenesis of endometrial hyperplasia?
34. what is "PTEN" and how is it related to endometrial hyperplasia?
35. describe the morphology of simple hyperplasia.
36. simple hyperplasia of the endometrium reflects...
37. what percentage of simple hyperplastic endometrium progresses to adenocarcinoma?
38. what is the morphology of complex hyperplasia of the endometrium.
39. complex hyperplasia is usually associated with...
PID...
40. PID is associated with...
41. statistically, what are the causes of PID in younger vs. older women?
42. what are the clinical manifestations of PID?
43. in PID, where does gonococcal inflammation begin?
44. what other areas are involved in gonococcal inflammation?
45. how else might infection travel to the tubes and ovaries?
46. what are the morphological characteristics of gonococcal derived PID 2-7 after infection?
answers
1. smooth muscle (myometrium)
2. excess bleeding during menses, and between menstrual cycles.
3. excess estrogenic stimulation, lack of progesterone, no corpus luteum development.
4. endocrine disorders, metabolic disorders, ovarian tumors.
5. puberty and perimenopause.
6. inadequate luteal function and low progesterone output with an irregular ovulatory cycle.
7. infertility, increased bleeding, or amenorrhea.
8. endometrial biopsy performed at postovulatory time shows immature secretory endometrium.
9. bacterial infection or incomplete miscarriage.
10. chronic PID
retained gestational tissues
IUD's
TB
[CE PID IUD TB RGT] [iCPTR] [I, COMPUTER]
11. acute: PMN. chronic: plasma cells, macrophages, lymphocytes.
12. presence of endometrial glands and stroma in ectopic locations.
13. 3rd and 4th decades.
14. endometrial tissues found in:
ovaries
uterine ligaments
rectovaginal septum
pelvic peritoneum
laparotomy scars
[oh... your butt has a poo poo scar]
15. presence of endometrial tissue in uterine wall.
16. irregular nests of endometrial stroma within myometrium.
17. in up to 20% of uteri.
18. menorrhagia, colicky dysmenorrhea, dyspareunia, pelvic pain
[add men dys dys pelvic] [the ADD man: "this- this pelvic pain!!!!"]
19. infertility
dysmenorrhea
pelvic pain
deep dyspareunia
pain with BM, urine
[endo infertility dys pelvic deep BM] [end this infertility with this deep pelvic shit]
20. retrograde menses through the fallopian tubes spreads endometrial tissue in the peritoneal cavity.
21. coelemic epithelium produces endometrial tissue directly.
22. dissemination of endometrial tissue through veins or lymph nodes.
23. lesions in lungs / lymph nodes.
24. GI dysbiosis (candida in particular), hereditary influences, aromatase cytochrome P450, dioxin / PCB exposure.
25. nodules with red-blue to yellow-brown appearance on or below serosal surfaces, sometimes with fibrous adhesions.
26. endometrial tissue on the ovaries.
27. a sessile mass projecting into the endometrial cavity.
28. 0.5-3cm.
29. functional and hyperplastic (doesn't respond to progesterone).
30. adenocarcinoma.
31. carcinoma.
32. prolonged estrogen stimulation of endometrium by anovulation or increased estrogen production.
33. menopause, PCOS, ovarian tumors, ERT.
[hyper men hurt because of tumors]
34. a tumor suppressor gene that, when inactivated, can contribute to endometrial hyperplasia by increasing endometrial sensitivity to estrogen.
35. irregular gland shape, similar to proliferative endometrium without mitotic figures.
36. persistent estrogen stimulation.
37. 1-8%.
38. increased number and size of endometrial glands with irregular shape
scalloped or tufted surface on epithelial lining
mitotic figures
39. altered PTEN gene expression.
40. STI's, endogenous vaginal flora.
41. younger: STI. older: endogenous flora.
42. pelvic pain
adnexal tenderness
fever
vaginal discharge and bleeding
nausea / vomiting
back pain
CMT
dysuria
deep dyspareunia
43. Bartholin glands and periurethral glands.
44. cervix, uterus, uterine tubes, ovarian region.
45. through procedures such as abortion, D+C.
46. inflamed glands
acute suppurative inflammation of superficial mucosa
spared endometrial tissue
lumen filled with purulent exudate
tubo-ovarian abscesses
hydrosalpinx
[PID glands superficial spared lumen tubo salpinx] [stuPID glands: spared the superficial tubs of lemons instead of the minx]
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