Histopathology of the Uterus I

omarys's version from 2017-05-11 23:48

Section 1

Question Answer
2 layers of uterine mucosa: functional andbasal
Does the basal layer contain glands?Yes, but they're less 'proliferative' than the functional layer. The basal layer is mostly stromal (spindle-shaped) cells.
What 2 "sublayers" are found within the functional layer and which is closer to the basal layer?Stratum compactum and stratum spongiosum. The spongiosum is closer to the basal.
Largest layer in the uterine mucosa?Stratum spongiosum
The layer of uterine mucosa that is shed each cyclefunctional layer
What is analogous to "uterine cycle ; secretory phase"?"ovarian cycle ; luteal phase"
Blood vessel proliferation occurs in which phase of the menstrual cycle, the proliferative or secretory?Secretory (i.e. the "latter")
Why is it hard to determine the invasiveness of uterine tumors?Because the endometrium has a fuzzy border (i.e. basement membrane) with the myometrium

Section 2

Question Answer
Ovulation day is designated day _________ (#?) in the menstrual cycle0
1.5-2 days after ovulation (days 2-3 in the cycle), the earliest morphologic evidence of ovulation can be observed, and it isbasal vacuolation
Tortuosity of the glands characterizes (increases in)both the proliferative and secretory phase (in the latter, it increases because mucin has that kind of effect on the glands)
"Early secretory phase ; mucin within cells (subnuclear vacuolation)" is analogous to"Late secretory phase ; mucin within lumen"
Stromal edema characterizes (peaks in)both the proliferative and secretory phases, but much more in the secretory
Decidual reaction occurs inthe secretory/luteal phase, in response to progesterone
What happens in the decidual reaction?All kinds of changes that are meant to prepare the uterus for pregnancy, the most notable is swelling of stromal cells (they become filled with glycogen and other nutrients)
Why do stromal cells swell in the decidual reaction?Because they fill with nutrients, which shall help the early embryo survive until the placenta develops
What causes menses?Leukocytic (neutrophilic) infiltration - located between the basal and functional layers

Section 3

Question Answer
T OR F- Dysfunctional uterine bleeding might result from a mass in or dysfunction of the uterine wall.False. DUB is by definition due to hormonal imbalances, not abnormal masses like tumors.
2 causes of DUBanovulatory cycle and inadequate luteal phase
High estrogen levels unbalanced by progesterone =anovulatory cycle- glands do proliferate (thanks to estrogen) but don't mature (bc of no progesterone), so they're shed in menses
Anovulatory cycle is MAINLY caused byAbnormal function of the gonadal hormonal axis
Anovulatory cycle might additionally be caused byObesity/metabolic syndrome (=secretion of ectopic estrogen), or some functional ovarian tumors (=that secrete estrogen)
In an anovulatory cycle, does the secretory phase occur?No. The endometrium does not "mature" properly and its functional layer is shed before the secretory phase begins.

Section 4

Question Answer
Other than anovulatory cycle, what might cause DUB?Luteal phase defect
A luteal phase defect manifests asFertility problems, frequent periods (If progesterone production is low, the luteal phase is shortened and menses occur too soon following ovulation)
Oral contraceptives cause adiscordant reaction of glands and stroma (the former being 'inactive' while the latter shows a decidual change)
Oral contraceptives prevent pregnancy by two mechanisms:inhibiting ovulation + disturbing 'synchronization' of glands and stroma in endometrium

Section 5

Question Answer
The main cause(s) of abnormal uterine bleeding in childhoodprecocious puberty (due to e.g. a hypothalamic tumor)
The main cause(s) of abnormal uterine bleeding in adolescenceDUB (anovulatory cycles), coagulation disorders
The main cause(s) of abnormal uterine bleeding in fertile womentumors or anatomic lesions, pregnancy complications, DUB
The main cause(s) of abnormal uterine bleeding in peri-menopausal womentumors or anatomic lesions, DUB
The main cause(s) of abnormal uterine bleeding in post-menopausal womentumors or anatomic lesions, endometrial atrophy

Section 6

Question Answer
Which is more common, acute or chronic endometritis?chronic
Causes of acute endometritis includeacute/sudden injury, e.g. after birth or abortion
Causes of chronic endometritis include (first 3 are of infectious origin)PID, tuberculosis, chlamydia, IUDs, remnants of placenta after birth/abortion
Dx of chlamydia can be done viaPCR of urine sample
What leukocytes can be found within the endometrium in endometritis that distinguish the condition from the physiological infiltrate of leukocytes in menses?Any chronic inflammation cell: plasma cells (foremost), macrophages, and lymphocytes

Section 7

Question Answer
Define endometriOSISEctopic endometrial tissue (glands and/or stromal cells)
Where does endometriosis most commonly occur?the ovaires
Clinical manifestations of endometriosis severe pain (no blood drainage if bleeding site is closed), infertility (scarring of the ovaries after macrophages come to clean up the blood)
Infertility due to endometriosis occurs via 2 mechanisms:mechanical (scarring of ovaries) and functional (hormonal dysfunction)
3 theories explain the development of endometriosisregurgitation (=retrograde menstruation), vascular or lymphatic dissemination, coelomic metaplasia
Genetic cause/background of endometriosis?The genes for SF1 and ER-beta are demethylated and thus more active >> the two proteins are produced in excess >> proliferation of (ectopic) endometrial tissueHint: the ENDOMETRIUM itself regulates its own proliferation by ABNORMAL/ECTOPIC (=non-ovarian) secretion of estrogen, instead of having the ovaries do the secretion/regulation
What other pathologies are in association w/ endometriosis?Endometriotic cysts, Ovarian carcinoma (endometrioid, clear cell)Ovarian carcinoma is associated with endometriosis when the endometriosis is ATYPICAL (mutations in PTEN and ARID1A)

Section 8

Question Answer
Activation of the ER-beta stimulates which important pro-inflammatory enzyme?COX-2
What stimulates COX-2?ER-beta, VEGF, IL-1, PGE2, other pro-inflammatory cytokines/proteins
What does COX-2 produce (from arachidonic acid)?PGE2recall that PGE2 itself stimulates COX-2 (positive feedback)
Other than promote inflammation, what does PGE2 do?Upregulates SF1
Upregulation of SF1 results inIncreased estrogen synthesis
Tx of endometriosisCOX-2 inhibitors, aromatase inhibitors, oral contraceptives (good old progesterone)
Dx of endometriosisobserve at least 2 out of these 3: endometrial glands, stroma, hemosidern pigment

Section 9

Question Answer
Atypical endometriosis is a pre-______ conditionmalignant
Atypical endometriosis can have 2 morphologies: atypical cytology (epithelium in cyst changes but overall cyst architecture is OK) or atypical architectural (which is usually accompanied by atypical cytology)when both the cytology and overall architecture of the cyst are atypical, the condition is morphologically similar to "complex atypical endometrial hyperplasia"
AdenomyosisA subtype of endometriosis where the ectopic location is the myometrium
Is adenomyosis common or rare?COMMON!
Etiology of adenomyosisUnknown
painful menses =dysmenorrhea
profuse menses =menorrhagia
Patients with adenomyosis often present withdysmenorrhea and menorrhagia