GYN path 2

Question 1

What is endometrial hyperplasia?

Answer 1

Non-physiologic, non-invasive proliferation of endometrium

Question 2

What is the cause of endometrial hyperplasia?

Answer 2

Increased, unopposed estrogen effect

Question 3

What is the clinical presentation of endometrial hyperplasia?

Answer 3

Abnormal bleeding

Question 4

What age group is more affected with endometrial hyperplasia?

Answer 4

Perimenopausal years (anovulatory cycles leads to relative dec in progesterone, things are unbalanced)

Question 5

What are the risk factors for endometrial hyperplasia?

Answer 5

Exogenous: estrogens

Endogenous:
-Ovarian lesions, obesity, hypertension, diabetes, reproductive factors (late menopause, early menarche, nulliparity=no births), smoking

Question 6

What are some protective factors for endometrial hyperplasia?

Answer 6

• Large # births
• Old age at first birth
• Long birth pd
• Short premenopausal delivery-free pd

Question 7

What are the histologic features of endometrial hyperplasia?

Answer 7

• Abundant material with curettage
• Diffuse abnormality
• Inc gland-to-stroma ratio
• Irregular gland shape/size
• Mitotic activity

Question 8

What are the classifications of endometrial hyperplasia?

Answer 8

Hyperplasia without atypia (simple or complex=based on glandular complexity and amt of stroma)

Hyperplasia with atypia (simple or complex)

Question 9

What classification type is most at risk for cancer?

Answer 9

Hyperplasia with atypia

Question 10

What is the difference between hyperplasia and carcinoma?

Answer 10

Carcinoma has…

• Myometrial invasion
• Invasion of endometrial stroma–any of the 3
  1. Irregular infiltration of glands associated with altered fibroblastic stroma (desmoplastic response=growth of fibrous or connective tissue)
  2. Confluent glandular pattern uninterrupted by stroma (cribriform glands=like honeycomb cereal)
  3. Extensive papillary pattern (fibrovascular cores lined by epithelial cells)

Question 11

What is endometrial carcinoma?

Answer 11

Most common malignant tumor of female genital tract

Question 12

What are the two types of endometrial carcinoma?

Answer 12

Type I: estrogen dependent (endometrioid type, related to hyperplasia)

Type II: estrogen independent (serous/clear cell type, not related to hyperplasia)

Question 13

What is the difference between type I and type II with regards to unopposed estrogen?

Answer 13

I: present

II: absent

Question 14

What is the difference between type I and type II with regards to menopausal status?

Answer 14

I: pre and peri

II: post

Question 15

What is the difference between type I and type II with regards to precursor lesion?

Answer 15

I: Atypical hyperplasia

II: Intraepithelial carcinoma

Question 16

What is the difference between type I and type II with regards to tumor grade?

Answer 16

I: Low

II: High

Question 17

What is the difference between type I and type II with regards to myometrial invasion?

Answer 17

I: minimal

II: deep

(both are variable)

Question 18

What is the difference between type I and type II with regards to histologic subtypes?

Answer 18

I: Endometrioid

II: Serous, clear cell

Question 19

What is the difference between type I and type II with regards to behavior?

Answer 19

I: Indolent

II: Aggressive

Question 20

What is the difference between type I and type II with regards to genetic alterations?

Answer 20

I: PTEN mut, K-ras mut, Microsatellite instability (proliferation)

II: P53 mut (no proliferation with abnormal nuclei)

Question 21

What is stage I endometrial carcinoma?

Answer 21

Confined to uterus
IA: confined to endomet
IB: invades 50% myomet

Question 22

What is stage II endometrial carcinoma?

Answer 22

Cervical involvement
IIA: Glandular involvement only
IIB: cervical and stromal involvement

Question 23

What is stage III endometrial carcinoma?

Answer 23

Uterine serosa, adnexa, pos cytology, vaginal or pelvic LN metastases

Question 24

What is stage IV endometrial carcinoma?

Answer 24

Invasion of bladder or bowel mucosa or distant metastases

Question 25

What is the prognosis for endometrial carcinoma?

Answer 25

Survival rate of 75-80% African Americans=poorer prognosis Survival for localized disease is 90%

Question 26

What are the symptoms/signs of cervical cancer?

Answer 26

Abnormal vaginal bleeding, post-coital bleeding

Question 27

What are the risk factors for cervical cancer?

Answer 27

HPV 16, 18 | Less evidence: >6 sexual partners, smoking, early age 1st interocourse, immunosuppresion

Question 28

What are the precursor lesions to cervical cancer?

Answer 28

Dysplasia of inc severity (CIN1-3), detection by pap and histology

Question 29

Where do precursor lesions to cervical cancer occur?

Answer 29

Squamocolumnar jxn (transformation zone)

Question 30

What viral genes of high risk HPV cause the cellular transformation?

Answer 30

E6 and E7 genes

Question 31

What is necessary for dev of cancer?

Answer 31

HPV persistence since immune system can often reverse low grade lesions