Female Genital Tract 2 – Uterine & Pregnancy Pathology

Question-and-Answer flashcards covering inflammatory, hyperplastic, dysfunctional, neoplastic, and pregnancy-related disorders of the uterus and placenta.

What infectious agents most commonly cause acute endometritis?

Neisseria gonorrhoeae and Chlamydia trachomatis

Which histologic cell type is REQUIRED to diagnose chronic endometritis?

Plasma cells in the endometrial stroma

List two classic clinical consequences of endometritis related to fallopian-tube damage.

Infertility and ectopic (tubal) pregnancy

In what patient population is granulomatous (tuberculous) endometritis most often seen?

Immunocompromised patients in tuberculosis-endemic regions

Define adenomyosis.

Growth of endometrial basal layer (glands & stroma) deep within the myometrium

Why do adenomyotic foci not undergo cyclic bleeding?

Because they originate from the non-cycling stratum basalis of the endometrium

What three main symptoms can adenomyosis produce?

Menorrhagia, dysmenorrhea, and pre-menstrual pelvic pain

Define endometriosis.

Presence of normal endometrial glands and stroma outside the uterus

Name two theories proposed to explain endometriosis.

Retrograde (reverse) menstruation theory and embryologic rest (metaplastic) theory

Give four common anatomic sites of endometriosis.

Ovary (chocolate cysts), broad ligament, pelvic peritoneum, bowel (e.g., sigmoid, rectovaginal septum)

What type of ovarian cyst is characteristic of endometriosis?

‘Chocolate cyst’ – a cyst filled with old hemorrhagic material

Which hormone imbalance drives endometrial hyperplasia?

Excess estrogen relative to progesterone

Identify the three histologic classes of endometrial hyperplasia.

Simple, complex, and atypical hyperplasia

Which class of endometrial hyperplasia carries the highest cancer risk?

Atypical hyperplasia

List four clinical or endocrine settings that cause unopposed estrogen exposure leading to hyperplasia.

Anovulation, prolonged estrogen therapy, polycystic ovary syndrome, estrogen-producing ovarian tumors (e.g., granulosa-theca cell tumors)

Why is obesity a risk factor for endometrial hyperplasia?

Adipose tissue converts steroid precursors into estrogens, raising systemic estrogen levels

Describe a typical endometrial polyp.

Sessile, hemispheric lesion composed of basalis-type endometrium with thick-walled vessels; may have cystically dilated glands

What is the main clinical presentation of an endometrial polyp?

Abnormal uterine bleeding

Define dysfunctional uterine bleeding (DUB).

Abnormal bleeding without an organic uterine lesion

Name four major etiologic categories of DUB.

Failure of ovulation, inadequate luteal phase, contraceptive-induced changes, perimenopausal hormonal fluctuations

What is the most common benign tumor of the female genital tract?

Leiomyoma (uterine fibroid)

How do estrogens and oral contraceptives affect leiomyomas?

They stimulate growth; tumors often enlarge during reproductive years and regress after menopause

List two common symptoms caused by leiomyomas.

Menorrhagia ± metrorrhagia and pelvic ‘dragging’ or mass effect

Do leiomyomas commonly transform into sarcomas?

No, malignant transformation is rare

How do leiomyosarcomas typically arise?

De novo from myometrial mesenchymal cells (not from pre-existing leiomyomas)

Give three gross or microscopic features diagnostic of leiomyosarcoma.

Tumor necrosis, marked cytologic atypia, high mitotic activity

What is the approximate 5-year survival rate for uterine leiomyosarcoma?

About 40%

Differentiate endometrioid and serous endometrial carcinoma regarding pathogenesis.

Endometrioid: estrogen excess & hyperplasia with PTEN/DNA mismatch repair mutations; Serous: arises in atrophic endometrium with early TP53 mutations

Which type of endometrial carcinoma is more aggressive with early metastasis?

Serous carcinoma

State four classical risk factors for endometrioid endometrial carcinoma.

Obesity, diabetes mellitus, hypertension, and infertility (anovulatory cycles)

What is the most important prognostic factor for both major types of endometrial carcinoma?

Tumor stage at diagnosis

Define spontaneous abortion.

Loss of pregnancy before 20 weeks’ gestation

What is an ectopic pregnancy?

Implantation of a fertilized ovum outside the uterine cavity, most commonly in the fallopian tube

List the key placental anomalies discussed.

Accessory lobes, bipartite placenta, circumvallate placenta, placenta accreta

Differentiate placental villitis from chorionamnionitis.

Villitis: inflammation of chorionic villi, usually hematogenous (TORCH); chorionamnionitis: inflammation of fetal membranes, usually ascending bacterial infection

Which placental lesions are characterized by persistent elevation of hCG?

Hydatidiform mole and choriocarcinoma

What are the two forms of hydatidiform mole and their karyotypes?

Complete mole – diploid (46,XX or 46,XY); Partial mole – triploid (69,XXY)

Which type of mole contains fetal parts?

Partial hydatidiform mole

State the approximate incidence of choriocarcinoma arising from complete hydatidiform moles.

About 2%

Why do gestational choriocarcinomas respond better to chemotherapy than gonadal choriocarcinomas?

Placental tumors express paternal antigens, allowing maternal immune response to aid chemotherapy; gonadal tumors lack these antigens

Give the three most common clinical settings in which gestational choriocarcinoma arises.

Complete mole (≈50%), after abortion (≈25%), during normal pregnancy (≈25%)

What are classic presenting signs of choriocarcinoma?

Bloody or brownish vaginal discharge with markedly rising hCG levels

Describe the typical metastatic pattern of choriocarcinoma.

Early hematogenous spread, especially to lungs and vagina; lymphatic spread is uncommon

What perinatal complication is grouped under ‘toxemia of pregnancy’?

Pre-eclampsia/eclampsia

Name two late-pregnancy conditions that contribute to intrauterine growth restriction (IUGR).

Placental insufficiency (e.g., vascular lesions, infections) and maternal toxemia (pre-eclampsia/eclampsia)

Which placental anomaly involves chorionic villi attaching DIRECTLY to myometrium without decidua?

Placenta accreta