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This Concept Map, created with IHMC CmapTools, has information related to: Uterus, Uterus Endometrial ENDOMETRIOSIS - 20s-30s -glands/stroma in: ovaries> ligaments>rectovag septum> peritoneum>umbilicus, vagina CLINICAL Can->infertility, dysmenorrhea, pain (defecation, dysuria, sex) etc. Might make own estrogen (aromatase) ORIGIN 1. retrograde menstruation->tubes 2. metaplasia from coelomic epith 3. vasc/lymph->lungs, etc. MORPH-undergo cylic changes -can bleed, then obliterate lumens 2 of 3: glands, stroma, hemosiderin, Uterus Fallopian Tubes Inflammations-often w/ other inflams (PID) SUPPURATIVE SALPINGITIS - gonococcus ᡴ%, chlamydiae -can -> pyosalpinx, hydrosalpinx, tubo-ovarian cyst TUBERCULOUS SALPINGITIS -1-2% of inflammations, Uterus Tumors LEIOMYOSARCOMA - 40-60yo DE NOVO (not from leiomyoma) MORPH- 1. bulky, fleshy into wall 2. polypoid into lumen Atypia, anaplastic or well-diff'd, mitoses (ᡂ/hpf), zonal necrosis -diff'd from leiomyoma -if can't distiguish->uncertain potential -recurs often, low survival rate ᡪ% eventually mets, disseminate, Uterus Endometrial ENDOMETRIAL HYPERPLASIA (ENDOMET INTRAEPITH NEOPLASIA) -lots of estrogen w/ no progest antag -esp at menopause (BLEEDING) or anovulation of younger women Conditions: PCOD, Stein-Leventhal, GRANULOSA cell tumors of ov, excess cortical fcn, estrogen replacement Tx May be continuum to CA MORPH- -Low-grade-simple-cystic-like prolif phase -frequently->atrophy complex-budding of glands, no atypia, epith more stratified ɝ% progress to CA High-grade-complex atypical hyperplasia=EIN -irreg gland lining (stratify), crowding -often cell atypia, mit figures, nucleoli ->can't differentiate w/out hysterectomy -benign->preCA seen w/ PTEN gene Tx-progesterone, hysterectomy, Uterus Endometrial ADENOMYOSIS -endomet nests in myomet -in 15-20% uteri -unknown cause ->myomet expansion -problems at menses -hemorrhage->menorrhagia, dysmen, dyspare, pelvic pain, Uterus Functional Endometrial Disorders Dysfcnal Uterine Bleeding ORAL CONTRACEPTIVES -INDUCED ENDOMETRIAL CHANGES -minimized w/ low-dose COC ->discordant stroma vs glands, Uterus Tumors CARCINOMA OF ENDOMETRIUM -7% of invasive CA in women -most common GYN MALIGNANCY -mostly POSTMENOPAUSAL 55-65yo ->ABNL bleeding->detection -higher incidence w/ obesity, DM, HTN, infertility(single, nulliparous) PATHOGENESIS 1. endomet hyperplasia (prolonged est) -anovulation -increased estrogen (obesity, ov CA) -well-diff'd, endometrioid, good Px -microsatellite instability 2. older age, poor diff'n, no hyperestrog -can look like serous ov CA -poorer Px -p53 overexpression CLINICAL- can be (-)Sx, irreg BLEEDING, leukorrhea -some detection on Pap, esp Clear cell -good Px if low stage -worsens quickly w/ higher stage, Uterus Tumors ENDOMETRIAL STROMAL TUMORS 1. benign stromal nodules 2. low-grade stromal sarcoma/ endolymphatic stromal myosis -stroma b/w mm fibers of myomet -PENETRATE LYMPHATICS (unlike 1) 3. endometrial stromal sarcoma -atypia, mitoses, indistinct margins -invade vessels-> mets -50% 5-yr survival, Uterus Tumors LEIOMYOMA-"FIBROIDS" -multiple in most cases -MOST COMMON WOMAN TUMOR -25% of reproductive women -estrogen-responsive -can increase during preg MORPH-usually in myomet in corpus -whorled on cut section -large tumors can be softer red-brown CLINICAL-can be (-)Sx -bleeding (submuc), bladder compression -impaired fert, sudden pain if ischemic -can ->spon abortion, postpartum hemor, fetal malpresentation, inertia malignant xformation RARE BENIGN METASTISIZING LEIO-rare -tumor extends into vessels->lung, Uterus Endometrial ENDOMETRIAL POLYPS ᡠyo Made of: 1. Fcnal endomet 2. *Hyperplastic endomet* responsive to estrogen BUT not progesterone -often seen w/ TAMOXIFEN -stromal cells w/ 6p21 muts -rarely harbor CA -can be (-)Sx or BLEEDING (IF NECROTIC), Uterus Fallopian Tubes PARATUBAL CYSTS HYDATIDS OF MORGAGNI -larger, near fimbriae or broad ligaments -remnants of mullerian duct ADENOMATOID TUMORS -benign mesotheliomas -subserosal -just like in testes/epid ADENOCARCINOMAS -papillary, tubal diff'n -usually from direct extension -poor Px b/c late Dx, Uterus Functional Endometrial Disorders Dysfcnal Uterine Bleeding MENOPAUSAL, POSTMENOPAUSAL CHANGES -anovulation->gland architectural changes ->mild hyperplasia, cystic dilation -if ovarian atrophy, can remain cystic -but inactive (unlike cystic hyperplasia), Uterus Functional Endometrial Disorders Dysfcnal Uterine Bleeding INADEQUATE LUTEAL PHASE -low progesterone output ->infertility, increased bleeding, amenorrhea -sec endometrium present, but not up to date, Uterus Functional Endometrial Disorders Dysfcnal Uterine Bleeding ANOVULATORY CYCLE -most common cause of DUB -excessive, prolonged estrogen Lack of ovulation due to: IDIOPATHIC* -perimenopausal or menarche endocrine d/o-thy, adrenal, pit primary lesion eg. PCOD, metabolic (malnutrition, obesity) ->overgrowth, dilation of glands -unscheduled breakdown->blood, CARCINOMA OF ENDOMETRIUM -7% of invasive CA in women -most common GYN MALIGNANCY -mostly POSTMENOPAUSAL 55-65yo ->ABNL bleeding->detection -higher incidence w/ obesity, DM, HTN, infertility(single, nulliparous) PATHOGENESIS 1. endomet hyperplasia (prolonged est) -anovulation -increased estrogen (obesity, ov CA) -well-diff'd, endometrioid, good Px -microsatellite instability 2. older age, poor diff'n, no hyperestrog -can look like serous ov CA -poorer Px -p53 overexpression CLINICAL- can be (-)Sx, irreg BLEEDING, leukorrhea -some detection on Pap, esp Clear cell -good Px if low stage -worsens quickly w/ higher stage MORPH Localized or diffuse thru endo Spread thru blood, lymph -lungs, liver, bones MOSTLY ADENOCA -malignant stratified col cells -can have some Sq metaplasia ADENOSQUAMOUS CA if ᡂ% Sq & less diff'd adeno Papillary serous-little CA in endo BUT lots of spread -behave as poorly diff'd Clear Cell CA-also behave as poorly BOTH always grade G3, Uterus Tumors MIXED MULLERIAN, MESENCHYMAL CARCINOSARCOMA-gland & stroma -sarcomatous->cart, mm, bone -often ass'd w/ previous XRT MORPH-fleshy, bulky, polypoid -can protude thru os Px differs w/ depth, worse w/ serous -mets as ADENOCA -high mort-highly malignant, Uterus Endometrial Acute- peripartum, IUDs, etc. -S pyogenes, staph, etc -just take the nasty crap out CHRONIC ENDOMETRITIS -in PID, retained gest tissue, IUDs, TB (tuberculous) -chlamydia->acute & chronic infiltrates -15% idio->abnl bleeding, pain, discharge, infertility, Uterus Tumors ADENOSARCOMAS-30-40s -polypoid -prolapse thru os -estrogen-sensitive Tx-oophorectomy DDx-benign polyps -see malig stromal histo