Endometrium/myometrium Endometrium: mucosal lining of uterine cavity Myometrium: smooth muscle underlies the endometrium Endometrium grows with

estrogen, prepares with progesterone, sheds without progesterone Asherman syndrome 2 amenorrhea from loss of basalis (regenerative layer, stem cell) no functionalis layer Aggressive dilation-&-curettage (dilate cervix, scrape uterine wall) Anovulatory cycle Proliferative phase, but no ovulation no secretory phase No progesterone, no preparation/shedding build-up of endometrium dysfn uterine bleeding Menarche/menopause Acute endometritis Bacterial infection b/c retained products of conception PC fever, uterine bleed, pelvic pain Chronic endometritis Presence of plasma B cells! b/c Chronic PID, IUD, TB, retained products of conception PC infertility, uterine bleed, pelvic pain Endometrial polyps PC bleed b/c tamoxifen (anti-estrogen in breast, pro-estrogen in endometrium) Endometriosis Endometrial glands AND stroma outside endometrial lining PC dysmenorrhea, pelvic pain, infertility Theories of cause: retrograde menstruation, metaplastic (from mallarian cell), lymphatic spread Ovary chocolate cyst, carcinoma Uterine ligaments (pelvic pain), pouch of Douglas (pain with defecation), bladder wall (pain on urination), bowel (abdo pain), fallopian tube (scarring infertility/ectopic pregnancy) Myometrium adenomyosis Soft tissue gunpowder lesions brown hemorrhagic specks Endometrial hyperplasia endometrial glands (stroma) b/c estrogen (obese: adipose tissue converts androgens to estrone) PC postmenopausal uterine bleeding carcinoma esp. complex hyperplasia & cellular atypia Endometrial carcinoma From hyperplasia (endometrioid on histo) (50-60y) estrogen-driven OR sporadic (papillary serous on hsito) (70+y) p53 sammomma body (=calcification) thyroid, meningioma

PC postmenopausal bleeding Leiomyoma b/c estrogen (pre-menopause) multiple, well-defined white whorled masses likely asymptomatic. (uterine bleed, infertility, pelvic mass) Lieomyosarcoma De novo (NO relation to leiomyoma!) Post-menopause Single lesion; necrosis & hemorrhage, cellular atypia

Ovarian cancer Surface epithelial tumour Most common Serous cyst or mucinous cyst (unilateral; bilateralKruckenberg secondary) CA-125 marker: not for screening, but yes for Tx response and recurrence Late/vague presentation; poor Px BRCA1-- serous carcinoma (ovary + fallopian tube) elective salpingo-oophorectomy Cystadenoma: benign, 30-40y, single cyst with simple flat lining Cystadenocarcinoma: malignant (invasive), 60-70y, multiple complex cysts, shaggy lining Endometrioid carcinoma: malignant, ass. Endometriosis, 15% already has endometrial cancer Brenner tumour: urothelial cell Borderline: metastatic potential, but better Px

Germ cell tumour 15-30y Teratoma (fetal tissue): skin/teeth/bone, most common germ cell tumour, 10% bilateral Benign, but immature tissue (neural ectoderm) or somatic malignancy (tumour within tumour; SCC skin) malignant Struma ovariithyroid Dysgerminoma (c.f. seminoma): malignant, large cells/clear cytoplasm, LDH, good Px Yolk sac: kids, AFP, Schiller-Duval bodies (glomeruloid) Choriocarcinoma (placenta): trophoblast cells (hCG) no villi, fast spread, poor chemo Embryonal: large primitive cells, fast spread Sex-cord stroma tumour Granulosa (estrogen) theca cell tumour Sertoli-Leydig: tubules, Reinke crystals, androgen (hirsutism) Fibroma: Meigs syndrome (pleural effusion & ascites) Metastasis Kruckenberg tumour: gastric mucin carcinoma mets to both ovaries, signet ring cells (nucleus pushed) Pseudomyxoma peritonei: appendix mucin carcinoma mucin in peritoneum (jelly belly)

Fallopian tubeserous cells Endometriumendometrial cells Endocervixmucinous cells

Carcinomalymphatic spread Sarcomahemo spread

Gestational Pathology Ectopic pregnancy Spontaneous abortion (=miscarriage): <20wk b/c hypercoagulable state (SLE) Placenta previa: lower uterine segment (cervical os), 3rd trimester bleed, Tx C-section Placental abruption: detaches from decidua stillbirth Bleed b/w placenta and decidua Placenta accreta: implants into myometrium (stuck), post-partum bleed, Tx hysterectomy Pre-eclampsia: HTN/proteinuria/edema in 3rd trimester b/c maternal-fetal vascular interface abnormality in placenta (fibrinoid necrosis), Tx placenta removal eclampsia (seizures) HELLP: Hemolysis, Elevated liver enzymes, low platelets Pre-eclampsia + thrombotic microangiopathy of liver Hydatidiform mole Complete: 2 sperm DNA, no egg DNA (46 chromosomes) no fetal tissue, choriocarcinoma Incomplete: 2 sperm DNA, 1 egg DNA (72 chromosomes) some fetal tissue, N hCG, uterus