Happy New Year!

Pathology Student is back after a nice long holiday hiatus. We will begin 2010 with a new series of real live questions from real live students. It is important to hear other students’ questions (and answers) because 1) you will probably learn or clarify something, and 2) it will hopefully encourage you to ask your own questions. So, without further ado, here are some questions and answers about female reproductive system pathology.

Q. In endometriosis, is the glandular tissue found outside of the uterus and not associated with it at all other than being of similar cellular makeup? In other words, is it essentially extra-uterine menses?
A. Endometriosis is extra-uterine endometrial tissue, not associated with the stuff inside the uterus at all – other than it is under the same hormonal control, so when the endometrial tissue inside the uterus undergoes cyclic changes, so will the endometrial tissue (endometriosis) outside the uterus.

Q. Is nulliparity a risk factor in endometrial hyperplasia?
A. Yes, actually, it is, although our textbook [Robbins Basic Pathology] doesn’t mention it. It falls into the category of things-that-increase-estrogen-exposure, so it’s a risk factor for any of the tumors related to estrogen excess.

Q. The risk factors for endometrial hyperplasia include exogenous hormone use. Is this the same thing as estrogen replacement therapy?
A. In this setting, yes, they are the same thing.  If you want to be complete about it, there are other kinds of exogenous hormones – like birth control pills – but when we’re talking about endometrial hyperplasia, the exogenous hormomes referred to are estrogen replacement therapy (birth control pills don’t have that effect on the endometrium).

Q. It seems like too much estrogen causes a bunch of issues. Do many of these pathologies arise simultaneously in the presence of excess estrogen?
A. No, not usually. The chances of any one tumor or lesion arising are relatively small (even though the risk is increased compared to the setting of normal estrogen), so the chances of two developing at the same time are very small.

Q. Can you give an example of what metrorrhagia is and when it might take place?
A. Metrorrhagia means there is bleeding outside the normal period time, for example: abnormally-timed bleeding during menopause, or bleeding from an intra-uterine tumor (which would not follow normal hormonal stimuli).

Q. Could a teratoma be an ectopic pregnancy?
A. No – a teratoma is a neoplasm; it is monoclonal. It arises from a germ cell that has gone bad and decided to develop into all three germ cell layers. The cells may grow to look like normal tissues, but they’re not under any embryologic organization or control (they just grow haphazardly). A pregnancy, whether it is intrauterine or extrauterine, is not monoclonal; the tissues are growing in response to embryologic signals, and if left alone, will organize into a human.

Q. What is peau d’orange?
A. Peau d’orange (French for “skin of the orange”) happens when you have a breast cancer that has infiltrated the lymphatics of the breast skin, making the skin edematous and orange-peel-looking. This change often happens in inflammatory breast cancer (so-named because the skin can look inflamed), in which the tumor preferentially involves lymphatics.