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Pathoma 13. Female Genital System and Gestational Pathology > 13.4 Endometrium and Myometrium > Flashcards

13.4 Endometrium and Myometrium Flashcards

1
Q

What is the mucosal lining of the uterine cavity csalled

A

endometrium

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2
Q

what is the specific layer of the uterine lining that sheds every cycle

A

stratum functionalis of the endometrium

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3
Q

What is the stem cell layer of the endometrium?

A

stratum basalis

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4
Q

what is beneath the endometrium

A

myometrium

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5
Q

what are the 3 phases of the menstrual cycle

A

proliferative (growth) –> secretory (Preparation)–> menstrual (shedding)

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6
Q

What hormone drives the proliferative (growth) phase of the endometrium

A

estrogen

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7
Q

What homo drives the secretory 0(preparation) phase of the endometrium

A

progesterone

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8
Q

What homo drives the shedding/menstrual phase

A

lack of progesterone

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9
Q

Define Asherman Syndrome

A

secondary amenorrhea

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10
Q

Why is there amenorrhea in Asherman Syndrome

A

the stratum basalis of the endometrium is lost and replaced by scarring

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11
Q

What causes loss and scarring of the basalis in asherman syndrome

A

overaggressive dilation and curettage (scraping that removes the basalis)

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12
Q

In an anovulatory cycle what phase of the cycle is left out?

A

the progesterone driven secretory (preparation) phase

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13
Q

what is the MOA of an anovulatory cycle?

A

lack of secretory phase results in another Est-driven growth phase laid down upon old growth phase. The proliferative (growth) glands outgrow their blood supply and die off –> bleeding

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14
Q

2 situations where anovulatory cycle is clasically seen

A

menarche and menopause

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15
Q

what is the clinical presentation with anovulatory cycle

A

dysfunctional uterine bleeding

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16
Q

define acute endometritus

A

bacterial infection of the endometrium

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17
Q

What is the MC cause of acute endometritus

A

retained products of conception

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18
Q

CP of acute endometritus (3)

A

fever, abnormal uterine bleeding, pelvic pain

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19
Q

what is necessary for the dx of chronic endometritus?

A

plasma cells in endometrium

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20
Q

What type of inflammatory cell is normal in the endometrium

A

lymphocytes

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21
Q

what are 4 causes of chronic endometritus

A
  1. IUD
  2. chronic pelvic inflammatory disease (chlamydia)
  3. retained products of conception
  4. TB
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22
Q

What else would you see if TB was the cause of chronic endometritus

A

granulomas

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23
Q

what are three things that chronic endometritus presents with?

A
  1. fever
  2. pain
  3. infertility
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24
Q

Define endometrial polyp

A

hyperplastic protrusion of endometrium

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25
Q

CP of endometrial polyp

A

abnormal uterine bleeding

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26
Q

Common cause of endometrial polyp

A

side effect of tamoxifen use

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27
Q

What is MOA of tamoxifen cuasing endometrial polyp

A

tamoxifen has anti-estrogen effect on breast and a weak anti-estrogen effect on endometrium

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28
Q

define endometriosis

A

presence of bothglands and stroma of endometrium outside the endometrial lining

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29
Q

what is cause of endometriosis

A

retrograde menstruation–> implantation of endometrium at ectopic site

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30
Q

CP of endometriosis (3)

A

dysmenorrhea, pelvic pain, infertility

31
Q

Why does endometriosis cause dysmenorrhea

A

becuase the ectopis endometriosis cycles just like the normal endometrium and when it sloughs = pain

32
Q

what is the MC site of involvement of endometriosis

A

ovary

33
Q

what is a classic finding in ovary in endometriosis and MOA

A

“chocolate cyst” - implanted ectopic endometrium sloughs and proliferates until it forms a cyst

34
Q

How does endometriosis cause infertility and ectopic pregnancy

A

Ectopic endometrium implants in the fallopian tubes and causes scarring

35
Q

When endometriosis cyst involves soft tissue what is it called

A

gunpowder nodules

36
Q

define adenomyosis (also break down the parts of the name)

A

presence of endometriosis in the uterine myometrium

Adeno = glands of endometrium
myo = myometrium
37
Q

what is there an increased risk of at the site of endometriosis? especially at what ectopic site?

A

risk of carcinoma

especially at the ovary

38
Q

define edndometrial hyperplasia

A

hyperplasia of endometrial glands relative to stroma

39
Q

wHAT CUASES endometrial hyperplasia

A

unopposed estrogen

40
Q

What are 3 causes of unopposed estrogen leading to endometrial hyperplasia

A

obesity
polycystic ovary syndrome
estrogen replacement therapy

41
Q

What population has what classic sx in endometrial hyperplasia (why?)

A

postmenopausal women have uterine bleeding (no progesterone phase in menopause = unopposed estrogen and proliferation of endo–> bleeding)

42
Q

How is endometrial hyperplasia classified?

A

histologically

43
Q

what is the histological growth pattern of endometrial hyperplasia

A

architechural growth pattern (simple or complex) +/- cellular atypia

44
Q

What is the most important predictor of endometrial hyperplasia progressing to endometrail carcinoma?

A

cellular atypia

45
Q

what classification of endometrial hyperplasia most often progresses to carcinoma?

A

simple hyperplasia with atypia

46
Q

what classification of endometrial hyperplasia least often progresses to carcinoma?

A

complex hyperplasia without atypia

47
Q

What happens with hormones in Adipose tissue (what gets converted in to what?

A

androgen–> estrone

48
Q

Is endometrial carcinoma benign or malignant

A

malignant

49
Q

define endometrial carcinoma

A

malignant proliferaiton of endometrial glands

50
Q

what is the MC invasive carcinoma of the female genital tract

A

endometrial carcinomoa

51
Q

how does endoemtrail carcinoma present

A

postmenopausal bleding

52
Q

what are the 2 pathways for endometrial carcinoma to arise

A

hyperplastic and sporadic

53
Q

average age of presentation of hyperplastic and sporadic endometrail carcinomas (2) which is earlier?

A

hyperplastic 60s

Sporadic 70s

54
Q

what is histology of hyperplastic endometrial carcinoma (DESCRIBE AND NAME)

A

endometrioid- looks like normal endometrium but les stroma

55
Q

the sporadic pathway to endometrial carcinoma arises from what condition/lesion

A

no precursor lesion- arises from atrophic endometrium

56
Q

which endometrial carcinoma pathway is more aggressive? (hyperplatic or sporadic)

A

hyperplastic

57
Q

what mutation is seen in sporadic endometrial carcinoma

A

p53

58
Q

the histology of sporadic endometrial carcinoma is chcized by what 3 things

A

serous histology
papillary structures
psammoma bodies

59
Q

what is a psammoma body

A

an area of necrosis and calcification in a papillary extension

60
Q

what are 3 cancers that display psammoma bodies other than endometrial carcinoma

A

mesothelioma- high yield
meningioma
papillary carcinoma of the thyroid

61
Q

What tissue type is involved in Leiomyoma (derivative of what specific tissue)

A

smooth muscle of myometrium

62
Q

IS a Leiomyoma benign or malignant

A

benign

63
Q

what is the most common tumor in females

A

Leiomyoma

64
Q

Leiomyoma is most often seen in what pop

A

pre-menopausal

65
Q

what is cause/correlation of Leiomyoma

A

estrogen exposure

66
Q

How do Leiomyomas change DUIRNg life? why

A

enlarge during pregnacy, shrink after menopause (estrogen related)

67
Q

Leiomyoma gross appearance

A

multiple white whorled masses

68
Q

SX of Leiomyoma (3)

A

often asx
infertility - uterine distorion
pelvic mass
abnormal uterine bleeding

69
Q

What do Leiomyomas progrss to?

A

nothing!!!!

70
Q

arise from what?

A

nothing!!!! they are de novo lesions

71
Q

what pop MC has leiomysarcomas

A

postmenopausal women

72
Q

gross appearance of leiomysarcoma (3)

A

single lesion
areas of:
necrosis, hemorrhage

73
Q

is leiomysarcoma benign or malignant

A

malignant

74
Q

3 diffrernces between leiomysarcomas and Leiomyomas

A

Leiomyomas: multiple lesions, premenopause, no necrosis/hemorrhage
Leiomyosarcomas: single lesion, postmenopause, shows necrosis and hemorrhage

Pathoma 13. Female Genital System and Gestational Pathology (7 decks)

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