13.4 Endometrium and Myometrium Flashcards
What is the mucosal lining of the uterine cavity csalled
endometrium
what is the specific layer of the uterine lining that sheds every cycle
stratum functionalis of the endometrium
What is the stem cell layer of the endometrium?
stratum basalis
what is beneath the endometrium
myometrium
what are the 3 phases of the menstrual cycle
proliferative (growth) –> secretory (Preparation)–> menstrual (shedding)
What hormone drives the proliferative (growth) phase of the endometrium
estrogen
What homo drives the secretory 0(preparation) phase of the endometrium
progesterone
What homo drives the shedding/menstrual phase
lack of progesterone
Define Asherman Syndrome
secondary amenorrhea
Why is there amenorrhea in Asherman Syndrome
the stratum basalis of the endometrium is lost and replaced by scarring
What causes loss and scarring of the basalis in asherman syndrome
overaggressive dilation and curettage (scraping that removes the basalis)
In an anovulatory cycle what phase of the cycle is left out?
the progesterone driven secretory (preparation) phase
what is the MOA of an anovulatory cycle?
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
2 situations where anovulatory cycle is clasically seen
menarche and menopause
what is the clinical presentation with anovulatory cycle
dysfunctional uterine bleeding
define acute endometritus
bacterial infection of the endometrium
What is the MC cause of acute endometritus
retained products of conception
CP of acute endometritus (3)
fever, abnormal uterine bleeding, pelvic pain
what is necessary for the dx of chronic endometritus?
plasma cells in endometrium
What type of inflammatory cell is normal in the endometrium
lymphocytes
what are 4 causes of chronic endometritus
- IUD
- chronic pelvic inflammatory disease (chlamydia)
- retained products of conception
- TB
What else would you see if TB was the cause of chronic endometritus
granulomas
what are three things that chronic endometritus presents with?
- fever
- pain
- infertility
Define endometrial polyp
hyperplastic protrusion of endometrium
CP of endometrial polyp
abnormal uterine bleeding
Common cause of endometrial polyp
side effect of tamoxifen use
What is MOA of tamoxifen cuasing endometrial polyp
tamoxifen has anti-estrogen effect on breast and a weak anti-estrogen effect on endometrium
define endometriosis
presence of bothglands and stroma of endometrium outside the endometrial lining
what is cause of endometriosis
retrograde menstruation–> implantation of endometrium at ectopic site
CP of endometriosis (3)
dysmenorrhea, pelvic pain, infertility
Why does endometriosis cause dysmenorrhea
becuase the ectopis endometriosis cycles just like the normal endometrium and when it sloughs = pain
what is the MC site of involvement of endometriosis
ovary
what is a classic finding in ovary in endometriosis and MOA
“chocolate cyst” - implanted ectopic endometrium sloughs and proliferates until it forms a cyst
How does endometriosis cause infertility and ectopic pregnancy
Ectopic endometrium implants in the fallopian tubes and causes scarring
When endometriosis cyst involves soft tissue what is it called
gunpowder nodules
define adenomyosis (also break down the parts of the name)
presence of endometriosis in the uterine myometrium
Adeno = glands of endometrium myo = myometrium
what is there an increased risk of at the site of endometriosis? especially at what ectopic site?
risk of carcinoma
especially at the ovary
define edndometrial hyperplasia
hyperplasia of endometrial glands relative to stroma
wHAT CUASES endometrial hyperplasia
unopposed estrogen
What are 3 causes of unopposed estrogen leading to endometrial hyperplasia
obesity
polycystic ovary syndrome
estrogen replacement therapy
What population has what classic sx in endometrial hyperplasia (why?)
postmenopausal women have uterine bleeding (no progesterone phase in menopause = unopposed estrogen and proliferation of endo–> bleeding)
How is endometrial hyperplasia classified?
histologically
what is the histological growth pattern of endometrial hyperplasia
architechural growth pattern (simple or complex) +/- cellular atypia
What is the most important predictor of endometrial hyperplasia progressing to endometrail carcinoma?
cellular atypia
what classification of endometrial hyperplasia most often progresses to carcinoma?
simple hyperplasia with atypia
what classification of endometrial hyperplasia least often progresses to carcinoma?
complex hyperplasia without atypia
What happens with hormones in Adipose tissue (what gets converted in to what?
androgen–> estrone
Is endometrial carcinoma benign or malignant
malignant
define endometrial carcinoma
malignant proliferaiton of endometrial glands
what is the MC invasive carcinoma of the female genital tract
endometrial carcinomoa
how does endoemtrail carcinoma present
postmenopausal bleding
what are the 2 pathways for endometrial carcinoma to arise
hyperplastic and sporadic
average age of presentation of hyperplastic and sporadic endometrail carcinomas (2) which is earlier?
hyperplastic 60s
Sporadic 70s
what is histology of hyperplastic endometrial carcinoma (DESCRIBE AND NAME)
endometrioid- looks like normal endometrium but les stroma
the sporadic pathway to endometrial carcinoma arises from what condition/lesion
no precursor lesion- arises from atrophic endometrium
which endometrial carcinoma pathway is more aggressive? (hyperplatic or sporadic)
hyperplastic
what mutation is seen in sporadic endometrial carcinoma
p53
the histology of sporadic endometrial carcinoma is chcized by what 3 things
serous histology
papillary structures
psammoma bodies
what is a psammoma body
an area of necrosis and calcification in a papillary extension
what are 3 cancers that display psammoma bodies other than endometrial carcinoma
mesothelioma- high yield
meningioma
papillary carcinoma of the thyroid
What tissue type is involved in Leiomyoma (derivative of what specific tissue)
smooth muscle of myometrium
IS a Leiomyoma benign or malignant
benign
what is the most common tumor in females
Leiomyoma
Leiomyoma is most often seen in what pop
pre-menopausal
what is cause/correlation of Leiomyoma
estrogen exposure
How do Leiomyomas change DUIRNg life? why
enlarge during pregnacy, shrink after menopause (estrogen related)
Leiomyoma gross appearance
multiple white whorled masses
SX of Leiomyoma (3)
often asx
infertility - uterine distorion
pelvic mass
abnormal uterine bleeding
What do Leiomyomas progrss to?
nothing!!!!
arise from what?
nothing!!!! they are de novo lesions
what pop MC has leiomysarcomas
postmenopausal women
gross appearance of leiomysarcoma (3)
single lesion
areas of:
necrosis, hemorrhage
is leiomysarcoma benign or malignant
malignant
3 diffrernces between leiomysarcomas and Leiomyomas
Leiomyomas: multiple lesions, premenopause, no necrosis/hemorrhage
Leiomyosarcomas: single lesion, postmenopause, shows necrosis and hemorrhage
