13.4 Endometrium, Myometrium Flashcards
chronic endometritis
-characterized by what microscopically
- chronic inflamm of endometrium
- characterized by lymphocytes and plasma cells.
(Plasma cells are necessary for dx b/c lymphocytes are normally found in endometrium)
endometriosis
-theories of mechanism (3)
- endometrial glands and stroma outside the uterine endometrial lining
1. Retrograde menstruation–prevailing theory. menstrual products go through tubes out to pelvis
2. metaplastic–mullerian duct creates many types of epithelium, which may have endometrial hyperplasia
3. lymphatic dissemination–spread in lymph. explains endometriosis in lung
Leiomyoma (fibroids)
-increase cancer risk?
-no. do not progress to leiomyosarcomas.
Anovulatory cycle
- clinical presentation
- classic populations (2)
common cause of Uterine bleeding, esp during:
- menarche
- menopause
Endometrial polyp
- mech
- clinical presentation
- HY cause
- hyperplastic protrusion of endometrium, possibly from estrogen stimulation
- presents as abnormal uterine bleeding
- can be side effect of tamoxifen–it has anti-estrogen effects on breast, BUT weak pro-estrogen effects on endometrium
Asherman syndrome
- mech
- cause
- secondary amenorrhea due to loss of the stem cell layer (basalis) and scarring. Loss of stem cells means uterus is unable to generate new endometrium for future cycles.
- caused by overaggressive dilation and curettage (D&C). Rare
think Ashes on endometrium, leading to scars
chronic endometritis
-clinical presentation (3)
- abnormal uterine bleeding
- pain
- infertility!
Female pt newly being treated for breast cancer presents with abnormal uterine bleeding. Think what?
Think side effect of tamoxifen: endometrial polyp.
tamoxifen: anti estrogenic in breast
weakly pro estrogenic in endometrium
Endometriosis
-increased cancer risk?
-Yes, increased risk of carcinoma at site of endometriosis, esp in ovary
(‘Endometrial tumor of ovary’)
What can happen if doctor is too aggressive in scraping cells from the uterus?
Asherman syndrome
-loss of stem cell layer of endometrium means endometrium cannot regrow after each cycle. Secondary amenorrhea
Adenomyosis
involvement of uterine myometrium in endometriosis
(invade past endometrium layer to myometrium)_
Leiomyoma (fibroids)
clinical symptoms include (3)
- multiple, well-defined, white, whorled masses that can distort uterus and impinge on pelvic structures
- usu asymptomatic
1. abnormal uterine bleeding (from stretching)
2. infertility (blockage of ovum to implant)
3. pelvic mass
Endometrial carcinoma
- clinical presentation
- divided into what types (and what %)
- what population each
- postmenopausal bleeding
1. hyperplasia pathway (75%)–from endometrial hyperplasia - 50/60 yo
2. sporadic pathway (25%)–p53 mutation - 70 yo
Why check for plasma cells in endometrial biopsy?
Plasma cell presence indicates chronic endometritis.
Acute endometritis
- cause
- clinical presentation (3)
Bacterial infection of endometrium
- usu b/c of retained products of conception (after delivery or miscarriage), eg placenta piece remains behind.
1. fever
2. abnormal uterine bleeding
3. pelvic pain
Endometriosis
-clinical symptoms
-dysmenorrhea and pelvic pain. (endometriosis cycles like normal endometrium)
endometrial hyperplasia
- histology (2 things)
- increased cancer risk?
- architecture–hyperplasia of glands relative to stroma
- presence of cellular atypia
Most important predictor for carcinoma progression is presence of cellular atypia!
endometrial hyperplasia
- what is it
- mech
- clinical presentation
Grow grow grow, then bleed.
- hyperplasia of endometrial glands relative to stroma
- occurs from unopposed estrogen (eg obesity, polycystic ovarian syndrome)
- postmenopausal uterine bleeding (no progresterone, so grow grow grow, then bleed)
Endometrium vs myometrium
-what hormones affect endometrium and what are the phases?
endometrium: mucosal lining of uterine cavity
myometrium: smooth m wall under endometrium
Endometrium:
- Proliferative: Growth–estrogen
- Secretory: Preparation for implantation–progesterone
- Menstrual: Shedding–withdrawal of progesterone
Which endometrial hyperplasia histology finding is more likely to progress to carcinoma?
- complex hyperplasia, no cellular atypia
- simple hyperplasia, cellular atypia
Cellular atypia is important factor. architecture (simple/complex) not.
- less likely
- more likely
endometriosis: symptoms of the following locations
- uterine ligaments
- pouch of douglas
- bladder wall
- bowel serosa
- fallopian tube mucosa
- uterine ligaments–pelvic pain
- pouch of douglas–pain with defecation
- bladder wall–pain with urination
- bowel serosa–abdominal pain and adhesions
- fallopian tube mucosa–scarring inreases risk for ectopoic tubal pregnancy
endometriosis
- gross appearance
- most common site of involvement
- other sites include (5)
-ovary: classic ‘chocolate cyst’
Other locations appear as yellow-brown ‘gun-powder’ nodules:
- uterine ligaments–pelvic pain
- pouch of douglas–pain with defecation
- bladder wall–pain with urination
- bowel serosa–abdominal pain and adhesions
- fallopian tube mucosa–scarring inreases risk for ectopoic tubal pregnancy
Endometrial carcinoma, hyperplasia type
- risk factors
- average age
- histology
- estogen exposure (caused the hyperplasia–grow grow grow, carcinoma)
- early menarche/late menopause
- 50/60 yo
- endometrioid–looks like normal endometrium, but crowded and piled on top of itself
chocolate cyst
-mech
endometriosis in ovaries
-cycles of growth/shedding result in accumulation of menstrual products inside ovary
