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13 Female Genital and Gestational > 13.4 Endometrium, Myometrium > Flashcards

13.4 Endometrium, Myometrium Flashcards

1
Q

chronic endometritis

-characterized by what microscopically

A
  • chronic inflamm of endometrium
  • characterized by lymphocytes and plasma cells.

(Plasma cells are necessary for dx b/c lymphocytes are normally found in endometrium)

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1
Q

endometriosis

-theories of mechanism (3)

A
  • 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
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1
Q

Leiomyoma (fibroids)

-increase cancer risk?

A

-no. do not progress to leiomyosarcomas.

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2
Q

Anovulatory cycle

  • clinical presentation
  • classic populations (2)
A

common cause of Uterine bleeding, esp during:

  1. menarche
  2. menopause
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3
Q

Endometrial polyp

  • mech
  • clinical presentation
  • HY cause
A
  • 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
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5
Q

Asherman syndrome

  • mech
  • cause
A
  • 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

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6
Q

chronic endometritis

-clinical presentation (3)

A
  1. abnormal uterine bleeding
  2. pain
  3. infertility!
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7
Q

Female pt newly being treated for breast cancer presents with abnormal uterine bleeding. Think what?

A

Think side effect of tamoxifen: endometrial polyp.

tamoxifen: anti estrogenic in breast

weakly pro estrogenic in endometrium

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8
Q

Endometriosis

-increased cancer risk?

A

-Yes, increased risk of carcinoma at site of endometriosis, esp in ovary

(‘Endometrial tumor of ovary’)

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9
Q

What can happen if doctor is too aggressive in scraping cells from the uterus?

A

Asherman syndrome

-loss of stem cell layer of endometrium means endometrium cannot regrow after each cycle. Secondary amenorrhea

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10
Q

Adenomyosis

A

involvement of uterine myometrium in endometriosis

(invade past endometrium layer to myometrium)_

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10
Q

Leiomyoma (fibroids)

clinical symptoms include (3)

A

  • 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
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11
Q

Endometrial carcinoma

  • clinical presentation
  • divided into what types (and what %)
  • what population each
A
  • postmenopausal bleeding
    1. hyperplasia pathway (75%)–from endometrial hyperplasia
  • 50/60 yo
    2. sporadic pathway (25%)–p53 mutation
  • 70 yo
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13
Q

Why check for plasma cells in endometrial biopsy?

A

Plasma cell presence indicates chronic endometritis.

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14
Q

Acute endometritis

  • cause
  • clinical presentation (3)
A

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
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15
Q

Endometriosis

-clinical symptoms

A

-dysmenorrhea and pelvic pain. (endometriosis cycles like normal endometrium)

16
Q

endometrial hyperplasia

  • histology (2 things)
  • increased cancer risk?
A
  • architecture–hyperplasia of glands relative to stroma
  • presence of cellular atypia

Most important predictor for carcinoma progression is presence of cellular atypia!

17
Q

endometrial hyperplasia

  • what is it
  • mech
  • clinical presentation
A

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)
19
Q

Endometrium vs myometrium

-what hormones affect endometrium and what are the phases?

A

endometrium: mucosal lining of uterine cavity
myometrium: smooth m wall under endometrium

Endometrium:

  1. Proliferative: Growth–estrogen
  2. Secretory: Preparation for implantation–progesterone
  3. Menstrual: Shedding–withdrawal of progesterone
19
Q

Which endometrial hyperplasia histology finding is more likely to progress to carcinoma?

  1. complex hyperplasia, no cellular atypia
  2. simple hyperplasia, cellular atypia
A

Cellular atypia is important factor. architecture (simple/complex) not.

  1. less likely
  2. more likely
20
Q

endometriosis: symptoms of the following locations

  1. uterine ligaments
  2. pouch of douglas
  3. bladder wall
  4. bowel serosa
  5. fallopian tube mucosa
A
  1. uterine ligaments–pelvic pain
  2. pouch of douglas–pain with defecation
  3. bladder wall–pain with urination
  4. bowel serosa–abdominal pain and adhesions
  5. fallopian tube mucosa–scarring inreases risk for ectopoic tubal pregnancy
21
Q

endometriosis

  • gross appearance
  • most common site of involvement
  • other sites include (5)
A

-ovary: classic ‘chocolate cyst’

Other locations appear as yellow-brown ‘gun-powder’ nodules:

  1. uterine ligaments–pelvic pain
  2. pouch of douglas–pain with defecation
  3. bladder wall–pain with urination
  4. bowel serosa–abdominal pain and adhesions
  5. fallopian tube mucosa–scarring inreases risk for ectopoic tubal pregnancy
22
Q

Endometrial carcinoma, hyperplasia type

  • risk factors
  • average age
  • histology
A
  • 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
24
Q

chocolate cyst

-mech

A

endometriosis in ovaries

-cycles of growth/shedding result in accumulation of menstrual products inside ovary

25
Q

You suspect your pt has new Endometrial carcinoma

-what type is most likely based on what age?

A

50-60: hyperplasia

70: sporadic (p53)

26
Q

Leiomyoma vs leiomyosarcoma:

how to differentiate? (3)

A

leiomyoma vs leiomyosarcoma:

  1. # :

multiple vs single

  1. gross appearance:

well-defined/white vs necrosis/hemorrhage

  1. age:

premenopause vs postmenopause

27
Q

‘gun-powder’ nodules

A

endometriosis outside ovaries (which would be a chocolate cyst)

29
Q

Female pt with complaint of infertility, uterine bleeding, and pain gets a biopsy of the endometrium. Check for what in the biopsy?

A

Check for plasma cells. This would dx chronic endometritis, which is consistent with this pt’s symptoms.

29
Q

Leiomyosarcoma

  • what cell type
  • precursor lesion
  • population
  • gross exam
A
  • smooth m myometrium, malignant proliferation
    1. arises de novo, no precursor lesion. Does not arise from leiomyomas
    2. postmenopausal women (vs premenopausal in fibroids)
    3. single lesion, with necrosis and hemorrhage.

know these 3

30
Q

Endometrial carcinoma, sporadic type

  • arises in what patient
  • what mutation is common
  • precursor lesion
  • histology
A
  • arises in an atrophic endometrium with no evident precursor lesion.
  • p53 mutation!
  • average age 70 yo
  • papillary, serous structures. with psammoma body formation (death of central papillary regions)
31
Q

Endometrial carcinoma

-what are the 2 histology types you might see?

A
  1. hyperplasia: endometrioid–looks like normal endometrium
  2. sporadic–papaillary, psamomma bodies (death of central papillary regions)
32
Q

How are symptoms different:

Acute vs chronic endometritis

A

acute: fever, abnormal uterine bleeding, pelvic pain
chronic: abnormal uterine bleeding, pain, infertility

33
Q

Leiomyoma (fibroids)

  • what cell types
  • cause
  • gross exam findings
A
  • smooth m neoplastic proliferation, myometrium
  • related to estrogen exposure (enlarge during pregnancy, shrink after menopause)
34
Q

chronic endometritis

-causes include (4)

A
  1. retained conception products
  2. chronic PID (eg chlamydia)
  3. IUD
  4. TB (with granulomas)
35
Q

Anovulatory cycle

  • cause
  • clinical presentation
A

lack of ovulation

  • caused by proliferative phase (E2) w/o subsequent secretory phase (Progesterone). The endometrium keeps growing with each phase (no shedding). eventually outgrows blood supply, leading to shedding/bleeding.
  • uterine bleeding, infertility

13 Female Genital and Gestational (6 decks)

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