5. Uterine corpus Flashcards
Disorders of the endometrium
- Benign tumours of endometrium
- Endometrial hyperplasia
- Endometrial polyps - Endometrial carcinoma
- Endometriosis
Disorders of the myometrium
- Leiomyomas
- Leiomyosarcomas
- Adenomyosis
Etiology of endometrial hyperplasia
Increased estrogen stimulation leads to excessive proliferation of the endometrium
- Follicle persistence in anovulatory cycles
- Polycystic ovary syndrome (PCOS)
- Granulosa cell tumors
- Hormone replacement therapy without progestin administration (progestin normally prevents endometrial hyperplasia)
Clinical features of endometrial hyperplasia
Vaginal bleeding (intermenstrual, postmenopausal, or constant bleeding)
Definition of endometrial polyps
Focal overgrowth of localized benign endometrial tissue
Characteristics of endometrial polyps
- Localized within the uterine wall, extends into the uterine cavity
- Can be pedunculated or sessile, single or multiple, and up to many centimeters in size
Expresses both estrogen and progesterone receptors (estrogen stimulates growth)
Epidemiology of endometrial polyps
most common in postmenopausal women
Risk factors for endometrial polyps
- Hypertension
- Obesity
- Tamoxifen; postmenopausal hormone therapy
Clinical features of endometrial polyps
- Irregular menstrual bleeding, spotting, menorrhagia, and postmenopausal bleeding
- Infertility
Definition of endometrial cancer
- Type I endometrial cancer: endometrioid adenocarcinomas (grade 1 and 2) derived from atypical endometrial hyperplasia
- Type II endometrial cancer: endometrioid adenocarcinomas (grade 3) and tumors of nonendometrioid histology; serous, clear cell, mucinous
Etiology of Type 1 endometrial cancer
- Long-term exposure to increased estrogen levels
- Some genetic mutations (e.g., in the PTEN gene or mismatch repair genes) are also associated with this type of cancer.
Etiology of Type 2 endometrial cancer
- Estrogen-independent
2. Associated with endometrial atrophy (especially in postmenopausal women)
Risk factors for estrogen-dependent tumors
- Nulliparity
- Early menarche and late menopause
- Polycystic ovary syndrome
- Obesity
Protective factors for estrogen-dependent tumors
- Multiparity
2. Combination oral contraceptive pills
Epidemiology of endometrial carcinoma
- Primarily affect postmenopausal women
2. Peak incidence: 65–74 years
Clinical features of endometrial carcinoma
- Abnormal uterine bleeding is the main symptom.
- Postmenopausal: any amount of vaginal bleeding
- Perimenopausal/premenopausal: metrorrhagia, menometrorrhagia - Later stages may present with pelvic pain
- Localised metastasis: contiguous spread to the cervix and vagina, fallopian tubes, and ovaries
Definition of uterine leiomyoma (fibroids)
Benign smooth muscle tumors within the uterine wall (submucous, subserous, or in myometrium)
Etiology of uterine leiomyoma
- Nulliparity
- Early menarche
- Age: 25–45 years
- Fibroids are largely found in women of reproductive age
- Influenced by hormones (i.e., estrogen, growth hormone, and progesterone)
- During menopause, hormone levels begin to decrease and leiomyomas begin to shrink
Clinical features of uterine leiomyoma
- Dysmenorrhea
- Abnormal bleeding
- Infertility (difficulty conceiving and increased risk of miscarriage)
Pathology of uterine leiomyoma
Smooth muscle tissue in a whorled pattern with well-demarcated borders
Complications of uterine leiomyoma
- Infertility
- Iron deficiency anemia (due to heavy menstrual bleeding)
- Very rare: malignant transformation to uterine leiomyosarcoma
Definition of uterine leiomyosarcoma
Rare malignant tumor arising from the smooth muscle cells of the myometrium
Risk factors for leiomyosarcoma
- Menopause
2. Tamoxifen use
Clinical features for leiomyosarcoma
- Dysmenorrhea
- Abnormal bleeding
- Infertility (difficulty conceiving and increased risk of miscarriage)
- Menstrual irregularities
- Postmenopausal bleeding
- Pelvic pain
Pathology for leiomyosarcoma
- Single lesions with areas of coagulative necrosis and/or hemorrhage
- Cords of polygonal cells with eosinophilic cytoplasm, abundant mitoses, and cellular atypia are common
Etiology for endometriosis
- Retrograde menstruation
- Other contributing factors include:
- Coelomic metaplasia
- lymphogenic dissemination of endometrial cells
Pathophysiology for endometriosis
- Endometrial tissue occurs outside of the uterus.
- Common locations of endometriotic implants include:
- Pelvic organs:
i. Ovaries: most common site; often affected bilaterally
ii. Rectouterine pouch
iii. Fallopian tubes
iv. Bladder
v. Cervix
- Peritoneum
- Extrapelvic organs (e.g., lung or diaphragm): less commonly affected - Reacts to the hormone cycle; proliferates under the influence of estrogen
- Endometriotic implants result in:
- ↑ Production of inflammatory and pain mediators
- Altered anatomy (e.g., pelvic adhesions) → infertility
Clinical features of endometriosis
- Chronic pelvic pain that worsens before the onset of menses.
- Dysmenorrhea
- Pre- or postmenstrual bleeding
- Dyspareunia
- Infertility
Pathology of endometriosis
Macroscopic findings
Ovaries
1. Gunshot lesions or powder-burn lesions
- yellow-brown
- on the serosal surfaces of the ovaries and peritoneum
2. Ovarian endometriomas or chocolate cysts; contain blood
Microscopic findings
- Normal endometrial glands
- Normal endometrial stroma
- Hemosiderin laden macrophages
Complications of endometriosis
- Anemia
- Endometriosis in the uterotubal junction inhibits implantation of the zygote: ↑ risk of ectopic pregnancy
- fibrous adhesions → strictures and entrapment of organs
Definition of adenomyosis
Benign disease characterized by the occurrence of endometrial tissue within the myometrium due to hyperplasia of the endometrial basal layer
Clinical features of adenomyosis
- Dysmenorrhea
- Abnormal uterine bleeding
- Chronic pelvic pain
- Globular, uniformly enlarged uterus that is soft but tender on palpation
