5. Uterine corpus

Question 1

Disorders of the endometrium

Answer 1

1. Benign tumours of endometrium
   - Endometrial hyperplasia
   - Endometrial polyps
2. Endometrial carcinoma
3. Endometriosis

Question 2

Disorders of the myometrium

Answer 2

1. Leiomyomas
2. Leiomyosarcomas
3. Adenomyosis

Question 3

Etiology of endometrial hyperplasia

Answer 3

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)

Question 4

Clinical features of endometrial hyperplasia

Answer 4

Vaginal bleeding (intermenstrual, postmenopausal, or constant bleeding)

Question 5

Definition of endometrial polyps

Answer 5

Focal overgrowth of localized benign endometrial tissue

Question 6

Characteristics of endometrial polyps

Answer 6

1. Localized within the uterine wall, extends into the uterine cavity
2. Can be pedunculated or sessile, single or multiple, and up to many centimeters in size
   Expresses both estrogen and progesterone receptors (estrogen stimulates growth)

Question 7

Epidemiology of endometrial polyps

Answer 7

most common in postmenopausal women

Question 8

Risk factors for endometrial polyps

Answer 8

1. Hypertension
2. Obesity
3. Tamoxifen; postmenopausal hormone therapy

Question 9

Clinical features of endometrial polyps

Answer 9

1. Irregular menstrual bleeding, spotting, menorrhagia, and postmenopausal bleeding
2. Infertility

Question 10

Definition of endometrial cancer

Answer 10

1. Type I endometrial cancer: endometrioid adenocarcinomas (grade 1 and 2) derived from atypical endometrial hyperplasia
2. Type II endometrial cancer: endometrioid adenocarcinomas (grade 3) and tumors of non­endometrioid histology; serous, clear cell, mucinous

Question 11

Etiology of Type 1 endometrial cancer

Answer 11

1. Long-term exposure to increased estrogen levels
2. Some genetic mutations (e.g., in the PTEN gene or mismatch repair genes) are also associated with this type of cancer.

Question 12

Etiology of Type 2 endometrial cancer

Answer 12

1. Estrogen-independent

2. Associated with endometrial atrophy (especially in postmenopausal women)

Question 13

Risk factors for estrogen-dependent tumors

Answer 13

1. Nulliparity
2. Early menarche and late menopause
3. Polycystic ovary syndrome
4. Obesity

Question 14

Protective factors for estrogen-dependent tumors

Answer 14

1. Multiparity

2. Combination oral contraceptive pills

Question 15

Epidemiology of endometrial carcinoma

Answer 15

1. Primarily affect postmenopausal women

2. Peak incidence: 65–74 years

Question 16

Clinical features of endometrial carcinoma

Answer 16

1. Abnormal uterine bleeding is the main symptom.
   - Postmenopausal: any amount of vaginal bleeding
   - Perimenopausal/premenopausal: metrorrhagia, menometrorrhagia
2. Later stages may present with pelvic pain
3. Localised metastasis: contiguous spread to the cervix and vagina, fallopian tubes, and ovaries

Question 17

Definition of uterine leiomyoma (fibroids)

Answer 17

Benign smooth muscle tumors within the uterine wall (submucous, subserous, or in myometrium)

Question 18

Etiology of uterine leiomyoma

Answer 18

1. Nulliparity
2. Early menarche
3. 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

Question 19

Clinical features of uterine leiomyoma

Answer 19

1. Dysmenorrhea
2. Abnormal bleeding
3. Infertility (difficulty conceiving and increased risk of miscarriage)

Question 20

Pathology of uterine leiomyoma

Answer 20

Smooth muscle tissue in a whorled pattern with well-demarcated borders

Question 21

Complications of uterine leiomyoma

Answer 21

1. Infertility
2. Iron deficiency anemia (due to heavy menstrual bleeding)
3. Very rare: malignant transformation to uterine leiomyosarcoma

Question 22

Definition of uterine leiomyosarcoma

Answer 22

Rare malignant tumor arising from the smooth muscle cells of the myometrium

Question 23

Risk factors for leiomyosarcoma

Answer 23

1. Menopause

2. Tamoxifen use

Question 24

Clinical features for leiomyosarcoma

Answer 24

1. Dysmenorrhea
2. Abnormal bleeding
3. Infertility (difficulty conceiving and increased risk of miscarriage)
4. Menstrual irregularities
5. Postmenopausal bleeding
6. Pelvic pain

Question 25

Pathology for leiomyosarcoma

Answer 25

1. Single lesions with areas of coagulative necrosis and/or hemorrhage 2. Cords of polygonal cells with eosinophilic cytoplasm, abundant mitoses, and cellular atypia are common

Question 26

Etiology for endometriosis

Answer 26

1. Retrograde menstruation 2. Other contributing factors include: - Coelomic metaplasia - lymphogenic dissemination of endometrial cells

Question 27

Pathophysiology for endometriosis

Answer 27

1. Endometrial tissue occurs outside of the uterus. 2. 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 3. Reacts to the hormone cycle; proliferates under the influence of estrogen 4. Endometriotic implants result in: - ↑ Production of inflammatory and pain mediators - Altered anatomy (e.g., pelvic adhesions) → infertility

Question 28

Clinical features of endometriosis

Answer 28

1. Chronic pelvic pain that worsens before the onset of menses. 2. Dysmenorrhea 3. Pre- or postmenstrual bleeding 4. Dyspareunia 5. Infertility

Question 29

Pathology of endometriosis

Answer 29

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 1. Normal endometrial glands 2. Normal endometrial stroma 3. Hemosiderin laden macrophages

Question 30

Complications of endometriosis

Answer 30

1. Anemia 2. Endometriosis in the uterotubal junction inhibits implantation of the zygote: ↑ risk of ectopic pregnancy 3. fibrous adhesions → strictures and entrapment of organs

Question 31

Definition of adenomyosis

Answer 31

Benign disease characterized by the occurrence of endometrial tissue within the myometrium due to hyperplasia of the endometrial basal layer

Question 32

Clinical features of adenomyosis

Answer 32

1. Dysmenorrhea 2. Abnormal uterine bleeding 3. Chronic pelvic pain 4. Globular, uniformly enlarged uterus that is soft but tender on palpation