Diseases of the Endometrium Flashcards
Name the diseases of the endometrium?
- Inflammatory: Chronic endometritis
- Functional disorders (hormonal)
- Iatrogenic disorders
- Non neoplastic organic lesions
- Neoplastic lesions including precursor lesions
Describe the proliferative phase of the menstrual cycle?
Effects of oestrogen
Tubular glands with pseudostratified epithelium and mitoses
Compact stroma with spindle/oval cells
Describe the secretory phase of the menstrual cycle?
Effects of progesterone
Stromal decidualisation: stromal cells acquire abundant eosinophilic cytoplasm
Coiled glands with secretions
What is menses?
stromal and glandular breakdown
Describe the cause of abnormal uterine bleeding during prepuberty?
Precocious puberty (hypothalamic, pituitary or ovarian origin
Describe the cause of abnormal uterine bleeding in adolescenvce?
Anovulatory cycle, coagulation disorders
What are causes of abnormal uterine bleeding seen in women of reproductive age?
Complications of pregnancy
Organic lesions (adenomyosis, polyps, hyperplasia)
Anovulatory cycles, inadequate luteal phase
Causes of abnormal uterine bleeding in perimenopausal women?
Anovulatory cycles
Irregular shedding
Organic lesions (carcinoma, hyperplasia, polyps)
Causes of abnormal uterine bleeding seen in postmenopausal women?
Organic lesions (carcinoma, hyperplasia, polyps) Endometriaal atrophy
When does dysfunctional uterine bleeding occur?
Occurs secondary to hormonal imbalances affecting the menstrual cycle
- Sometimes cause cannot be ascertained
Examples of dysfunctional uterine bleeding?
Luteal phase insufficiency
Irregular shedding
Anovulatory cycles
Describe luteal phase insufficiency?
Result from inadequate progesterone production by the corpus luteum
Endometrium shows inadequate secretory maturation
Glands and stroma are out of phase for the appropriate post-ovulatory day
Describe irregular shedding?
Result from a persistent corpus luteum with continued progesterone production
At the same time, endometrium is trying to proliferate
Endometrium shows combination of secretory, menstrual and proliferative changes
Describe the anovulatory cycle?
Cycles are not accompanied by ovulation
Which results in excessive and prolonged oestrogen stimulation
There is no development of secretory phase
Commonly occur at menarche and perimenopausal period
Endometrium shows proliferative glands and stromal breakdown without secretory changes
Causes of iatrogenic disorders?
Oral contraceptive use
Hormone replacement therapy (HRT)
Tamoxifen for treatment of breast cancer
Intrauterine contraception devices
Types of oral contraceptives?
combined oestrogen and progesterone (COC)
progesterone only
What does the endometrium show under COC use?
small tubular and inactive glands in a poorly developed stroma
Similar changes also seen in HRT but more pronounced
What does the endometrium show under progesterone only use?
Atrophic glands
Stroma pseudo-decidualisation
What is tamoxifen?
Anti-eostrogen drug for treatment of breast cancer
Paradoxical oestrogenic effects on endometrium include increase risk of?
Endometrial polyps
Endometrial hyperplasia
Endometrial carcinoma
Intrauterine contraceptive devices cause?
Inflammation: acute or chronic
Ulceration
Various metaplasia including papillary metaplasia
Vascular thrombosis
Focal irregular ripening (some glands and stroma appear out of phase)
Pseudodecidual change
Describe non neoplastic organic lesions?
- Endometriosis
Presence of endometrial glands outside the uterus - Adenomyosis
Presence of endometrial glands within myometrium - Endometrial polyps
Occur as a result of oestrogenic stimulation
What is a endometrial neoplastic precursor lesion?
endometrial intraepithelial neoplasia (EIN)
Causes of endometrial intraepithelial neoplasia?
Consequence of unopposed oestrogenic stimulation Source of oestrogen may be endogenous (ovarian tumour, ovarian polycystic disease etc) Or exogenous (e.g. obesity)
How is endometrial hyperplasia classified?
Classified according to architectural and cytologic atypia
What are the classes of the endometrial hyperplasia?
Simple hyperplasia
With or without atypia
Complex hyperplasia
With or without atypia
Epidemiology of endometrial carcinoma?
Common in older women peri and postmenopausal
What are the 2 groups of endometrial carcinoma?
- type 1: endometrioid carcinoma; develops on background of oestrogen stimulation and EIN
- Common type - type2: Serous carcinoma develops on background of atrophic endometrium with P53 mutations
- Seen in very elderly women
What are the risk factors for endometrioid carcinoma?
Obesity Infertility with anovulatory cycles Ovarian oestrogen secreting tumours Oestrogen replacement therapy Diabetis hypertension
