DISORDERS OF THE ENDOMETRIUM

Question 1

INTRODUCTION

Answer 1

The uterus is a pear Shaped orga
8cm in length, 6cm wide and 3cm thick
Weighs 50gm
3 parts- the Fundus, Body and Cervix

Uterus is divided into 2
The Myometrium- wall composed of tightly interwoven smooth muscle bundle

The Endometrium - mucosal lining of yhe uterus composed of glands within a cellular stroma

Question 2

AUB & DUB

Answer 2

Causes of Abnormal uterine bleeding includes; endometritis, endometrial polyp, submucosal leiomyomas, endometrial neoplasms and Dysfunctional uterine bleeding (bleeding from no known origin)

DUB defined as uterine bleeding with no known underlying structural abnormalities

Etiology:The most common cause are:
•1.Anovulatory cycle-is prolonged excessive endometrial stimulation by estrogen without progesterone effect seen in endocrine disease such as thyroid, adrenal and pituitary tumour, ovarian tumour such as granulosa cell tumour or metabolic disorder such as marked obesity,malnutrition

The causes for anovulation at different
•ages are as follows:
•A.1. In pre-puberty: precocious puberty of hypothalamic,
•pituitary or ovarian origin.
•2. In adolescence: anovulatory cycles at the onset of
•menstruation.
•3. In reproductive age: complications of pregnancy, endometrial hyperplasia, carcinoma, polyps, leiomyomas and adenomyosis

• 4. At premenopause: anovulatory cycles, irregular shed ding,
• endometrial hyperplasia, carcinoma and polyps.
• 5. At perimenopause: endometrial hyperplasia, carci noma,
• polyps and senile atrophy.
• B. Inadequate luteal phase:inadequate corpus luteum function resulting in low progesterone output.

Question 3

ENDOMETRIOSIS

Answer 3

DEFINITION: Is present of endometrial tissue (glands and stroma) outside of the uterus.

Commonly found site include:
•1.ovaries
•2.uterine ligaments
•3.rectovaginal septum
•4.cul de sac
•5.pelvic peritoneum.
•6.large and small bowel and appendix
•7.mucosa of the cevix,vagina and fallopian tube
•8.laparatomy scars

ETIOLOGY: Two theories:
• 1. Metastatic : implantation at abnormal site is due to retrograde menstration from the fallopian tube.
• 2. Metaplastic: Embrologically arise directly from the coelomic epithelium.
•

MORPHOLOGY: It can present as infertility, menstral irregularity,dysmenorrhea,dysparuenia,pelvic pain etc

Grossly as cystic lession.
•Histology: show endometrial glands and stroma with or without presence of hemosiderin.

Question 4

ADENOMYOSIS

Answer 4

Is a related disorder. Defined as presence of endometrial tissue within the myometrium. Symptoms commomly in the premenstral period include menometrorrhagia,colicky dysmenorrhia, dysparuenia and pelvic pain

Question 5

COMMON BENIGN AND MALIGNANT TUMOR OF THE UTERUS.

Answer 5

Tumours from the endometrium or myometrium can be benign or malignant.
•These are:
•1. Endometrial glands: endometrial polyps or carcinoma.
•2. Endometrial stroma:stroma nodules or sarcoma.
•3.Smooth muscle of the myometrium; leiomyoma and leiomyosarcoma.
•4.Mullerian mesoderm:mullerian tumour

Question 6

ENDOMETRIAL POLYP

Answer 6

GROSS: single or multiple small but occasionally large and Pedunculated

HISTOLOGY: mixture of endometrial glands (showing some cystic changes) and stroma (spindle cells)

Question 7

ENDOMETRIAL CARCINOMA

Answer 7

Most common invasive tumor of the female genital tract

Classified into TYPE 1 and TYPE 2 Based on molecular analysis and clinicopathological studies

TYPE1: occurs as a result of excess estrogen stimulation and it develops against a background of endometrial hyperplasia (precursor). Morphology is Endometroid

TYPE 2: it develops de novo in the setting of endometrial atrophy with a precursor endometrial Intraepithelial carcinoma. Morphology is serous carcinoma

Risk factors:
Obesity, Diabetes, Hypertension, infertility, Dub, long standing estrogen users, breast cancer patients treated with tamoxifen

Question 8

ENDOMETRIAL CARCINOMA(TYPE 1)

Answer 8

80% of cases
Mutations in KRAS and P53 gene PTEN tumor suppressor gene

GROSS: either as localised POLYPOID or infiltrating tumor

HISTOLOGY: Tumor characterized by gland pattern resembling normal endometrial epithelium

Question 9

ENDOMETRIAL CARCINOMA(TYPE2)

Answer 9

15-20%
Poorly differentiated tumor(grade 3)
P53 mutation most common cause

Clinical features: may be asymptomatic or present as irregular menstrual bleeding or post menopausal vaginal bleeding
Investigations include: Biopsy and curettage of tissue for Histology
Treated by: Treated by Surgery, Prophylactic radiation and Chemotherapy

Question 10

LEIOMYOMAS

Answer 10

Commonly called Fibroids
Above 20% harbor leiomyomas with no symptoms
Malignant transformation in less than 0.5%

Risk factors: estrogen stimulation, human growth hormone and sterility

Clinical symptoms: abnormal bleeding, lower abdominal pain, frequent urination, infertility

GROSS: multiple, circumscribed, firm, nodular gray white masses of variable sizes located either intramural, submucosa or subserosa

Cut section has characteristic of whorling appearance

HISTOLOGY: whorl bundles of spindle cells of uniform size, oval nuclei and long slender bipolar cytoplasm, mitosis is scarce

SECONDARY CHANGES
Hyaline degeneration 
Cystic degeneration 
Infarction
Calcification 
Necrosis
Fatty change
Infections and suppurations

Question 11

LEIOMYOSARCOMA

Answer 11

Uncommon

Histology: Hallmark of diagnosis is nuclear atypia, mitosis and Zonal necrosis