Endometriosis and Adenomyosis

Question 1

What is endometriosis?

Answer 1

Benign but progressive conditions with growth of endometrial-like glands and stroma outside the uterus.

Question 2

Major histological feature of endometriosis.

Answer 2

Hemosiderin-laden Marcrophages

Question 3

What are the 3 endometrial implant types in endometriosis?

Answer 3

1. Pigmented
2. Non-pigmented
3. Cryptic

Question 4

What is an Endometrioma?

Answer 4

Endometrial-like tissue that forms beneath the surface of the ovary. It causes bleeding which becomes de-oxygenated and turns a dark brown color and becomes viscous (chocolate cyst).

Question 5

What are the usual presentations of endometriosis?

Answer 5

1. Cyclic Pelvic pain associated with menses
   - dysmenorrhea
   - dyspareunia
   - dyschezia (painful bowel movements)
2. Infertility

Question 6

What is associated with endometriosis in adolescents?

Answer 6

Genital outflow tract obstruction

Question 7

What is the “enigma” of endometriosis?

Answer 7

Less severe disease (fewer sites of ectopic tissue) often cause the worst symptoms and pain.

Question 8

What is the most accepted theory explaining the cause of endometriosis?

Answer 8

Retrograde Menstruation
-endometrial tissue passes up thru the fallopian tubes and into the pelvic cavity where it can possibly attach and grow another blood supply

Question 9

Method to diagnose endometriosis.

Answer 9

Laparoscopy: you have to actually visualize the tissue, can’t be done on signs and symptoms alone.

Question 10

Which marker can indicate endometriosis and when is it the most valid?

Answer 10

Cancer Antigen 125 (CA 125)

-it can rise for a variety of benign conditions but is most closely related to endometriosis in post-menopausal women

Question 11

How does endometriosis staging work?

Answer 11

Based on a point scoring system.  Points are awarded based on type, location, and amount of ectopic tissue.
Stage 1: 1-5
Stage 2: 6-15
Stage 3: 16-40
Stage 4; 40+

Question 12

How does the staging of endometriosis correlate to pain and infertility?

Answer 12

Pain is inversely related (stage 1: most pain)

Infertility is directly related (stage 1: most fertile)

Question 13

Best management to prevent recurrence of endometriosis.

Answer 13

Surgical:

-hysterectomy with oophorectomy

Question 14

Name the estrogen antagonist that can be used to treat endometriosis.

Answer 14

Danocrine

Question 15

Name the 3 GnRH agonists that can be used to treat endometriosis.

Answer 15

1. Lupron
2. Zoladex
3. Synarel (nasal spray)

continuous release of GnRH to prevent LH and FSH secretion

Question 16

What is adenomyosis?

Answer 16

Extension of endometrial glands and stroma into the uterine musculature.

(AKA endometriosis interna)

Question 17

How can adenomyosis be differentiated from fibroids?

Answer 17

Palpation

-fibroids create a “stiff” uterus whereas adenomyosis allows the uterus to still be soft

Question 18

What are symptoms of adenomyosis and how is it different from endometriosis?

Answer 18

Menorrhagia (heavy uterine bleeding) without the pain that is seen in endometriosis).

Also can see severe dysmenorrhea (rare)

Question 19

How is adenomyosis diagnosed?

Answer 19

Signs and symptoms

-it is a diagnosis of exclusion and is actually only definitively diagnosed on biopsy after a hysterectomy.

Question 20

Treatment for adenomyosis.

Answer 20

Hysterectomy: usually the last resort of uncontrolled uterine bleeding of unknown origin. Diagnosis isn’t made until the uterus is examined with biopsies