Endometrium

Question 1

What does the endometrium contain during the proliferative phase
(days 0-14)?

Answer 1

Tubular glands with pseudostratification

Question 2

What does the endometrium contain during the early secretory phase?

Answer 2

Piano key vacuoles

Question 3

What does the endometrium contain during the late secretory phase?

Answer 3

Tortuous and serrated glands with secretory material

Question 4

What does the endometrium contain during menses?

Answer 4

Tight clusters of stromal cells

Question 5

Abnormal uterine bleeding can be due to anovulatory cycles. What are 3 conditions that can have this?

Answer 5

PCOS - ovarian lesions
Obesity
Endocrine disorders

Question 6

When does Acute Endometritis occur and what is it?

Answer 6

After delivery of a baby – bacterial infection

Question 7

What histo change will be present with Acute Endometritis?

Answer 7

Neutrophils destroy endometrial epithelium +/- microabscesses

Question 8

What are 3 symptoms of Acute Endometritis?

Answer 8

Post-partum fever
Abdominal pain
Uterine tenderness

Question 9

What are some causes of Chronic Endometritis?

Answer 9

PID
IUD (actinomyces)
Retained conception products

Question 10

What histo change will be present with Chronic Endometritis?

Answer 10

Plasma cells in stroma

Question 11

What are the symptoms of Chronic Endometritis?

Answer 11

Asymptomatic or bleeding/cramping

Question 12

What is Endometriosis?

Answer 12

Endometrial tissue OUTSIDE the uterus

– usually at ovaries and pelvic tissues

Question 13

What are some symptoms of Endometriosis?

Answer 13

Dysmenorrhea (pain with menses)
Ovarian mass
Pain with sex
Infertility

Question 14

Severe Dysmenorrhea, pain with sex, ovarian mass and infertility is likely?

Answer 14

Endometriosis

- endometrial tissue outside the uterus

Question 15

What 3 mechanisms allow for survival of endometrial tissue with Endometriosis?

Answer 15

1. Inflammatory factors
2. Increased aromatase enzyme => increased estrogen
3. Mutations in tumor genes

Question 16

What type of lesions are present with Endometriosis?

Answer 16

“powder-burn” lesions

Question 17

What histo changes are needed to diagnose Endometriosis?

Answer 17

Need 2/3:

1. Endometrial glands
2. Endometrial stroma
3. Hemosiderin laden macrophages – evidence of hemorrhage

Question 18

Adenomyosis

Answer 18

Endometriotic tissue in the myometrium

Question 19

What condition has the same symptoms as Endometriosis?

Answer 19

Adenomyosis

- endometriotic tissue in the myometrium

Question 20

What factors can increase endometrial polyp formation and what is an example?

Answer 20

Proestrogenic factors – Tamoxifen

Question 21

What is Endometrial hyperplasia?

Answer 21

Increased endometrial glands

Question 22

Typical Endometrial Hyperplasia

Answer 22

Glandular crowding

– slight risk of carcinoma

Question 23

Atypical Endometrial Hyperplasia

Answer 23

Nuclear atypia

– substantial risk of carcinoma

Question 24

What are the risk factors for Endometrial Hyperplasia/Carcinoma/

Answer 24

Chronic unopposed ESTROGEN

• Obesity, PCOS
• Early menarche, late menopause and no pregnancies

Question 25

What is the main risk factor for Endometrial hyperplasia/carcinoma?

Answer 25

Chronic unopposed estrogen

Question 26

What is pro-estrogen in the uterus but anti-estrogen in the breast?

Answer 26

Tamoxifen

Question 27

What is the main symptom with Endometrial Carcinomas?

Answer 27

Abnormal uterine bleeding

Question 28

When does Type 1 Endometrial Carcinoma occur compared to Type 2/

Answer 28

10 years earlier

Question 29

What is type 1 Endometrial Carcinoma?

Answer 29

Endometrioid

Question 30

What is the risk factor for Type 1 Endometrial Carcinoma?

Answer 30

Unopposed Estrogen | -- also obesity

Question 31

What is the precursor lesion with Type 1 Endometrial Carcinoma?

Answer 31

``` Endometrial Hyperplasia (increased glands) ```

Question 32

What 3 genes are often involved in Type 1 Endometrial Carcinomas?

Answer 32

PTEN P13K/AKT MSI

Question 33

What are the 2 options for Type 2 Endometrial Carcinomas?

Answer 33

- serous | - malignant mixed mullerian tumor

Question 34

What are the risk factors for Type 2 Endometrial Carcinomas?

Answer 34

Age and BLACK people post menopause atrophy

Question 35

What gene is often involved with Type 2 Endometrial Carcinoma?

Answer 35

TP53

Question 36

Which type of Endometrial Carcinoma has the WORSE prognosis?

Answer 36

Type 2 | -- serous/malignant mixed mullerian tumor

Question 37

How is Lynch syndrome inherited?

Answer 37

AD

Question 38

What is there a mutation in with Lynch syndrome?

Answer 38

Mismatch repair gene (mlh1/msh2)

Question 39

What does the mutation in mismatch repair genes with Lynch Syndrome give rise to?

Answer 39

Microsatellite Instability (MSI)

Question 40

What does lynch syndrome increase your risk for?

Answer 40

Colorectal cancer | Endometrial and ovarian cancers

Question 41

Adenosarcomas can be mistaken for a polyp. What are they?

Answer 41

Benign glands + malignant stroma

Question 42

Low grade endometrial stromal sarcoma is a malignant tumor of the stroma. What can it invade?

Answer 42

Myometrium and/or lymph and vascular

Question 43

What gene translocation is found with a low grade endometrial stomal sarcoma?

Answer 43

JAZF1

Question 44

What are 2 Myometrial Tumors?

Answer 44

1. Leiomyoma | 2. Leiomyosarcoma

Question 45

Leiomyoma

Answer 45

Benign myometrial tumor

Question 46

How do Leiomyomas look?

Answer 46

Tan-white circumscribed nodules

Question 47

Leiomyomas are usually asymptomatic. What mutation can be present?

Answer 47

MED12 mutation

Question 48

Leiomyosarcoma

Answer 48

Malignant myometrial tumor

Question 49

How do Leiomyosarcomas look?

Answer 49

Bulky fleshy mass

Question 50

What 3 histo changes differentiate a Leiomyosarcoma from a Leiomyoma?

Answer 50

1. Atypia 2. Increased mitoses 3. Tumor necrosis