endometrium and myometrium Flashcards
Asherman’s syndrome
secondary amenorrhea due to loss of the basalis (the layer that regenerates the endometrium- stem cells of the endometrium) and scarring. it is the result of overaggressive D&C
anovulatory cycle
lack of ovulation. results in an estrogen-driven proliferative phase without a subsequent progesterone-driven secretory phase. however, proliferative glands do break down and cause uterine bleeding. this is a common cause of bleeding in menarche and menopause
acute endometriosis: what is it, causes, presetnation, treatment
bacterial infection of the endometrium. usually due to retained products of conception (after miscarriage, abortion, or delivery), or an IUD. retained products act as a nidus for infection. presents as fever, abnormal uterine bleeding, and pelvic pain
gentamicin and clindamycine with or without ampicillin
chronic endometriosis: what is it, causes, presentation
chronic inflammation of the endometrium characterized by lymphocytes and plasma cells. You MUST see plasma cells to make the diagnosis, since lymphocytes are normally present in the uterus.
causes: retained products of conception, chronic pelvic inflammatory disease, IUD, TB
presents as abnormal uterine bleeding, pain and infertility
endometrial polyp: what is it, causes, presentation
hyperplastic protrusion of the endometrium. presents as abnormal uterine bleeding. car arise as a side effect of tamoxifen (anti-estrogen effects on the breast but mild pro-estrogen effects on the uterus)
endometriosis: definition, presentation
endometrial glands and stoma outside of the uterine endometrial lining. most likely due to retrograde menstruation with implantation at an ectopic site, though can also be caused by metaplastic transformation of multipotent cells or transportation of endometrial tissue via lympathics. presents as dysmenorrhea and pelvic pain with a NORMAL-SIZED UTERUS; may cause infertility. the endometriosis cycles just like normal endometrium
common sites of involvement for endometriosis; complications
most common site is the ovary, which can result in the formation of a “chocolate cyst.” other sites include the uterine ligaments (pelvic pain), pouch of douglas (pain with defectaion), bladder wall (pain with urination), bowel serosa (abdominal pain and adhesions), and fallopian tube mucosa (which can increase risk of ectopic tubal pregnancy). Implants may look like yellow-brown “gun powder” nodules.
uterine myometrium can also be involved. this is caled adenomyosis.
incr. risk of carcinoma at the site of endometriosis, esp. the ovary.
endometriosis treatment
NSAIDs, OCPs, progestins, GnRH agonists, surgery
adenomyosis: definition, casues, presentation, tx
extension of endometria tissue into the uterine muometrium. caused by hyperplasia of the basalis layer of the endometrium. causes dysmenorrhea and menorrhagia. presents as a ENLARGED, SOFT, globular uterus.
tx: hysterectomy
endometrial hyperplasia: definition, presentation, cuases
hyperplasia of endometrial glands relative to stroma. occurs as a consequence of unopposed estrogen. classically presents as postmenopausal uterine bleeding.
endometrial hyperplasia classification
classifed by architectural growth pattern (simple vs. complex) and presence of absence of cellular atypia. most important predictor for progression to carcinoma is the presence of cellular atypia. simple hyperplasia with atypia often progresses to cancer, while complex hyperplasia without atypia rarely does.
endometrial carcinoma: definition, causes
presents as post-menopausal bleeding. may be due to hyperplasia, or may be sporatic. in the hyperplastic pathway, carcinoma arises from the endometrial hyperplasia (risk factors related to estrogen exposure; age is around 60; histo is endometriod).
in sporatic pathway, carcinoma arises in an atrophic endometrium without an evident precursor lesion. histology is usually serous and characterized by papillary structures WITH PSOMMOMA BODIES. p53 mutation common. age around 70. tumor is aggressive.
leiomyoma: what is it, causes, gross exam, presentation
benign neoplastic proliferation of smooth muscle arising from the myometrium. most common female tumor. related to estrogen exposure (common in premenopausal women; often multiple; enlarge with pregnancy and shrink with menopause). gross exam shows multiple well defined white whored masses that may distort the uterus. usually asymptomatic but may present as abnormal uterine bleeding, infertility and a pelvic mass
leiomyosarcoma: definition, gross and histologic exam
malignant proliferation of smooth muscle arising from the myometrium. arises de novo. usually in post-menopausal women. gross exam shows single lesion with areas of necrosis and hemorrhage. histo features include necrosis, mitotic activity, and cellular atypia.
