Endometrium and Myometrium Flashcards
What drives the growth of the endometrium and the preparation for implantation?
Growth is estrogen driven (proliferative phase) and Implantation is progesterone driven (secretory phase)
What is asherman syndrome and what causes it?
Secondary ammenorrhea due to los of basalis and scarring. Results in overaggressive dilation and curettage (D&C)
What happens in an anovulatory cycle?
Estrogen driven proliferation phase without a subsequent progesterone driven secretory phase. Proliferative glands break down and shed resulting in uterine bleeding. Common cause of dysfunctional uterine bleeding especially menarche and menopause.
A 26 year old new mother presents with fever, abnormal uterine bleeding and pelvic pain. What could she be having and what usually causes it?
Acute endometriosis due to bacterial infection. Usually due to retained product of conception (after delivery or miscarriage)
A 26 year old woman who has been trying to get pregnant but not succeeding presents with abnormal uterine bleeding and pelvic pain. What could she be having and what usually causes it? What is it characterized by?
She has chronic endometriosis which is characterized by lymphocytes and plasma cells (necessary for diagnosis). Causes include retained products of conception, chronic pelvic inflammatory disease, IUB and TB.
What is a side effect of tamoxifen? How does it present?
Endometrial polyp which is a hyperplastic protrusion of endometrium. Presents as abnormal uterine bleeding.
A 34 year old woman presents with pain during menstruation and pelvic pain. What condition could she have and what causes it? What can it cause? What is the most common site of involvement and what does it result in?
Endometriosis which is the presence of endometrial glands and stroma outside of the uterine endometrial lining. Most likely due to retrograde menstruation with implantation at an ectopic site. Can cause infertility. Most common site of involvement is the ovary which classically results in formation of a chocolate cyst.
How does endometriosis present at the uterine ligaments? pouch of Douglas? Bladder wall? Bowel serosa and fallopian tube mucosa? How do implants classically appear?
Implants classically appear as yellow-brown gun powder nodules.
Uterine ligaments - pelvic pain
Pouch of Douglas- pain with defecation
Bladder wall - pain with urination
Bowel serosa -abdominal pain and adhesions
Fallopian tube mucosa - scarring increases risk for ectopic tubal pregnancy
A woman presents with post menopausal uterine bleeding. What is it and what can cause this?
Endometrial hyperplasia of endometrial glands relative to stroma which occurs as a consequence of unopposed estrogen.
How is endometrial hyperplasia classified? Which is the most important predictor for progression to carcinoma?
Based on architectural growth pattern (simple or complex) and the presence or absence of cellular atypia.. Cellular atypia.
What is the most common invasive carcinoma of the female genital tract and how does it present? How does it arise?
Endometrial carcinoma which is a malignant proliferation of endometrial glands. Presents as post menopausal bleeding. Arises via hyperplasia or sporadic pathway.
Where does carcinoma arise in the hyperplasia pathway of endometrial carcinoma? What are the risk factors and the average age of presentation? What is seen on histology?
75% of cases where carcinoma arises from endometerial hyperplasia. Risk factors are related to estrogen exposure and include early menarche/late menopause, nulliparity, infertility with anovulatory cycles and obesity. 60 years of age. Histology is endometroid (normal endommetrium-like).
Where does carcinoma arise in the sporadic pathway of endometrial carcinoma? What are the risk factors and the average age of presentation? What is seen on histology? What mutation is common? Is this an aggressive tumor?
25% of cases, carcinoma arises in an atrophic endometrium with no evident precursor lesion. Average age of presentation is 70 years. Histology is usually serous and is characterized by papillary structures with psammoma body formation. p53 mutation is common and tumor exhibits aggressive behavior.
What is the most common tumor in females and what is it related to? What does gross exam show? Symptoms?
Leiyoma (fibroids) which is a benign neoplastic proliferation of smooth muscle arising from myometrium. Related to estrogen exposure (common in premenopausal women, often multiple and enlarge during pregnancy then shrink after menopause). Gross exam shows multiple, well defined, white whorled masses that may distort the uterus and impinge on pelvic structures. Usually asymptomatic, but can present with abnormal uterine bleeding, infertility and a pelvic mass.
What is a leiomyosarcoma and where does it arise from? What do you see on gross exam? Histology?
Malignant proliferation of smooth muscle arising from the myometrium. Arises de novo and not from leiomyoma. Usually seen in post menopausal women. Gross exam often shows a single lesion with areas of necrosis and hemorrhage. Histological features include necrosis, mitotic activity and cellular atypia.
