Endometrium and Myometrium Flashcards
What is endometrium
mucosal lining of uterine cavity
what is myometrium
smooth muscle wall underlying endometrium
what hormone drives the growth of endometrium during each phase?
proliferative phase: estrogen
secretory phase: progesterone
menstrual phase: loss of progesterone
what is asherman syndrome
secondary amenorrhea due to loss of basalis and scarring FROM overaggressive dilation and curettage (D&C)
What is anovulatory cycle
lack of ovulation
what is wrong in the phases in anovulatory cycle
proliferative phase: estrogen driven
secretory phase: NO PROGESTERONE, proliferative glands break down and shed resulting in uterine bleeding
anovulatory cycle’s dysfunctional bleeding usually occurs under what circumstances
menarche
menopause
what is acute endometritis
bacterial infection of the endometrium
clinical presentation for acute endometritis
fever
abnormal uterine bleeding
pelvic pain
what can cause bacterial infection in acute endometritis
retained products of conception
after delivery or miscarriage
what is chronic endometritis
chronic inflammation of endometrium
what causes chronic endometritis
retained products of conception
chronic pelvic inflammatory disease ( chlamydia )
IUD
TB
clinical features of chronic endometritis
abnormal uterine bleeding, pain and infertility
what cells characterize chronic endometritis? which one is diagnositc
lymphocytes and plasma cells (B cells- diagnostic)
what is endometrial polyp
hyperplastic protrusion of endometrium
clinical presentation of endometrial polyp
abnormal uterine bleeding
what drug can give an endometrial polyp. MOA of drug
Tamoxifen
- anti-estrogen effects on breast
- weak pro-estrogenic effects on endometrium
What is endometriosis
endometrial glands and stroma outside of uterine endometrial lining
endometriosis is commonly due to what
retrograde menstruation with implantation at an ectopic site
clinical presentation of endometriosis
dysmenorrhea
pelvic pain
may cause infertility
dysmenorrhea
pain during menstration
what are changes in cycles for endometriosis
normal cyces
what is the most common site of involvement for endometriosis? what does it form?
ovary
“chocolate cyst”
other sites of involvement for endometriosis and their clinical features
uterine ligament (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 pregnancy)
typically implants in endometriosis classically look like what
yellow-brown ‘gun-powder- nodules
in endometriosis, involvement of uterine myometrium is called
adenomyosis
what are the risks at site of endometriosis
carcinoma
What is endometrial hyperplasia
hyperplasia of endometrial glands relative to stroma
What causes endometrial hyperplasia
unopposed estrogen
- obesity
- PCOS
- estrogen replacement
clinical presentation of endometrial hyperplasia
postmenopausal uterine bleeding
what type of histo is an important predictor for progression to carcinoma in endometrial hyperplasia
presence of cellular atypia
what is the most common invasive carcinoma of female genital tract
endometrial carcinoma
what is endometrial carcinoma
malignant proliferation of endometrial glands
clinical features of endometrial carcinoma
postmenopausal bleeding
what are two pathways endometrial carcinoma arises
hyperplasia or sporadic
in hyperplasia pathway, endometrial carcinoma arises from what
endometrial hyperplasia
in sporadic pathway, endometrial carcinoma arises from what
atrophic endometrium with not evident precursor lesion
what are risk factors for hyperplasia endometrial carcinoma
estrogen exposure early menarche/late menopause nulliparity infertility anovulatory cycles obesity
At what age does hyperplasia endometrial carcinoma present
60s
histo for hyperplasia endometrial carcinoma
endometrioid ( normal endometrium-like)
at what age does sporadic endometrial carcinoma present
70s
histo for sporadic endometrial carcinoma
serous
papillary structure
psammoma body formatoin
What is the most common tumor in females
leiomyoma (fibroids)
what is leiomyoma (fibroids)
benign neoplastic proliferation of smooth muscle arising from myometrium
what is cause of leiomyoma (fibroids)
estrogen exposure
- premenopausal women
- enlarge during pregnancy , shrink after menopause
what is gross exam for leiomyoma
multiple-well-defined, white, whorled masses
clinical symptoms for leiomyoma
usually asymptomatic
- abnormal uterine bleeding
- infertility
- pelvic mass
what is leiomyosarcoma
malignant proliferation of smooth muscle arising from the myometrium
do leiomyosarcoma arise from leiomyomas
no
who usually gets leiomyosarcomas
postmenopausal women
gross exam for leiomyosarcomas
single lesion with areas of necrosis and hemorrhage
histo features of leiomyosarcomas
necrosis
mitotic activity
cellular atypia
