Endometrium and Myometrium (Pathoma)

Question 1

The endometrium hormone-sensitive. What 3 phases does the endometrium exist in and what are the associated hormones?

Answer 1

Proliferative phase- Estrogen
Secretory phase- Progesterone
Menstrual phase- No progesterone

Question 2

Asherman Syndrome

Answer 2

Secondary amenorrhea (previously had periods but now has no menstruation for > 6 months)
Due to no basalis layer
D&C complication

Question 3

Anovulatory cycle

Answer 3

No ovulation
Estrogen leads to proliferation but no progesterone for secretory phase (so no menstruation)
Dysfunctional uterine bleeding (DUB) especially during menarche and menopause

Question 4

Acute endometritis (Cause and symptoms)

Answer 4

Cause: Retained POC
Symptoms: Fever, pelvic pain, abnormal uterine bleeding

Question 5

Chronic endometritis

Answer 5

Due to retained POC, chronic PID, IUD placement and TB (+granulomas)
Plasma cells are present
Infertility is common

Question 6

Endometrial Polyp

Answer 6

Hyperplastic growth (protrusion) of endometrium
Presents as abnormal uterine bleeding
Side effect of Tamoxifen

Question 7

Tamoxifen

Answer 7

Anti-estrogenic in breast

Pro-estrogenic in endometrium

Question 8

Endometriosis

• Definition
• Symptoms
• Complication
• Causes

Answer 8

Presence of endometrial glands and stroma outside uterine endometrium
Symptoms: Dysmenorrhea and pelvic pain
Complication: May cause infertility, increases risk of carcinoma at site of involvement (especially ovaries)
Causes: Retrograde menstruation, metaplastic development of Mullerian duct or lymphatic dissemination

Question 9

Common sites of involvement for endometriosis and pathological findings

Answer 9

Ovary- chocolate cysts
Retrouterine pouch- Pain with defecation
Uterine ligaments- Pelvic pain
Bladder- Pain with urination
Bowel serosa- Abdominal pain and adhestions
Fallopian tube mucosa: Scarring, increases risk of ectopic pregnancy and no implantation

Question 10

Adenomyosis

Answer 10

Endometrial glands in myometrium

Question 11

Endometrial hyperplasia

• Definition
• Cause
• Symptoms
• Complication

Answer 11

Def: Increased growth of endometrial glands relative to stroma
Cause: Unopposed estrogen
Symptoms: Postmenopausal bleeding
Comp: Most important predictor of progression to carcinoma (architecture and cellular atypia)

Question 12

Endometrial carcinoma

• Defintion
• Symptom
• Pathways

Answer 12

• Malignant proliferation of endometrial glands
• Most common invasive carcinoma in the female GU tract
• Symptom: Lots of postmenopausal uterine bleeding
• Sporadic and hyperplasia pathways

Question 13

Endometrial pathway for endometroid carcinoma (75% of cases)

• Risk factors
• Average age of presentation
• Histology

Answer 13

RFs: Estrogen exposure, early menarche/late menopause, nulliparity, infertility with anovulatory cycles, obesity
Average age of presentation: 60
Histology: Endometroid

Question 14

Sporadic pathway for endometroid carcinoma (25% of cases)

• Site of occurence
• Average age of presentation
• Histology
• Genetic mutation
• Tumor behavior

Answer 14

• Site: Atrophic endometrium with no precursor lesion
• Average age: 70
• Histology: Serous, papillary xtures with PSAMOMMA BODIES
• p53 mutation
• Aggressive

Question 15

Leiomyoma

• Definition
• Histology
• Affected population
• Symptoms
• Cancer precursor or nah?

Answer 15

• Def: Benign SM tumor in myometrium
• Xtics: Enlarges during pregnancy (with estrogen exposure)
• Histo: Multiple, well-defined white whorled masses (benign)
• Symptoms: Usually asymptomatic. can use uterine bleeding or infertility
• Does not lead to leiomyosarcoma

Question 16

Leiomyosarcoma

Answer 16

Arises de novo
Postmenopausal women
Gross exam: Single lesion with necrosis and hemorrhage
Histo: Necrosis, mitotic activity and cellular atypia