Endometrium and Myometrium - Pathoma

Question 1

What hormones have an effect on the Endometrium? What effects?

Answer 1

Estrogen => growth of the endometrium

Progesterone => preparation of the endometrium for implantation

Loss of progesterone => shedding occurs

Question 2

What do you call secondary amenorrhea due to the loss of the basalis layer (regenerative layer) and scarring?

Answer 2

Asherman Syndrome

Question 3

What events/procedures can cause Asherman Syndrome?

Answer 3

Overaggressive dilation and curettage (D&C)

Question 4

What does an Anovulatory Cycle (i.e. lack of ovulation) result in?

Answer 4

Estrogen-driven proliferative phase without progesterone-driven secretory phase

Question 5

Anovulatory Cycles are common causes of what conditions?

Answer 5

Dysfunctional uterine bleeding, especially during menarche and menopause

Question 6

What are the most common causes of anovulation according to First Aid?

Answer 6

Pregnancy

Polycystic ovarian syndrome

Obesity

HPO axis abnormalities

Premature ovarian failure

Hyperprolactinemia

Thyroid disorders

Eating disorders

Competitive athletes

Cushing syndrome

Adrenal insufficiency

Question 7

What is one of the most common causes of Acute endometritis?

Answer 7

retained products of conception

Question 8

How does Acute Endometritis typically present?

Answer 8

Fever

Abnormal uterine bleeding

Pelvic pain

Question 9

How do you distinguish Chronic endometritis from Acute endometritis?

Answer 9

• Chronic inflammation

- Plasma cells present (always have lymphocytes in endometrium)

Question 10

What are the common causes of Chronic Endometritis?

Answer 10

Retained products of conception

Chronic PID (esp. chlamydia)

IUD

TB (would get granulomas)

Question 11

How does Chronic Endometritis typically present?

Answer 11

Abnormal uterine bleeding

Pelvic pain

Infertility

Question 12

What is an Endometrial Polyp?

Answer 12

hyperplastic protrusion of endometrium

Question 13

How do Endometrial Polyps typically present?

Answer 13

May be asymptomatic

Painless abnormal uterine bleeding

Question 14

Endometrial Polyps can arise as a side effect of what medication?

Answer 14

Tamoxifen (anti-estrogenic effects on breast, pro-estrogenic effects on endometrium)

Question 15

What condition is characterized by misplaced endometrial glands and stroma outside of the uterine endometrial lining?

Answer 15

Endometriosis

Question 16

How does endometriosis typically present?

Answer 16

Dysmenorrhea (pain during menses) and Pelvic pain

May cause Infertility

Question 17

What are the three current theories of how Endometriosis develops?

Answer 17

1. ***Retrograde menstruation - some menstrual products go backwards up through the fallopian tubes and into the abdomen
2. Metaplastic theory - metaplasia of Mullerian duct epithelium
3. Lymphatic dissemination - endometrium goes through lymphatics and spreads to other places (lung)

Question 18

What is the most common site of involvement in Endometriosis?

Answer 18

Ovary => results in “chocolate cyst”

Question 19

What are the common sites of involvement in Endometriosis? How do they manifest?

Answer 19

Ovary - chocolate cyst

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

Question 20

What is endometriosis that involves the myometrium called?

Answer 20

Adenomyosis

Question 21

There is an increased risk for what condition at the site of endometriosis, especially if it involves the ovary?

Answer 21

Carcinoma

Question 22

What happens in endometrial hyperplasia?

Answer 22

Hyperplasia of endometrial glands relative to the stroma.

Glands (more glands/glandular tissue) > stroma

Question 23

How does Endometrial Hyperplasia present?

Answer 23

Post-menopausal uterine bleeding

Question 24

What causes endometrial hyperplasia?

Answer 24

unopposed estrogen

Question 25

How is endometrial hyperplasia classified?

Answer 25

Histologically - based on architectural growth and cellular atypia

Question 26

What is the most important predictor for progression to carcinoma in endometrial hyperplasia?

Answer 26

Cellular atypia

Question 27

How does malignant proliferation of endometrial glands (i.e. Endometrial Carcinoma) typically present?

Answer 27

Post-menopausal bleeding

Question 28

What are the two distinct pathways that Endometrial Carcinoma may arise from?

Answer 28

1. Hyperplasia: unopposed estrogen, endometrium undergoes uncontrolled growth => endometrioid histology pattern (looks like normal endometrium), middle-aged women
2. Sporadic: due to atrophic endometrium, no hyperplasia/precursor lesion, serous and papillary histology pattern, elderly women >70, p53 mutations => aggressive

Question 29

What do you call a benign proliferation of the smooth muscle in the myometrium?

Answer 29

Leiomyoma

Question 30

Leiomyomas are related to exposure to what?

Answer 30

Estrogen

Question 31

What is the classic gross finding in Leiomyomas?

Answer 31

multiple (benign), well-defined white whorled masses

Question 32

How is Leiomyosarcoma different from the benign Leiomyoma?

Answer 32

Leiomyosarcoma: single tumor/mass, hemorrhagic and necrotic center, disease of post-menopausal women (elderly)

Question 33

What are the symptoms of Leiomyomas?

Answer 33

***Usually asymptomatic!

If symptoms: pre-menopausal abnormal uterine bleeding (due to stretched uterus), infertility, pelvic mass

Question 34

How do Leiomyosarcomas develop?

Answer 34

Arise de novo

Do not develop from Leiomyomas!

Question 35

What are the key histologic findings in Leiomyosarcoma?

Answer 35

necrosis + increased mitotic activity + cellular atypia