Endometrium and Myometrium - Pathoma Flashcards
What hormones have an effect on the Endometrium? What effects?
Estrogen => growth of the endometrium
Progesterone => preparation of the endometrium for implantation
Loss of progesterone => shedding occurs
What do you call secondary amenorrhea due to the loss of the basalis layer (regenerative layer) and scarring?
Asherman Syndrome
What events/procedures can cause Asherman Syndrome?
Overaggressive dilation and curettage (D&C)
What does an Anovulatory Cycle (i.e. lack of ovulation) result in?
Estrogen-driven proliferative phase without progesterone-driven secretory phase
Anovulatory Cycles are common causes of what conditions?
Dysfunctional uterine bleeding, especially during menarche and menopause
What are the most common causes of anovulation according to First Aid?
Pregnancy
Polycystic ovarian syndrome
Obesity
HPO axis abnormalities
Premature ovarian failure
Hyperprolactinemia
Thyroid disorders
Eating disorders
Competitive athletes
Cushing syndrome
Adrenal insufficiency
What is one of the most common causes of Acute endometritis?
retained products of conception
How does Acute Endometritis typically present?
Fever
Abnormal uterine bleeding
Pelvic pain
How do you distinguish Chronic endometritis from Acute endometritis?
- Chronic inflammation
- Plasma cells present (always have lymphocytes in endometrium)
What are the common causes of Chronic Endometritis?
Retained products of conception
Chronic PID (esp. chlamydia)
IUD
TB (would get granulomas)
How does Chronic Endometritis typically present?
Abnormal uterine bleeding
Pelvic pain
Infertility
What is an Endometrial Polyp?
hyperplastic protrusion of endometrium
How do Endometrial Polyps typically present?
May be asymptomatic
Painless abnormal uterine bleeding
Endometrial Polyps can arise as a side effect of what medication?
Tamoxifen (anti-estrogenic effects on breast, pro-estrogenic effects on endometrium)
What condition is characterized by misplaced endometrial glands and stroma outside of the uterine endometrial lining?
Endometriosis
How does endometriosis typically present?
Dysmenorrhea (pain during menses) and Pelvic pain
May cause Infertility
What are the three current theories of how Endometriosis develops?
- ***Retrograde menstruation - some menstrual products go backwards up through the fallopian tubes and into the abdomen
- Metaplastic theory - metaplasia of Mullerian duct epithelium
- Lymphatic dissemination - endometrium goes through lymphatics and spreads to other places (lung)
What is the most common site of involvement in Endometriosis?
Ovary => results in “chocolate cyst”
What are the common sites of involvement in Endometriosis? How do they manifest?
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
What is endometriosis that involves the myometrium called?
Adenomyosis
There is an increased risk for what condition at the site of endometriosis, especially if it involves the ovary?
Carcinoma
What happens in endometrial hyperplasia?
Hyperplasia of endometrial glands relative to the stroma.
Glands (more glands/glandular tissue) > stroma
How does Endometrial Hyperplasia present?
Post-menopausal uterine bleeding
What causes endometrial hyperplasia?
unopposed estrogen
How is endometrial hyperplasia classified?
Histologically - based on architectural growth and cellular atypia
What is the most important predictor for progression to carcinoma in endometrial hyperplasia?
Cellular atypia
How does malignant proliferation of endometrial glands (i.e. Endometrial Carcinoma) typically present?
Post-menopausal bleeding
What are the two distinct pathways that Endometrial Carcinoma may arise from?
- Hyperplasia: unopposed estrogen, endometrium undergoes uncontrolled growth => endometrioid histology pattern (looks like normal endometrium), middle-aged women
- Sporadic: due to atrophic endometrium, no hyperplasia/precursor lesion, serous and papillary histology pattern, elderly women >70, p53 mutations => aggressive
What do you call a benign proliferation of the smooth muscle in the myometrium?
Leiomyoma
Leiomyomas are related to exposure to what?
Estrogen
What is the classic gross finding in Leiomyomas?
multiple (benign), well-defined white whorled masses
How is Leiomyosarcoma different from the benign Leiomyoma?
Leiomyosarcoma: single tumor/mass, hemorrhagic and necrotic center, disease of post-menopausal women (elderly)
What are the symptoms of Leiomyomas?
***Usually asymptomatic!
If symptoms: pre-menopausal abnormal uterine bleeding (due to stretched uterus), infertility, pelvic mass
How do Leiomyosarcomas develop?
Arise de novo
Do not develop from Leiomyomas!
What are the key histologic findings in Leiomyosarcoma?
necrosis + increased mitotic activity + cellular atypia
