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HRM > Endometrium and Myometrium Witrak > Flashcards

Endometrium and Myometrium Witrak Flashcards

1
Q

What are the two concerns with abnormal uterine bleeding?

A

Is it sufficient to cause anemia?

Is endometrial cancer present?

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2
Q

A patient comes in with abnormal uterine bleeding. How old would she have to be to automatically do an endometrial biopsy?

A

> 45yo is an indication to do an endometrial biopsy

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3
Q

A patient comes in with abnormal uterine bleeding, she is under 45yo. What would be necessary to indicate getting an endometrial biopsy done?

A

History of unopposed estrogen exposure (obese, chronic an ovulation)

Failed treatment of bleeding

Tamoxifen treatment

Hereditary cancer syndrome

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4
Q

What causes anovulation in postmenarche and perimenopausal females?

A

Estrogen driven proliferation without progesterone driven secretion

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5
Q

Besides when the body is trying to figure out what it’s doing, when else does anovulation happen?

A

PCOS

Endocrine disease/abnormalities… includes stress/exercise

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6
Q

What can be a sign/symptom of endometrial polyps? Who is most likely to have endometrial polyps?

A

Endometrial polyps → uterine bleeding…NOT necessarily carcinoma

Endometrial polyps are more common in postmenopausal women

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7
Q

What causes endometrial hyperplasia?

A

Chronic estrogen excess

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8
Q

Endometrial cancer is the most common GYN cancer in the developed world. Why is the incidence of endometrial cancer increasing?

A

Obesity → unopposed estrogen → endometrial cancer

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9
Q

Besides obesity, what else are risk factors for endometrial cancer?

A

Other unopposed estrogen states (chronic anovulation, nulliparity, tamoxifen treatment)

Diabetes/HTN

Lynch Syndrome

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10
Q

Unopposed estrogen states are most likely to cause which type of endometrial cancer?

A

Unopposed estrogen states → Type 1 endometrial cancer (80% of endometrial cancers)

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11
Q

What is seen in histology of Type 1 endometrial cancer?

A

Type 1 endometrial cancer presents with endometrioid tissue

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12
Q

What mutation is associated with Type 1 endometrial cancer?

A

Type 1 endometrial cancer often has a PTEN tumor suppressor mutation

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13
Q

What mutation is associated with Type 2 endometrial cancer?

A

p53 tumor suppressor gene is often mutated in Type 2 endometrial cancer

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14
Q

What is Endometrial Stromal Sarcoma (ESS)?

A

Typically diffuse myometrial or lymphatic invasion

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15
Q

How is ESS treated?

A

Hysterectomy is usually curative

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16
Q

What can happen with ESS even decades after treatment?

A

ESS → distant metastases (lungs)

17
Q

What is it called when endometrial glands and stroma are ectopic?

A

Endometriosis

18
Q

Where does endometriosis most often occur?

A

In the pelvis (Fallopian tubes, ovaries, uterine serosa, pelvic peritoneum, colorectal serosa)

19
Q

What are the vague symptoms of endometriosis? (basically, think about what happens with the endometrium, and now put that same process somewhere else…)

A 
Pelvic pain
Dysmenorrhea
Deep dyspareunia
Cyclical bowel/bladder symptoms
Infertility
20
Q

How is endometriosis diagnosed?

A

Laparoscopy with findings of typically punctuate surface lesions (usually dark and small)

21
Q

What in the ovaries would be diagnostic of endometriosis?

A

Chocolate cyst

ovarian endometriosis has an especially high risk of carcinoma

22
Q

How is endometriosis treated?

A

Meds: (progestins, multiple OCPs, GnRH analogs)

Laparoscopic ablation with adhesion lysis, salpingo-oophorectomy +/- hysterectomy

23
Q

What is it called when endometriosis is with in the myometrium?

A

Adenomyosis

24
Q

What could be seen on physical exam of a patient with adenomyosis?

A

Poorly circumscribed focal/nodular myometrial wall thickening

25
Q

What is the most common visceral tumor in women? Which group of women is most at risk of having a leiomyoma?

A

Leiomyomas (within the myometrium)

Black women are most likely to have a leiomyoma

26
Q

What are leiomyomas related to?

A

Estrogen exposure

27
Q

What do leiomyomas look like on microscopic exam? What symptoms are usually seen with leiomyomas?

A

Circumscribed white, rubbery nodules with bland smooth muscle proliferation

Leiomyomas are usually asymptomatic, but can present with bleeding, infertility, or mass

28
Q

What are some rare phenomena associated with leiomyomas?

A

Benign metastasizing leiomyoma
Intravenous leiomyomatosis
Disseminated peritoneal leiomyomatosis
Ectopic hormone production

29
Q

How are leiomyomas treated?

A

Myomectomy (w/ impaired fertility or adverse pregnancy outcomes)
Hysterectomy (all other cases)

30
Q

What do leiomyosarcoma arise from?

A

Definitely NOT leiomyomas

31
Q

What do leiomyosarcomas look like?

A

Large, soft/fleshy cut surfaces that show hemorrhage and necrosis

32
Q

What is the outlook on leiomyosarcomas?

A

Even post-hysterectomy they often reoccur and/or metastasize

5yr survival is 40%

HRM (40 decks)

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