Endometrium and Myometrium Witrak Flashcards
What are the two concerns with abnormal uterine bleeding?
Is it sufficient to cause anemia?
Is endometrial cancer present?
A patient comes in with abnormal uterine bleeding. How old would she have to be to automatically do an endometrial biopsy?
> 45yo is an indication to do an endometrial biopsy
A patient comes in with abnormal uterine bleeding, she is under 45yo. What would be necessary to indicate getting an endometrial biopsy done?
History of unopposed estrogen exposure (obese, chronic an ovulation)
Failed treatment of bleeding
Tamoxifen treatment
Hereditary cancer syndrome
What causes anovulation in postmenarche and perimenopausal females?
Estrogen driven proliferation without progesterone driven secretion
Besides when the body is trying to figure out what it’s doing, when else does anovulation happen?
PCOS
Endocrine disease/abnormalities… includes stress/exercise
What can be a sign/symptom of endometrial polyps? Who is most likely to have endometrial polyps?
Endometrial polyps → uterine bleeding…NOT necessarily carcinoma
Endometrial polyps are more common in postmenopausal women
What causes endometrial hyperplasia?
Chronic estrogen excess
Endometrial cancer is the most common GYN cancer in the developed world. Why is the incidence of endometrial cancer increasing?
Obesity → unopposed estrogen → endometrial cancer
Besides obesity, what else are risk factors for endometrial cancer?
Other unopposed estrogen states (chronic anovulation, nulliparity, tamoxifen treatment)
Diabetes/HTN
Lynch Syndrome
Unopposed estrogen states are most likely to cause which type of endometrial cancer?
Unopposed estrogen states → Type 1 endometrial cancer (80% of endometrial cancers)
What is seen in histology of Type 1 endometrial cancer?
Type 1 endometrial cancer presents with endometrioid tissue
What mutation is associated with Type 1 endometrial cancer?
Type 1 endometrial cancer often has a PTEN tumor suppressor mutation
What mutation is associated with Type 2 endometrial cancer?
p53 tumor suppressor gene is often mutated in Type 2 endometrial cancer
What is Endometrial Stromal Sarcoma (ESS)?
Typically diffuse myometrial or lymphatic invasion
How is ESS treated?
Hysterectomy is usually curative
What can happen with ESS even decades after treatment?
ESS → distant metastases (lungs)
What is it called when endometrial glands and stroma are ectopic?
Endometriosis
Where does endometriosis most often occur?
In the pelvis (Fallopian tubes, ovaries, uterine serosa, pelvic peritoneum, colorectal serosa)
What are the vague symptoms of endometriosis? (basically, think about what happens with the endometrium, and now put that same process somewhere else…)
Pelvic pain Dysmenorrhea Deep dyspareunia Cyclical bowel/bladder symptoms Infertility
How is endometriosis diagnosed?
Laparoscopy with findings of typically punctuate surface lesions (usually dark and small)
What in the ovaries would be diagnostic of endometriosis?
Chocolate cyst
ovarian endometriosis has an especially high risk of carcinoma
How is endometriosis treated?
Meds: (progestins, multiple OCPs, GnRH analogs)
Laparoscopic ablation with adhesion lysis, salpingo-oophorectomy +/- hysterectomy
What is it called when endometriosis is with in the myometrium?
Adenomyosis
What could be seen on physical exam of a patient with adenomyosis?
Poorly circumscribed focal/nodular myometrial wall thickening
What is the most common visceral tumor in women? Which group of women is most at risk of having a leiomyoma?
Leiomyomas (within the myometrium)
Black women are most likely to have a leiomyoma
What are leiomyomas related to?
Estrogen exposure
What do leiomyomas look like on microscopic exam? What symptoms are usually seen with leiomyomas?
Circumscribed white, rubbery nodules with bland smooth muscle proliferation
Leiomyomas are usually asymptomatic, but can present with bleeding, infertility, or mass
What are some rare phenomena associated with leiomyomas?
Benign metastasizing leiomyoma
Intravenous leiomyomatosis
Disseminated peritoneal leiomyomatosis
Ectopic hormone production
How are leiomyomas treated?
Myomectomy (w/ impaired fertility or adverse pregnancy outcomes)
Hysterectomy (all other cases)
What do leiomyosarcoma arise from?
Definitely NOT leiomyomas
What do leiomyosarcomas look like?
Large, soft/fleshy cut surfaces that show hemorrhage and necrosis
What is the outlook on leiomyosarcomas?
Even post-hysterectomy they often reoccur and/or metastasize
5yr survival is 40%
