Endometrium/Myometrium

Question 1

3 Phases/Hormones of Endometrium

Answer 1

Proliferative phase - growth of endometrium driven by estrogen
Secretory phase - preparation for implantation by progesterone
Menstrual phase - shedding by loss of progesterone

Question 2

Asherman Syndrome

Answer 2

Loss of the basalis (where the stem cells are) loses regenerative function causing amenhorrhea, usually from overaggressive dilation and cutterage (D&C)

Question 3

Anovulatory Cycle (what/why/when)

Answer 3

Lack of ovulation because have E-driven proliferative phase but no P-driven secretory phase, so eventually will outgrow and break down with bleeding
Usually during menarche or menopause

Question 4

Acute Endometritis Cause

Answer 4

Retained products of conception like after delivery or miscarriage

Question 5

Chronic Endometritis (when you check for and what you check for)

Answer 5

Check for with infertility

On histo see lymphocytes (but always there) and PLASMA CELLS (only time they’re there)

Question 6

Endometrial Polyp as a Side Effect

Answer 6

Tamoxifen, which has anti-E effects on breast but weak pro-E on endometrium

Question 7

Endometriosis (most common location, presentation, most likely spread, 2 gross, cancer risk)

Answer 7

Most common ovary, but can be other places
Presents as dysmenorrhea and pelvic pain
Probably retrograde mensturation. Maybe lymphatic (weirder distant locations) or Mullerian metaplasia
In ovary - chocolate cyst (keeps growing and cycling and shit)
Elsewhere - yellow brown “gunpowder nodules”
Increased risk of carcinoma at site, especially in ovarian

Question 8

Adenomyosis

Answer 8

Endometriosis in the uterine myometrium

Question 9

Endometrial Hyperplasia (cause, presentation, cancer prediction)

Answer 9

Unopposed estrogen (so like postmenopausal obesity because still make estrone, PCOS, E replacement)
Postmenopausal uterine bleeding
Presence of cellular atypia is the risk factor

Question 10

Endometrial Carcinoma Hyperplasia Pathway vs. Sporadic Pathway (arises, age, histology, mutation in the last)

Answer 10

From hyperplasia vs. from atrophic endometrium with no precursor
60 vs. 70 or very elderly
Endometrioid vs. Serous, characterized by papillary structures which necrose to psamomma bodies (p53 mutation common)

Question 11

4 Tumors Exhibiting Psamomma Bodies

Answer 11

Serous papillary endometrial carcinoma
Papillary cancer of the thyroid
Meningioma
Mesothelioma

Question 12

Leiomyoma (Fibroids) (what, exposure/demographic, gross, symptoms, cancer risk)

Answer 12

Benign prolif of smooth muscle in myometrium, VERY COMMON
Related to estrogen exposure in females, so premenopausal. Enlarge during pregnancy, shrink after menopause
Multiple, well-defined white whorled masses
Usually asymptomatic unless impinge on other structures/bleed
DO NOT PROGRESS TO LEIOMYOSARCOMA

Question 13

Leiomyosarcoma 3 Differences from Leiomyoma

Answer 13

Arise de novo (not one of the differences, just another point)
Usually postmenopausal
Single lesion
Areas of necrosis and hemorrhage