Female Pathology: Endometrium and Myometrium

Question 1

What is endometrium

Answer 1

mucosal lining of uterine cavity

Question 2

what is myometrium

Answer 2

smooth muscle wall underlying endometrium

Question 3

what hormone drives the growth of endometrium during each phase?

Answer 3

proliferative phase: estrogen
secretory phase: progesterone
menstrual phase: loss of progesterone

Question 4

what is asherman syndrome

Answer 4

secondary amenorrhea due to loss of basalis and scarring

Question 5

clinical presentation of asherman syndrome

Answer 5

overaggressive dilation and curettage (D&C)

Question 6

What is anovulatory cycle

Answer 6

lack of ovulation

Question 7

what is wrong in the phases in anovulatory cycle

Answer 7

proliferative phase: estrogen driven

secretory phase: no progesterone, proliferative glands break down and shed resulting in uterine bleeding

Question 8

anovulatory cycle’s dysfunctional bleeding usually occurs under what circumstances

Answer 8

menarche

menopause

Question 9

what is acute endometritis

Answer 9

bacterial infection of the endometrium

Question 10

clinical presentation for acute endometritis

Answer 10

fever
abnormal uterine bleeding
pelvic pain

Question 11

what can cause bacterial infection in acute endometritis

Answer 11

retained products of conception

after delivery or miscarriage

Question 12

what is chronic endometritis

Answer 12

chronic inflammation of endometrium

Question 13

what causes chronic endometritis

Answer 13

retained products of conception
chronic pelvic inflammatory disease ( chlamydia )
IUD
TB

Question 14

clinical features of chronic endometritis

Answer 14

abnormal uterine bleeding, pain and infertility

Question 15

what cells characterize chronic endometritis? which one is diagnositc

Answer 15

lymphocytes and plasma cells ( diagnostic)

Question 16

what is endometrial polyp

Answer 16

hyperplastic protrusion of endometrium

Question 17

clinical presentation of endometrial polyp

Answer 17

abnormal uterine bleeding

Question 18

what drug can give an endometrial polyp. MOA of drug

Answer 18

Tamoxifen

• anti-estrogen effects on breast
• weak pro-estrogenic effects on endometrium

Question 19

What is endometriosis

Answer 19

endometrial glands and stroma outside of uterine endometrial lining

Question 20

endometriosis is commonly due to what

Answer 20

retrograde menstruation with implantation at an ectopic site

Question 21

clinical presentation of endometriosis

Answer 21

dysmenorrhea
pelvic pain
may cause infertility

Question 22

dysmenorrhea

Answer 22

pain during menstration

Question 23

what are changes in cycles for endometriosis

Answer 23

normal cyces

Question 24

what is the most common site of involvement for endometriosis? what does it form?

Answer 24

ovary

“chocolate cyst”

Question 25

other sites of involvement for endometriosis and their clinical features

Answer 25

``` uterine ligament (pelvic pain) pouch of douglas ( pain with defecation) bladder wall ( pain with urination) bowel serosa ( abdominal pain and adhesions) fallopian tube mucosa ( scarring increases risk for ectopic pregnancy) ```

Question 26

typically implants in endometriosis classically look like what

Answer 26

yellow-brown 'gun-powder- nodules

Question 27

in endometriosis, involvement of uterine myometrium is called

Answer 27

adenomyosis

Question 28

what are the risks at site of endometriosis

Answer 28

carcinoma

Question 29

What is endometrial hyperplasia

Answer 29

hyperplasia of endometrial glands relative to stroma

Question 30

What causes endometrial hyperplasia

Answer 30

unopposed estrogen - obesity - PCOS - estrogen replacement

Question 31

clinical presentation of endometrial hyperplasia

Answer 31

postmenopausal uterine bleeding

Question 32

what patterns are seen in histo for endometrial hyperplasia

Answer 32

- simple or complex | - presence or absence of cellular atypia

Question 33

what type of histo is an important predictor for progression to carcinoma in endometrial hyperplasia

Answer 33

presence of cellular atypia

Question 34

what is the most common invasive carcinoma of female genital tract

Answer 34

endometrial carcinoma

Question 35

what is endometrial carcinoma

Answer 35

malignant proliferation of endometrial glands

Question 36

clinical features of endometrial carcinoma

Answer 36

postmenopausal bleeding

Question 37

what are two pathways endometrial carcinoma arises

Answer 37

hyperplasia or sporadic

Question 38

in hyperplasia pathway, endometrial carcinoma arises from what

Answer 38

endometrial hyperplasia

Question 39

in sporadic pathway, endometrial carcinoma arises from what

Answer 39

atrophic endometrium with not evident precursor lesion

Question 40

what are risk factors for hyperplasia endometrial carcinoma

Answer 40

``` estrogen exposure early menarche/late menopause nulliparity infertility anovulatory cycles obesity ```

Question 41

At what age does hyperplasia endometrial carcinoma present

Answer 41

60s

Question 42

his for hyperplasia endometrial carcinoma

Answer 42

endometrioid ( normal endometrium-like)

Question 43

at what age does sporadic endometrial carcinoma present

Answer 43

70s

Question 44

histo for sporadic endometrial carcinoma

Answer 44

serous papillary structure psammoma body formatoin

Question 45

what genetic mutation is present in sporadic endometrial carcinoma

Answer 45

p53 mutation

Question 46

What is the most common tumor in females

Answer 46

leiomyoma (fibroids)

Question 47

what is leiomyoma (fibroids)

Answer 47

benign neoplastic proliferation of smooth muscle arising from myometrium

Question 48

what is cause of leiomyoma (fibroids)

Answer 48

estrogen exposure - premenopausal women - enlarge during pregnancy , shrink after menopause

Question 49

what is gross exam for leiomyoma

Answer 49

multiple-well-defined, white, whorled masses

Question 50

clinical symptoms for leiomyoma

Answer 50

usually asymptomatic - abnormal uterine bleeding - infertility - pelvic mass

Question 51

what is leiomyosarcoma

Answer 51

malignant proliferation of smooth muscle arising from the myometrium

Question 52

do leiomyosarcoma arise from leiomyomas

Answer 52

no

Question 53

who usually gets leiosarcoma

Answer 53

postmenopausal women

Question 54

gross exam for leiomyomoas

Answer 54

single lesion with areas of necrosis and hemorrhage

Question 55

histo features of leiomyomas

Answer 55

necrosis mitotic activity cellular atypia