Female Reproductive Tract Pathology Part 3 (endometrium) Flashcards
the mentrual cycle is driven through complex interactions of endocrine signals released from the _, _, and _
hypothalamus, pituitary, and ovaries
menstrual cycle abnormalities are caused by both _ lesions that affect secretion of estradiol and progesterone and _ disorders that affect the pituitary. or hypothalamic axis
ovarian
endocrine
the average menstrual cycle lasts _ days
28
during menses the superficial portion of _ is shed
endometrium
menses is followed by the / phase which is when there is a risk in estrogen levels that are released in response follicular stimulating hormone causing rapid growth of glands and stroma
follicular/proliferative phase
at the midpoint of the cycle _ and _ both surge causing a release of the egg from the ovary. After which the ovarian corpus luteum forms.
lutenizing hormone and follicule stimulating hormone
the corpus luteum releases a lot of _ driving the secretory ot luteal phase which prepares the endometrium to carry pregnancy
progesterone
if the egg is fertilized the corpus luteum will persists and form adequate amounts of progesterone to until the _ takes over
placenta
if fertilization does not occur the corpus luteum will degenerate and _ and _ levels will drop and menses will occur again
estrogen and progesterone
on histology what does the proliferative/follicular stage look like?
stroma
glands
cellular blue stroma with many round tubular glands
psuedostratification in glands with mitotic figures
unlike proliferative endometroim the glands of secretory endometrium are much more _
tortuous/serrated
in early secretory endometrium _ are present which mimics the apperance of piano keys
subliminal/subnuclear vacuoles
as the menstural cycle progresses in secretory endometrium the subnuclear vacules more adjacent to he lumen and evnetially give rise to _ secretions
luminal
the endometrial stroma in secretory endometrium starts out similar in apperance to strome of proliferative endometrium but by the end the stromal cells have abundant pink cytoplasm termed?
what else is present
predecidualized stroma
spiral arteries
during menses with a lack of progesterone the spiral arteries _ and the endometrial tissue becomes _
constict
ischemic
mestrual phase endometrium histology
tight blue clusters of stromal cells
sloughing off with hemorrhage
what is abnormal uterine bleeding?
bleeding that is longer, heavier or occurs outside of the time of menstruration
the most common subtype of abnormal uterine bleeding is?
dyfunctional uterine bleeding
- hormone distubances that lead to anovulation
lacks a structural basis
in early adolescents anovulatory cyles are related to the immaturitry and lack of a fiunctioning _
hypothalamic-pituitary axis
in the perimenopasal period anovulatory cycles are caused by _ imbalances culminating in menopause
hormone
anatomic lesions can cause abnormal uterine bleeding as you increase in age these lesions are more suggextive of?
a malignant lesion/process
anvoulatory cycles leading to AUB are most commonly caused by hormone imbalances during menarch and the perimenopausal period. What other disorders can lead to an anovulatory cycle and AUB?
ovarian lesions like PCOS
Obesity
endocrine disorders: thyroid, adrenal, pituitary disease)
how does obesity increase estrogen levels
these is peripheral conversion to estrogen in adipose tissue
acute endometritis is an acute infection of the _ and is a relatively common cause of _, _ , and _
post partum fever
uterine tenderness
abdominal pain
often times acute endometritis occurs after _ and is precipiated by reatin products of _
pregnancy
conception
acute endometritis is caused by _ infection
bacterial
acute endometritis on histology
acute inflammation with neutrophils and microabcess formation
the hitologic hallmark of chronic endometritis is ?
plasma cells in the stroma
how do plasma cells look?
eccentrically placed nucleus with cleared halo (perinuclear hoff)
clearing is representative of where immunoglobulines are made
what causes chronic endometritis?
retained products of conception, PID (especially the chlaymdia type)
IUD
intrauterine devices are associated with infections like fungus-like bacteria _
actinomyces
_ is a rare cause of endometritis
tuberculosis
symptoms of chronic endometritis
abnormal bleeding (postcoital, intermenstural), crampy lower abdominal pain
endometriosis is _ ?
ectopic endometrial tissue outside of the uterus
endometriosis commonly affects what sites?
ovaries and pelvic tissue (ligaments, serosal surfaces) however it can be found in different locations like the fallopian tubes, colon, small intestine, bladder etc.
ectopic deometrium reacts to the _ (same/different) hormonal signals that the normal endometrium reacts to, causing it to buildup and breakdown during menses
same
symptoms of endometriosis
severe menstrual cramps (dysmenorrhea) , dyspareuinia (pain with intercourse) and issues with infertility
sometimes if the ectopic tissue is on the ovary it can present with an ovarian mass
what are some theories about the pathogenesis of endometriosis
regurgitation theory- retrograde flow of normal endometrial tissue
benign metastases- spread through lymphatics of bloodstream
metaplastic theory- embryologic
reminants
extrauterine stem cell theory - from bone marrow
persistance and survivial of ectopic endometrial tissue in endometriosis is achieved through?
proinflammatory and inflammatory factors like IL-1, TNFa, etc.
metalloproteases
aromatase enzyme production from endometrial stromal cells that increase estrogen and lead to more robust implants/response
mutations in the ectopic endometrial tissue that allows them to survive outside of their normal environment the endometrium
gross findings of endometriosis
red-brown to blue-black lesion termed powder burn lesions on the surface
when endometriosis involves the ovary it can create?
a large blood filled cysts termed a chocolate cyst
on histology of endometriosis 2/3 of the following need to be seen?
- endometrial glands
- endometrial stroma
- hemosiderin laden macrophages: shows hemorrage
what is hemosiderin?
a brown granular pigment that is a byproduct of breakdown of red blood cells
what is adenomyosis
endometrial tissue in the myometrium (muscle of the uterus)
clinical findings of adenomyosis?
same as endometriosis: painful menses, pain with intercourse, infertility
endometrial polyps are _ (endophytic/exophiitic) and are _ (benign/malignant)
exophytic meaning they protrufe from the surface of the endometrium
benign
cystically dilated glands and stroma : polypoid apperance
the formation and growth of a endometrial polyp is through?
estrogenic factors the most important is tamoxifen use
can be obesity, hormone replacement etc.
what is one of the most common causes of vaginal bleeding
endometrial polyps
what is tamoxifen?
a selective estrogen modulator that inhibits estrogen effect in the breast but increases estrogen in the endometrium
