PATH - Endometrial conditions

Question 1

Polyp

Answer 1

Well-circumscribed collection of *endometrial tissue *within uterine wall.

May contain smooth muscle cells.

Can extend *into endometrial cavity in the form of a polyp.

May be asymptomatic or present with *painless abnormal uterine bleeding.

Question 2

Adenomyosis

Answer 2

Extension of *endometrial tissue (glandular) *into uterine myometrium.

Caused by hyperplasia of
*basal layer of endometrium.

Presents with dysmenorrhea, menorrhagia, uniformly enlarged, soft, globular uterus.

TX: GnRH agonists, hysterectomy

Question 3

Leiomyoma (fibroid)

Answer 3

Most common tumor in females.

Often presents with multiple discrete tumors

Benign smooth muscle tumor

May be asymptomatic, cause abnormal uterine bleeding, or result in miscarriage

Severe bleeding may lead to *iron deficiency anemia.

*Whorled pattern of smooth muscle bundles with well-demarcated borders

Estrogen sensitive—tumor size INC with pregnancy and  DEC with menopause

malignant transformation to leiomyosarcoma is rare

Peak occurrence at 20–40 years old

Question 4

Endometrial hyperplasia

Answer 4

Abnormal endometrial gland proliferation usually caused by excess estrogen stimulation

Presents as *postmenopausal vaginal bleeding

Risk factors include anovulatory cycles, hormone
replacement therapy, polycystic ovarian syndrome, granulosa cell tumor

INC risk for
endometrial carcinoma

Question 5

Endometrial carcinoma

Answer 5

Most common gynecologic malignancy

Presents with vaginal bleeding

Peak occurrence at 55–65 years old

Typically preceded by endometrial hyperplasia.

Risk factors include prolonged use of estrogen without progestins, obesity, diabetes, hypertension, nulliparity, late menopause,
Lynch syndrome

Question 6

Endometritis

Answer 6

Inflammation of endometrium associated with retained products of conception following
delivery, miscarriage, abortion, or with foreign body (IUD)

Retained material in uterus
promotes infection by bacterial flora from vagina or intestinal tract.

TX: gentamicin + clindamycin +/− ampicillin.

Question 7

Endometriosis

Answer 7

Non-neoplastic endometrial glands/stroma outside endometrial cavity

Can be found anywhere;
most common sites are *ovary (frequently bilateral), pelvis, peritoneum

In ovary, appears as
*endometrioma (blood-filled “chocolate cyst”)

May be due to retrograde flow, metaplastic transformation of multipotent cells, transportation of endometrial tissue via lymphatic system

cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia (pain with
defecation), infertility

normal-sized uterus

TX: NSAIDs, OCPs, progestins, GnRH agonists, danazol, laparoscopic removal