Pathology - Endometrium Flashcards
What is a Well-circumscribed collection of endometrial tissue within uterine wall.
Endometrial Polyp
Endometrial polyps can contain what kind of tissue?
Smooth Muscle Cells
How does an endometrial polyp present?
May be asymptomatic or present with painless abnormal uterine bleeding.
What is an Adenomyosis?
Extension of endometrial tissue (glandular) into uterine myometrium.
What causes Adenomyosis?
Caused by hyperplasia of basal layer of endometrium.
What presents with dysmenorrhea, menorrhagia, uniformly enlarged, soft, globular uterus?
Adenomyosis
How do you treat Adenomyosis?
GnRH agonists, hysterectomy.
Most common tumor in females?
Leiomyoma (Fibroma)
Who is at risk for Leiomyomas?
20-40 y/o African American
What is a Leiomyoma (fibroma)?
Benign smooth muscle tumor; malignant transformation to leiomyosarcoma is rare.
How does a Leiomyoma present?
Often presents with multiple discrete tumors. May be asymptomatic, cause abnormal uterine bleeding,
What are some complications with Leiomyomas? (2)
Miscarriage
Severe bleeding may lead to iron deficiency anemia.
How does estrogen effect Leiomyosarcomas?
Estrogen sensitive—increased tumor size with pregnancy and decreased with menopause.
What do you see on histo for Leiomyosarcomas?
Whorled pattern of smooth muscle bundles with well-demarcated borders
What normally causes endometrial hyperplasia? What is at increased risk with endometrial hyperplasia?
Abnormal endometrial gland proliferation usually caused by excess estrogen stimulation. Can progress to Endometrial Carcinoma
What is the greatest risk factor for progression of endometrial hyperplasia to carcinoma?
nuclear atypia is greater risk factor than complex (vs simple) architecture.
How does Endometrial Hyperplasia present?
Presents as postmenopausal vaginal bleeding.
Risk factors for Endometrial Hyperplasia? (4)
Risk factors include anovulatory cycles, hormone replacement therapy, polycystic ovarian syndrome, granulosa cell tumor.
Most common gynecologic malignancy?
Endometrial Carcinoma
What is the peak occurrence of Endometrial Carcinoma?
Peak occurrence at 55–65 years old.
How does Endometrial Carcinoma present?
Presents with vaginal bleeding.
What chronic disorders increase risk for Endometrial carcinoma?
obesity, diabetes, hypertension
What obstetric and gynecologic risk factors are there for Endometrial Carcinoma?
use of estrogen without progestins, nulliparity, late menopause
What genetic syndrome increases risk for Endometrial Carcinoma?
Lynch syndrome
What are some causes of endometritis? (4)
associated with retained products of conception following delivery, miscarriage, abortion, or with foreign body (eg, IUD).
How does retained material in uterus promote infection?
Retained material in uterus promotes infection by bacterial ora from vagina or intestinal tract.
How do you treat Endometritis?
gentamicin + clindamycin +/− ampicillin.
Most common site for endometriosis?
most common sites are ovary (frequently bilateral)
How does endometriosis present in ovaries?
In ovary, appears as endometrioma (blood- lled “chocolate cyst”).
Theories on how Endometriosis occurs? (3)
May be due to retrograde flow
metaplastic transformation of multipotent cells
transportation of endometrial tissue via lymphatic system.
What is Characterized by cyclic pelvic pain, bleeding, dysmenorrhea, dyspareunia, dyschezia (pain with defecation), infertility?
Endometriosis
What is the size of the uterus in Endometriosis?
normal
Treatment for Endometriosis?
NSAIDs, OCPs, progestins, GnRH agonists, danazol, laparoscopic removal.