Pathology Of The Endometrium And Myometrium Flashcards
Describe the histology of the endometrium during the proliferative phase
- thickening of smooth muscle
- low glands to stroma ratio
- glands are tubular (long and thin cuboidal cells) separated by abundant stroma (small ovoid nuclei)
- presence of dividing cells normal
Describe the histology of the endometrium during the secretory phase
- glands change shape to coil appearance (nuclei separated from basement membrane by vacuoles)
- mitotic activity halted
- gland to stroma ratio still low
Describe the histology of the endometrium during the menstrual phase
- fragmentation of endometrium
- condensing of stroma (cells closer together and darker on histology)
- cell death and inflammatory cells normal
Describe the histology of the endometrium after menopause
- cystic atrophy
- low gland to stroma ratio
- inactive glands with cells mainly occupied by nuclei
- no mitotic activity or cell death
Describe the histology of the myometrium
- smooth muscle (long nuclei with blunted end with portions running opposite each other)
- appearance should not change
Describe endometriosis and Adenomyosis
- endometriosis is the presence of endometrial tissue outside of the uterus (eg. Ovaries, peritoneal surfaces etc.)
- symptoms: dysmenorrhea, pelvic pain, infertility
- Adenomyosis: presence of endometrial tissue within the myometrium
Describe the theories of pathogenesis of endometriosis
- metastatic theory: retrograde menstruation or surgical procedure introduces endometrium to sites outside of the uterine cavity
- metaplastic theory: endometrium arises directly from coelomic epithelium from pelvis as that is where it originates from in development
Describe features of endometrial polyps
- exophytic mass which projects into the endometrial cavity (can be associated with tamoxifen)
- can present with abnormal bleeding
- can be treated with hysteroscope in outpatient clinic
Describe the histology of an endometrial polyp
- disorganised glands
- low gland to stroma ratio
- thick walled blood vessels
- fibrous stroma
- glands can be inactive (some can be in other phases)
- rarely cytological atypia
Describe features of endometrial hyperplasia and adenocarcinoma
- associated with prolonged oestrogenic stimulation of the endometrium
- causes: anovulatory cycles, endogenous sources of oestrogen (obesity, PCOS, tumours), exogenous sources of oestrogen
- resembles normal smooth muscle
- presentation: post-menopausal bleeding
Describe the histology of endometrial hyperplasia and adenocarcinoma
- increase of gland to stroma ratio (less stroma between glands
- +/- cytological atypia (atypia precursor for adenocarcinoma)
- nuclei not as uniform
What is the management for endometrial hyperplasia?
- progesterone therapy such as mirena, IUS, hysterectomy
What is the management for endometrial adenocarcinoma?
- hysterectomy with subsequent management depending on tumour grade and stage
Describe features of leiomyoma
- benign smooth muscle tumour of myometrium
- asymptomatic, abnormal bleeding, increased urinary frequency, impaired fertility
- defined grey-white tumours on whorled surface that resembles normal smooth muscle
- treatment: progesterone secreting IUS, hormone therapy, tranexamic acid, uterine artery embolisation, myoectomy, hysterectomy
Describe features of leiomyosarcoma
- malignant smooth muscle tumour of the myometrium
- symptoms: none initially, then bleeding and pain
- pathology: bulky, invasive mass, necrosis, haemorrhage
- can spread to lung, liver, brain
