Pathology of the Uterus

Question 1

subnuclear vacuoles are seen in _____ (phase of menstrual period)

Answer 1

early secretory phase (predominated by progesterone, while the follicular phase is predominated by estrogen)

Question 2

coiled glands is seen in ______ phase of the endometrium

Answer 2

secretory

proliferative phase would have straight glands

Question 3

compare the epithelium seen in proliferative and secretory endometrium

Answer 3

proliferative: cuboidal to tall w/ single or double layer
secretory: tall with vacuoles w/ single layer

Question 4

secretory endometrium has _____ stroma

Answer 4

edematous stroma;

proliferative endometrium would have dense stroma

Question 5

spiral arteries are seen in the _____ endometrium

Answer 5

secretory

Question 6

what are 4 most common causes of abnormal uterine bleeding (DUB)

Answer 6

1. unopposed estrogen (most common)
2. exogenous progesterone
3. inadequate luteal phase (secretory)
4. persistent luteal phase (secretory)

Question 7

one of the most common presentations of unopposed estrogen effect is _______
how does unopposed estrogen lead to DUB (dysfunctional uterine bleeding)?

Answer 7

anovulatory cycles;
unopposed estrogen will cause persistent proliferation and will not go into secretory phase → irregular bleeding and breakdown

Question 8

what does the glands look like due to exogenous progesterone effect?

Answer 8

glands will be small and atrophic due to the lack of priming by estrogen

Question 9

inadequate luteal phase is characterized by what levels of progesterone, FSH, and LH

Answer 9

↓ progesterone, ↓ FSH, ↓ LH

↓ progesterone causes inadequate corpus luteum function

Question 10

what does the endometrium look like in someone with an inadequate luteal phase?

Answer 10

has a poorly developed secretory endometrium so lags behind in secretory features for that day.
will not see late secretory changes: large glands, secretions, etc

Question 11

how does a persistent luteal phase present?

Answer 11

periods are regular bud bleeding is excessive and prolonged (10-14 days as opposed to 3-4 days) because the corpus luteum continues to secrete low levels of progesterone

Question 12

after 5 days of menstruation, you see there is secretory endometrium. What is the cause of this?

Answer 12

should be seeing proliferative endometrium after menstruation but in this case the patient has a persistent luteal phase

Question 13

fibrosis caused by endometriosis causes ↑ risk for: (4)

Answer 13

• infertility (tubes)
• intestinal obstruction
• risk of tubal pregnancy
• urinary obstruction

Question 14

what are some of the presentations of the cyclical bleeding in endometriosis?

Answer 14

if there is endometrial tissue in the urinary tract it can present with hematuria or in the rectum it can present as rectal bleeding

Question 15

presence of _______ (inflammatory cells) is indicative of chronic endometritis

Answer 15

plasma cells; usually don’t see them there.

Question 16

what stage of life does endometrial polyps usually occur?

Answer 16

peri-menopausal

Question 17

________ (gene) is associated with endometrial hyperplasia

Answer 17

PTEN tumor suppressor gene

Question 18

endometrial _____ can arise as a side effect of tamoxifen

Answer 18

endometrial polyp due to its anti estrogenic effects on the breast but weak pro estrogen effect on the endometrium