Pathology - Uterus (Myometrium and Endometrium) Flashcards
What is acute endometritis?
Bacterial infection of the endometrium
- Usually from retained products of conception
What does acute endometritis present with?
- Fever
- Abnormal uterine bleeding
- Pelvic pain
What needs to be seen on histology to diagnose chronic endometritis?
Plasma cells
What are other causes of endometritis?
- IUD
- TB
- Chronic PID (e.g STI)
What does chronic endomtritis present with?
- Abnormal uterine bleeding
- Pelvic pain
- Infertility
What will chornic endometritis show on histology?
Plasma cells
What are the 2 layers of the endometrium?
- Functionalis layer (shedded) (outer layer)
- Basalis (regenerative) layer - regenerates functionalis
What is asherman syndrome?
Secondary amenorrhea due to loss of basalis (regenerative) layer and scarring
What can ashermans be due to?
- Overaggressive dilation and curettage (removal of tissue often for diagnosis or as treatment) or abortion
Where are the stem cells of the endometrium located?
Basalis layer
What is Adenomyosis due to?
Extension of endometrial tissue (glandular) into uterine myometrium
- Caused by hyperplasia of endometrium
What does Adenomyosis show / present with?
- Dysmenorrhea, heavy uterine bleeding and abnormal uterine bleeding
- Uniformly enlarged, soft, globular uterus
How is adenomyosis treated?
- GnRH agonists
- Hysterectomy
- Excision of adenomyoma
Describe the levels of estrogen and progesterone in an anovulatory cycle?
- Estrogen-driven proliferative phase
- No Progesterone-driven secretory phase
What is an endometrial polyp?
- Hyperplastic protrusion of endometrium
- Presents as abnormal uterine bleeding
What disease is associated with tamoxifen use?
Endometrial polyp (ant-estrogenic on breat, pro on endometrium)
What is endometriosis?
Endometrial glands and stroma outside the uterine endometrial lining
What does endometriosis present with?
- Dysmennorhea
- cyclic pelvic pain
What are the different theories behind endometriosis?
- Retrograde menstruation theory
- Metaplastic theory - metaplasia
- Lymphatic dissemination theory
What areas may be involved in endometriosis?
- Ovary (chocolate cysts)
- Uterine ligaments - pelvic pain
- Pouch of Douglas - Pain w. defecation
- Bladder wall - pain with urination
- Bowel serosa - abdo pain and adhesions
- Fallopian tube mucosa - scarring
How may endometriosis be treated/
- NSAIDs
- OCP
- Progestins
- GnRH agonists
- Danazol
- Laparoscopic removal
What does endometriosis involving soft-tissues look like/
Brown specs - “gun-powder” lesions
What is there an increased risk of in people with endometriosis/
Carcinoma at sight of endometriosis (especially ovary)
What is endometrial hyperplasia?
Hyperplasia of endometrial glands relative to storma
- Consequence of unopposed estrogen
What does endometrial hyperplasia present with?
Postmenopausal uterine bleeding
What is the most important predictor for endometrial hyperplasia to progress to carcinoma?
Cellular atypia
What does endometrial carcinoma present with?
Postmenopausal bleeding
What are the 2 pathways by which endometrial carcinoma arise?
- Hyperplasia -> Endometroid (looks like the normal endometrium)
- Sporadic -> Serous (papillary)
What is endometritis treated with/
- Gentamicin
- Clindamycin
+/- Ampicillin
What type of endometrial carcinoma occurs in elderly women?
Serous (papillary, finger-like growths) carcinoma
Which type of endometrial carcinoma is more likely to occur in obese women?
Endometrioid (hyperplastic)
What type of endometrial carcinoma is associated with psammoma bodies?
Serous (papillary) carcinoma
What type of endometrial carcinoma is particularly aggressive?
Serous (papillary) carcinoma
What type of endometrial cancer is associated with loss of PTEN and mismatch repair proteins?
Endometroid
What is a leiomyoma better known as?
Fibroid
What is a leiomyoma?
Benign proliferation of SM arising from myometrium
What do leiomyomas look like?
Multiple, well-defined white whorled masses
What is leiomyoma related to?
Estrogen exposure
Describe leiomyosarcomas
- Malignant proliferation of SM
- Usually postmenopausal females
- Single lesion (unlike leiomyomas) w. areas of necrosis and hemorrhage
- Necrosis, mitotic activity, and cellular atypia
What is the most common symptom of leiomyomas?
- Nothing (asymptomatic)
- Abnormal uterine bleeding
- Infertility
- Pelvic mass
Does leiomyosarcoma usually arise from a leiomyoma
No
