Pathology - Uterus (Myometrium and Endometrium)

Question 1

What is acute endometritis?

Answer 1

Bacterial infection of the endometrium

- Usually from retained products of conception

Question 2

What does acute endometritis present with?

Answer 2

• Fever
• Abnormal uterine bleeding
• Pelvic pain

Question 3

What needs to be seen on histology to diagnose chronic endometritis?

Answer 3

Plasma cells

Question 4

What are other causes of endometritis?

Answer 4

• IUD
• TB
• Chronic PID (e.g STI)

Question 5

What does chronic endomtritis present with?

Answer 5

• Abnormal uterine bleeding
• Pelvic pain
• Infertility

Question 6

What will chornic endometritis show on histology?

Answer 6

Plasma cells

Question 7

What are the 2 layers of the endometrium?

Answer 7

• Functionalis layer (shedded) (outer layer)

- Basalis (regenerative) layer - regenerates functionalis

Question 8

What is asherman syndrome?

Answer 8

Secondary amenorrhea due to loss of basalis (regenerative) layer and scarring

Question 9

What can ashermans be due to?

Answer 9

• Overaggressive dilation and curettage (removal of tissue often for diagnosis or as treatment) or abortion

Question 10

Where are the stem cells of the endometrium located?

Answer 10

Basalis layer

Question 11

What is Adenomyosis due to?

Answer 11

Extension of endometrial tissue (glandular) into uterine myometrium
- Caused by hyperplasia of endometrium

Question 12

What does Adenomyosis show / present with?

Answer 12

• Dysmenorrhea, heavy uterine bleeding and abnormal uterine bleeding
• Uniformly enlarged, soft, globular uterus

Question 13

How is adenomyosis treated?

Answer 13

• GnRH agonists
• Hysterectomy
• Excision of adenomyoma

Question 14

Describe the levels of estrogen and progesterone in an anovulatory cycle?

Answer 14

• Estrogen-driven proliferative phase

- No Progesterone-driven secretory phase

Question 15

What is an endometrial polyp?

Answer 15

• Hyperplastic protrusion of endometrium

- Presents as abnormal uterine bleeding

Question 16

What disease is associated with tamoxifen use?

Answer 16

Endometrial polyp (ant-estrogenic on breat, pro on endometrium)

Question 17

What is endometriosis?

Answer 17

Endometrial glands and stroma outside the uterine endometrial lining

Question 18

What does endometriosis present with?

Answer 18

• Dysmennorhea

- cyclic pelvic pain

Question 19

What are the different theories behind endometriosis?

Answer 19

• Retrograde menstruation theory
• Metaplastic theory - metaplasia
• Lymphatic dissemination theory

Question 20

What areas may be involved in endometriosis?

Answer 20

• 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

Question 21

How may endometriosis be treated/

Answer 21

• NSAIDs
• OCP
• Progestins
• GnRH agonists
• Danazol
• Laparoscopic removal

Question 22

What does endometriosis involving soft-tissues look like/

Answer 22

Brown specs - “gun-powder” lesions

Question 23

What is there an increased risk of in people with endometriosis/

Answer 23

Carcinoma at sight of endometriosis (especially ovary)

Question 24

What is endometrial hyperplasia?

Answer 24

Hyperplasia of endometrial glands relative to storma

- Consequence of unopposed estrogen

Question 25

What does endometrial hyperplasia present with?

Answer 25

Postmenopausal uterine bleeding

Question 26

What is the most important predictor for endometrial hyperplasia to progress to carcinoma?

Answer 26

Cellular atypia

Question 27

What does endometrial carcinoma present with?

Answer 27

Postmenopausal bleeding

Question 28

What are the 2 pathways by which endometrial carcinoma arise?

Answer 28

• Hyperplasia -> Endometroid (looks like the normal endometrium)
• Sporadic -> Serous (papillary)

Question 29

What is endometritis treated with/

Answer 29

• Gentamicin
• Clindamycin
  +/- Ampicillin

Question 30

What type of endometrial carcinoma occurs in elderly women?

Answer 30

Serous (papillary, finger-like growths) carcinoma

Question 31

Which type of endometrial carcinoma is more likely to occur in obese women?

Answer 31

Endometrioid (hyperplastic)

Question 32

What type of endometrial carcinoma is associated with psammoma bodies?

Answer 32

Serous (papillary) carcinoma

Question 33

What type of endometrial carcinoma is particularly aggressive?

Answer 33

Serous (papillary) carcinoma

Question 34

What type of endometrial cancer is associated with loss of PTEN and mismatch repair proteins?

Answer 34

Endometroid

Question 35

What is a leiomyoma better known as?

Answer 35

Fibroid

Question 36

What is a leiomyoma?

Answer 36

Benign proliferation of SM arising from myometrium

Question 37

What do leiomyomas look like?

Answer 37

Multiple, well-defined white whorled masses

Question 38

What is leiomyoma related to?

Answer 38

Estrogen exposure

Question 39

Describe leiomyosarcomas

Answer 39

• Malignant proliferation of SM
• Usually postmenopausal females
• Single lesion (unlike leiomyomas) w. areas of necrosis and hemorrhage
• Necrosis, mitotic activity, and cellular atypia

Question 40

What is the most common symptom of leiomyomas?

Answer 40

• Nothing (asymptomatic)
• Abnormal uterine bleeding
• Infertility
• Pelvic mass

Question 41

Does leiomyosarcoma usually arise from a leiomyoma

Answer 41

No