Pathoma: Endometrium and Myometrium

Question 1

Growth of the endometrium is driven by _______________.

Answer 1

estrogen

Question 2

Shedding of the endometrium occurs by _____________.

Answer 2

loss of progesterone

Question 3

What is D&C?

Answer 3

Dilation and curettage

Question 4

Describe Asherman syndrome.

Answer 4

With loss of the regenerative basalis layer of the endometrium, such as by overaggressive D&C, women can develop secondary amenorrhea.

Question 5

What presentation is typical of anovulatory cycle?

Answer 5

In an anovulatory cycle, the endometrium grows due to estrogen but does not shed because progesterone (normally made by the corpus luteum) never rises and thus never leads to shedding through loss. The next cycle, however, is likely to present with bleeding because the endometrium grows until it becomes hypoxic.

Question 6

Acute endometritis is often caused by ____________.

Answer 6

placental remnants

Question 7

What cells are characteristic of chronic endometritis?

Answer 7

Plasma cells (this is important because there are normally lymphocytes in the endometrium)

Question 8

What drug can cause a hyperplastic protrusion of endometrium?

Answer 8

Tamoxifen

Question 9

Endometriosis presents with ___________________ outside the endometrial lining of the uterus.

Answer 9

endometrial glands and stroma

Question 10

What are some theories as to why endometriosis occurs?

Answer 10

Some think that during shedding some basalis tissue might get pushed up into the fallopian tubes (and in some cases out of the tubes) and seed there. Others think it’s a process of metaplasia. Lastly, some think basalis tissue spreads lymphatically, as there are some rarer cases of endometriosis in the lungs.

Question 11

The most classic presentation of endometriosis is ____________.

Answer 11

in the ovary (a “chocolate cyst”)

Question 12

What is adenomyosis?

Answer 12

Endometriosis of the myometrium

Question 13

Endometriosis increases the risk of ________________.

Answer 13

carcinoma, especially in the ovary

Question 14

What does estrogen do on a histologic level to the endometrium?

Answer 14

It leads to gland hyperplasia within the endometrium. This is evidenced by more glands related to stroma.

Question 15

What can help predict whether endometrial hyperplasia will progress to carcinoma?

Answer 15

Nuclear atypia

Question 16

Talk about the two pathways to endometrial carcinoma.

Answer 16

• Hyperplasia can lead to carcinoma. This is called “endometrioid” cancer. More often in perimenopausal women.
• Carcinoma can arise sporadically from an atrophic endometrium. This is called serous papillary. More often in elderly women. This is also caused by p53 mutations.

Question 17

Leiomyomas occur most often in ______________.

Answer 17

menopausal women

Question 18

What’s the best way to distinguish between leiomyoma and leiomyosarcoma?

Answer 18

The malignant version will have necrotic cores while the benign version looks like “white, whorled masses.”

Also, the malignant form more often occurs in older women.

Question 19

What symptoms does leiomyoma most often present with?

Answer 19

Nothing. It is usually asymptomatic.

Question 20

True or false: leiomyomas carry no increased risk for malignancy.

Answer 20

True. Leiomyosarcomas occur sporadically.