W10_05 Endometriosis

Question 1

define endometriosis

Answer 1

the presence of endometrial glands and stroma outside of the uterus; can be a cause of secondary dysmenorrhea

Question 2

define adenomyosis

Answer 2

infiltration of endomtrial glands and stroma in the myometrium

Question 3

what are 4 proposed theories for endometriosis?

Answer 3

retrograde menstruation;
hematogenous or lymphatic transport;
altered immunologic responses;
coelomic metaplasia

Question 4

where do endometriosis lesions most typically present?

Answer 4

dependent portion of the pelvis - cul-de-sac, posteriod uterus, etc

Question 5

note: some sort of polygenic inheritance for endometriosis

Answer 5

ok

Question 6

what’s the classic triad of endometriosis?

Answer 6

dysmenorrhea, deep dyspareunia, infertility;
also, chronic pelvic pain

Question 7

what are other symptoms of endometriosis?

Answer 7

menstrual irregularities, dyschezia, dysuria, hematochezia, hematuria

Question 8

what are physical findings of endometriosis?

Answer 8

focal tenderness on pelvic exam;
uterosacral nodularity (almost pathonomonic for endometriosis);
fixed retroversion of uterus;
adnexal mass with tenderness

Question 9

what are laparoscopic findings of endometriosis?

Answer 9

lesions: clear, red, white, black powder burn

Question 10

how to definitively diagnose endometriosis?

Answer 10

surgery. Note that findings correlate poorly with symptoms. Also you can start medical treatment before surgery

Question 11

what’s the first line therapy for endometriosis pain?

Answer 11

NSAIDs, OCP, Progestin

Question 12

what’s the second line therapy for endometriosis pain?

Answer 12

prostaglandin analog - dienogest, anti-estrogen agents (Danazol), GnRH agonist

Question 13

what’s the difference between conservative surgery and definitive surgery in endometriosis?

Answer 13

conservative is just getting the lesions, while definitive is removing tubes, ovaries, uterus

Question 14

what are the two conservative surgery methods?

Answer 14

ovarian cystectomy “enucleation” or ;
cyst aspiration with cauterization

Question 15

note: there’s an increased incidence of ovarian cancer among women with endometriosis (although it’s still low)

Answer 15

cancers include endometriod and clear cell cancers

Question 16

how to tell if the ovarian cancer transformed from endometriosis?

Answer 16

both endometriosis and malignancy within same ovary;
carcinoma must arise from the endometriosis;
specimen must have histological characteristics of endometriosis;
morphological continuation between benign and malignant epithelium

Question 17

note: only about 0.9% of cases fit the 4 sampson criteria for endometriosis to malignancy transformation

Answer 17

ok