13.4 Endometrium and Myometrium

Question 1

What is the mucosal lining of the uterine cavity csalled

Answer 1

endometrium

Question 2

what is the specific layer of the uterine lining that sheds every cycle

Answer 2

stratum functionalis of the endometrium

Question 3

What is the stem cell layer of the endometrium?

Answer 3

stratum basalis

Question 4

what is beneath the endometrium

Answer 4

myometrium

Question 5

what are the 3 phases of the menstrual cycle

Answer 5

proliferative (growth) –> secretory (Preparation)–> menstrual (shedding)

Question 6

What hormone drives the proliferative (growth) phase of the endometrium

Answer 6

estrogen

Question 7

What homo drives the secretory 0(preparation) phase of the endometrium

Answer 7

progesterone

Question 8

What homo drives the shedding/menstrual phase

Answer 8

lack of progesterone

Question 9

Define Asherman Syndrome

Answer 9

secondary amenorrhea

Question 10

Why is there amenorrhea in Asherman Syndrome

Answer 10

the stratum basalis of the endometrium is lost and replaced by scarring

Question 11

What causes loss and scarring of the basalis in asherman syndrome

Answer 11

overaggressive dilation and curettage (scraping that removes the basalis)

Question 12

In an anovulatory cycle what phase of the cycle is left out?

Answer 12

the progesterone driven secretory (preparation) phase

Question 13

what is the MOA of an anovulatory cycle?

Answer 13

lack of secretory phase results in another Est-driven growth phase laid down upon old growth phase. The proliferative (growth) glands outgrow their blood supply and die off –> bleeding

Question 14

2 situations where anovulatory cycle is clasically seen

Answer 14

menarche and menopause

Question 15

what is the clinical presentation with anovulatory cycle

Answer 15

dysfunctional uterine bleeding

Question 16

define acute endometritus

Answer 16

bacterial infection of the endometrium

Question 17

What is the MC cause of acute endometritus

Answer 17

retained products of conception

Question 18

CP of acute endometritus (3)

Answer 18

fever, abnormal uterine bleeding, pelvic pain

Question 19

what is necessary for the dx of chronic endometritus?

Answer 19

plasma cells in endometrium

Question 20

What type of inflammatory cell is normal in the endometrium

Answer 20

lymphocytes

Question 21

what are 4 causes of chronic endometritus

Answer 21

1. IUD
2. chronic pelvic inflammatory disease (chlamydia)
3. retained products of conception
4. TB

Question 22

What else would you see if TB was the cause of chronic endometritus

Answer 22

granulomas

Question 23

what are three things that chronic endometritus presents with?

Answer 23

1. fever
2. pain
3. infertility

Question 24

Define endometrial polyp

Answer 24

hyperplastic protrusion of endometrium

Question 25

CP of endometrial polyp

Answer 25

abnormal uterine bleeding

Question 26

Common cause of endometrial polyp

Answer 26

side effect of tamoxifen use

Question 27

What is MOA of tamoxifen cuasing endometrial polyp

Answer 27

tamoxifen has anti-estrogen effect on breast and a weak anti-estrogen effect on endometrium

Question 28

define endometriosis

Answer 28

presence of bothglands and stroma of endometrium outside the endometrial lining

Question 29

what is cause of endometriosis

Answer 29

retrograde menstruation--> implantation of endometrium at ectopic site

Question 30

CP of endometriosis (3)

Answer 30

dysmenorrhea, pelvic pain, infertility

Question 31

Why does endometriosis cause dysmenorrhea

Answer 31

becuase the ectopis endometriosis cycles just like the normal endometrium and when it sloughs = pain

Question 32

what is the MC site of involvement of endometriosis

Answer 32

ovary

Question 33

what is a classic finding in ovary in endometriosis and MOA

Answer 33

"chocolate cyst" - implanted ectopic endometrium sloughs and proliferates until it forms a cyst

Question 34

How does endometriosis cause infertility and ectopic pregnancy

Answer 34

Ectopic endometrium implants in the fallopian tubes and causes scarring

Question 35

When endometriosis cyst involves soft tissue what is it called

Answer 35

gunpowder nodules

Question 36

define adenomyosis (also break down the parts of the name)

Answer 36

presence of endometriosis in the uterine myometrium ``` Adeno = glands of endometrium myo = myometrium ```

Question 37

what is there an increased risk of at the site of endometriosis? especially at what ectopic site?

Answer 37

risk of carcinoma | especially at the ovary

Question 38

define edndometrial hyperplasia

Answer 38

hyperplasia of endometrial glands relative to stroma

Question 39

wHAT CUASES endometrial hyperplasia

Answer 39

unopposed estrogen

Question 40

What are 3 causes of unopposed estrogen leading to endometrial hyperplasia

Answer 40

obesity polycystic ovary syndrome estrogen replacement therapy

Question 41

What population has what classic sx in endometrial hyperplasia (why?)

Answer 41

postmenopausal women have uterine bleeding (no progesterone phase in menopause = unopposed estrogen and proliferation of endo--> bleeding)

Question 42

How is endometrial hyperplasia classified?

Answer 42

histologically

Question 43

what is the histological growth pattern of endometrial hyperplasia

Answer 43

architechural growth pattern (simple or complex) +/- cellular atypia

Question 44

What is the most important predictor of endometrial hyperplasia progressing to endometrail carcinoma?

Answer 44

cellular atypia

Question 45

what classification of endometrial hyperplasia most often progresses to carcinoma?

Answer 45

simple hyperplasia with atypia

Question 46

what classification of endometrial hyperplasia least often progresses to carcinoma?

Answer 46

complex hyperplasia without atypia

Question 47

What happens with hormones in Adipose tissue (what gets converted in to what?

Answer 47

androgen--> estrone

Question 48

Is endometrial carcinoma benign or malignant

Answer 48

malignant

Question 49

define endometrial carcinoma

Answer 49

malignant proliferaiton of endometrial glands

Question 50

what is the MC invasive carcinoma of the female genital tract

Answer 50

endometrial carcinomoa

Question 51

how does endoemtrail carcinoma present

Answer 51

postmenopausal bleding

Question 52

what are the 2 pathways for endometrial carcinoma to arise

Answer 52

hyperplastic and sporadic

Question 53

average age of presentation of hyperplastic and sporadic endometrail carcinomas (2) which is earlier?

Answer 53

hyperplastic 60s | Sporadic 70s

Question 54

what is histology of hyperplastic endometrial carcinoma (DESCRIBE AND NAME)

Answer 54

endometrioid- looks like normal endometrium but les stroma

Question 55

the sporadic pathway to endometrial carcinoma arises from what condition/lesion

Answer 55

no precursor lesion- arises from atrophic endometrium

Question 56

which endometrial carcinoma pathway is more aggressive? (hyperplatic or sporadic)

Answer 56

hyperplastic

Question 57

what mutation is seen in sporadic endometrial carcinoma

Answer 57

p53

Question 58

the histology of sporadic endometrial carcinoma is chcized by what 3 things

Answer 58

serous histology papillary structures psammoma bodies

Question 59

what is a psammoma body

Answer 59

an area of necrosis and calcification in a papillary extension

Question 60

what are 3 cancers that display psammoma bodies other than endometrial carcinoma

Answer 60

mesothelioma- high yield meningioma papillary carcinoma of the thyroid

Question 61

What tissue type is involved in Leiomyoma (derivative of what specific tissue)

Answer 61

smooth muscle of myometrium

Question 62

IS a Leiomyoma benign or malignant

Answer 62

benign

Question 63

what is the most common tumor in females

Answer 63

Leiomyoma

Question 64

Leiomyoma is most often seen in what pop

Answer 64

pre-menopausal

Question 65

what is cause/correlation of Leiomyoma

Answer 65

estrogen exposure

Question 66

How do Leiomyomas change DUIRNg life? why

Answer 66

enlarge during pregnacy, shrink after menopause (estrogen related)

Question 67

Leiomyoma gross appearance

Answer 67

multiple white whorled masses

Question 68

SX of Leiomyoma (3)

Answer 68

often asx infertility - uterine distorion pelvic mass abnormal uterine bleeding

Question 69

What do Leiomyomas progrss to?

Answer 69

nothing!!!!

Question 70

arise from what?

Answer 70

nothing!!!! they are de novo lesions

Question 71

what pop MC has leiomysarcomas

Answer 71

postmenopausal women

Question 72

gross appearance of leiomysarcoma (3)

Answer 72

single lesion areas of: necrosis, hemorrhage

Question 73

is leiomysarcoma benign or malignant

Answer 73

malignant

Question 74

3 diffrernces between leiomysarcomas and Leiomyomas

Answer 74

Leiomyomas: multiple lesions, premenopause, no necrosis/hemorrhage Leiomyosarcomas: single lesion, postmenopause, shows necrosis and hemorrhage