Diseases of the Endometrium

Question 1

Name the diseases of the endometrium?

Answer 1

1. Inflammatory: Chronic endometritis
2. Functional disorders (hormonal)
3. Iatrogenic disorders
4. Non neoplastic organic lesions
5. Neoplastic lesions including precursor lesions

Question 2

Describe the proliferative phase of the menstrual cycle?

Answer 2

Effects of oestrogen
Tubular glands with pseudostratified epithelium and mitoses
Compact stroma with spindle/oval cells

Question 3

Describe the secretory phase of the menstrual cycle?

Answer 3

Effects of progesterone
Stromal decidualisation: stromal cells acquire abundant eosinophilic cytoplasm
Coiled glands with secretions

Question 4

What is menses?

Answer 4

stromal and glandular breakdown

Question 5

Describe the cause of abnormal uterine bleeding during prepuberty?

Answer 5

Precocious puberty (hypothalamic, pituitary or ovarian origin

Question 6

Describe the cause of abnormal uterine bleeding in adolescenvce?

Answer 6

Anovulatory cycle, coagulation disorders

Question 7

What are causes of abnormal uterine bleeding seen in women of reproductive age?

Answer 7

Complications of pregnancy
Organic lesions (adenomyosis, polyps, hyperplasia)
Anovulatory cycles, inadequate luteal phase

Question 8

Causes of abnormal uterine bleeding in perimenopausal women?

Answer 8

Anovulatory cycles
Irregular shedding
Organic lesions (carcinoma, hyperplasia, polyps)

Question 9

Causes of abnormal uterine bleeding seen in postmenopausal women?

Answer 9

Organic lesions (carcinoma, hyperplasia, polyps)
Endometriaal atrophy

Question 10

When does dysfunctional uterine bleeding occur?

Answer 10

Occurs secondary to hormonal imbalances affecting the menstrual cycle
- Sometimes cause cannot be ascertained

Question 11

Examples of dysfunctional uterine bleeding?

Answer 11

Luteal phase insufficiency
Irregular shedding
Anovulatory cycles

Question 12

Describe luteal phase insufficiency?

Answer 12

Result from inadequate progesterone production by the corpus luteum
Endometrium shows inadequate secretory maturation
Glands and stroma are out of phase for the appropriate post-ovulatory day

Question 13

Describe irregular shedding?

Answer 13

Result from a persistent corpus luteum with continued progesterone production
At the same time, endometrium is trying to proliferate
Endometrium shows combination of secretory, menstrual and proliferative changes

Question 14

Describe the anovulatory cycle?

Answer 14

Cycles are not accompanied by ovulation
Which results in excessive and prolonged oestrogen stimulation
There is no development of secretory phase
Commonly occur at menarche and perimenopausal period
Endometrium shows proliferative glands and stromal breakdown without secretory changes

Question 15

Causes of iatrogenic disorders?

Answer 15

Oral contraceptive use
Hormone replacement therapy (HRT)
Tamoxifen for treatment of breast cancer
Intrauterine contraception devices

Question 16

Types of oral contraceptives?

Answer 16

combined oestrogen and progesterone (COC)

progesterone only

Question 17

What does the endometrium show under COC use?

Answer 17

small tubular and inactive glands in a poorly developed stroma
Similar changes also seen in HRT but more pronounced

Question 18

What does the endometrium show under progesterone only use?

Answer 18

Atrophic glands

Stroma pseudo-decidualisation

Question 19

What is tamoxifen?

Answer 19

Anti-eostrogen drug for treatment of breast cancer

Question 20

Paradoxical oestrogenic effects on endometrium include increase risk of?

Answer 20

Endometrial polyps
Endometrial hyperplasia
Endometrial carcinoma

Question 21

Intrauterine contraceptive devices cause?

Answer 21

Inflammation: acute or chronic
Ulceration
Various metaplasia including papillary metaplasia
Vascular thrombosis
Focal irregular ripening (some glands and stroma appear out of phase)
Pseudodecidual change

Question 22

Describe non neoplastic organic lesions?

Answer 22

1. Endometriosis
   Presence of endometrial glands outside the uterus
2. Adenomyosis
   Presence of endometrial glands within myometrium
3. Endometrial polyps
   Occur as a result of oestrogenic stimulation

Question 23

What is a endometrial neoplastic precursor lesion?

Answer 23

endometrial intraepithelial neoplasia (EIN)

Question 24

Causes of endometrial intraepithelial neoplasia?

Answer 24

Consequence of unopposed oestrogenic stimulation
Source of oestrogen may be endogenous (ovarian tumour, ovarian polycystic disease etc) 
Or exogenous (e.g. obesity)

Question 25

How is endometrial hyperplasia classified?

Answer 25

Classified according to architectural and cytologic atypia

Question 26

What are the classes of the endometrial hyperplasia?

Answer 26

Simple hyperplasia
With or without atypia
Complex hyperplasia
With or without atypia

Question 27

Epidemiology of endometrial carcinoma?

Answer 27

Common in older women peri and postmenopausal

Question 28

What are the 2 groups of endometrial carcinoma?

Answer 28

1. type 1: endometrioid carcinoma; develops on background of oestrogen stimulation and EIN
   - Common type
2. type2: Serous carcinoma develops on background of atrophic endometrium with P53 mutations
   - Seen in very elderly women

Question 29

What are the risk factors for endometrioid carcinoma?

Answer 29

Obesity 
Infertility with anovulatory cycles
Ovarian oestrogen secreting tumours
Oestrogen replacement therapy 
Diabetis
hypertension