Endometrium Flashcards
(35 cards)
Compare and contrast the two layers of the endometrium with regard to:
- hormonal responsiveness
- shedding
Functional Layer
- responds to hormonal stimulation
Basal Layer
- is never shed it just maintains the foundation on whcih the functional layer develops
Compare the histology that you would see in the following phases of the menstrual cycle.
- Proliferative
- Early Secretory
- Late Secretory
- Menses
**In what cell layer are these changes occuring?
Proliferative:
- Round Glands that are fairly straight with Mitotic Figures
Secretory:
- Corkscrew Glands with no mitotic Figures
- *Early** - Glands are empty with vacuoles on the basal side
- *Late** - Gland are filled with fluid (not blood) and vacuoles are on the apical side
Menses:
- blood and hemorrhage coming off in clumps
What is Dysfunctional Uterine Bleeding?
* most common cause?
* pathophysiology of that cause?
Bleeding that lacks any underlying anatomical explanation, most often due to **hormonal abnormalities
Dysfunctional Uterine Bleeding**
is commonly due to anovulatory cycles caused by unopposed estrogen that leads to tissue proliferation and eventual shedding
What would you see on an endometrial biopsy of a woman with dysfunctional uterine bleeding/anovulatory cycles?
Biopsy shows disorded proliferative pattern with glands shooting off in many directions
When are anovulatory cycles most likely to occur?
*cause?
Hormonal Imbalances in general
- *Menarche** - HPO axis hasn’t gotten in rhythm yet
- *Perimenopausa**l - Follicles are taking longer to meet the estrogen theshold of to induce postive estrogen feedback on LH in the anterior pituitary
Other than normal hormone imbalances in women around menarche and menopause, what causes Anovulatory Cycles?
Endocrine Disorders - e.g. Hypothyroidism => increased TRH => increased TSH and Prolactin Secretion => Prolactin inhibits GnRH release and FSH and LH decrease
Ovarian Lesions - Polycystic Ovaries and Functional Ovarian Tumors
Generalized Disturbances - Obesity, Malnutrition, other Chronic Diseases (all could lead to hyperestrogen or hypo-hormone states)
A woman presents with a pedunculated, localized overgrowth of endometrial GLAND and STROMA in the uterine cavity.
- What is this lesion?
- Likely cause?
- Symptoms?
- *Endometrial Polyp**
- likely causesd by a hyperplastic response of endometrial tissue to estrogen (most not functional)
Symptoms:
May be an incidental finding (most often) or may present with abnormal bleeding
What do you need to rule out before calling something an endometrial polyp?
Cancer
Endometrial Polyp
- what do you expect the tissue to look like on gross examination?
- Histologically?
Very Red Polyp - from unopposed estrogen and vessel proliferation and WHITE areas of hyperplastic stroma (often have cystic change)
Histologically this will resemble normal endometrial glandular tissue, cystic changes will show up as gaps in the cells with a fibrous stroma and thickened vessel walls
3 common sources of unopposed estrogen leading to endometrial polyps.
- *1. Tamoxifen** (anti-estrogen in breast, pro-estrogen in endometrium)
- *2. Obesity
3. Estrogen Therapy**
What is Ashermann Syndrome?
- what causes it?
**lack of ovulation secondary to LOSS OF THE BASALIS and scarring
Often due to OVERAGGRESIVE dilation and CURETTAGE**
Acute Endometritis
- How does this present?
- What causes it?
Presentation:
- Fever, abdominal pain, Uterine Bleeding, Pelvic Pain
Cause:
- Often from retained products of conception - these serve as a nidus for infection
Acute Endometritis
- Treatment?
Remove the retained products of conception that probably caused the acute episode in the first place
Give Abx
Chronic Endometritis
- what 4 potential causes should you have in your differential?
- what are you looking for on histology?
- *1. Pelvic Inflammatory Disease** (Gonorrhea, Chlamydia)
- *2.** Retained Gestational tissue (post-pardum, post-abortion)
- *3.** Intrauterine Contraceptives
4. TB
Histology Should Show PLASMA CELLS (lymphocytes aren’t good enough because they’re there all the time)
Ectopic Endometrial tissue is found the pouch of Douglas and is thought to the etiology or your patients recurrent pain with bowel movements.
- What is this called?
- What might it look like on histo?
Endometriosis - while it is ectopic it still has the appearance of normal endometrial tissue with BOTH Glands and Stroma
What can severe endometriosis in the ovary cause?
- what risk is associated with endometriosis in the fallopian tube?
Chocolate Cyst
Fallopian Tube endometriosis puts the patient at a high risk of endometriosis
What is endometriosis in the myometrium called?
Adenomyosis
Note: endometriosis may be referred to as having a gun powder appearance due to hemosiderin that has resided in the tissue has it has cycled with the rest of the endometrial tissue, but had nowhere to dump the blood.
Endometriosis
Typical Presentation
- *Pelvic Pain** and Pain during Menses in a woman between 25 and 30 years old
- *Infertility** may also bring this to attention
Who typically presents with ENDOMETRIAL HYPERPLASIA?
- risk factors for getting this disease?
Endometrial Hyperplasia:
Should be suspected in a postmenopausal woman with uterine bleeding (note: this is hyperplasia so it is a precursor to endometrial carcinoma)
Risks (all have to do with HYPERESTROGENIC STATES):
- **Granulosa cell tumor
- Obesity
- Polycystic Ovarian Disease
- Estrogen Therapy**
Endometrial Hyperplasia
- what do you expect to see histologically?
- what gene is associated with this disease (gain of function or loss of function)?
- what is the most important predictor of whether it will progress to cancer?
Histologically:
Persistent Estogen stimulation leads to and increased ratio of glands to stroma
Gene - PTEN - tumor suppressor gene also implicated frequently in endometrial carcinoma
CELLULAR ATYPIA IS THE MOST IMPORTANT PREDICTOR OF WHETHER THESE LESIONS WILL PROGRESS TO CANCER
What are the 3 categories of Endometrial Hyperplasia?
Hyperplasia without Atypia
Endometrial Intraepithelial Neoplasia
Endometrial Carcinoma
**I think this is more of a progression than distinct categories
What is the difference between simple and complex variants of Endometrial Hyperplasia?
Complex has glands that are increased to the point of there being very little stroma in between them and glands are back to back
**This is a prognostic indicator but is not nearly as important as atypia
Hyperplasia without Atypia
- Histology?
NL glands, there are just more of them Nuclear Polarity (towards the bottom of the cell) is maintained
