Endometrium and Myometrium

Question 1

What is endometrium

Answer 1

mucosal lining of uterine cavity

Question 2

what is myometrium

Answer 2

smooth muscle wall underlying endometrium

Question 3

what hormone drives the growth of endometrium during each phase?

Answer 3

proliferative phase: estrogen
secretory phase: progesterone
menstrual phase: loss of progesterone

Question 4

what is asherman syndrome

Answer 4

secondary amenorrhea due to loss of basalis and scarring FROM overaggressive dilation and curettage (D&C)

Question 5

What is anovulatory cycle

Answer 5

lack of ovulation

Question 6

what is wrong in the phases in anovulatory cycle

Answer 6

proliferative phase: estrogen driven

secretory phase: NO PROGESTERONE, proliferative glands break down and shed resulting in uterine bleeding

Question 7

anovulatory cycle’s dysfunctional bleeding usually occurs under what circumstances

Answer 7

menarche

menopause

Question 8

what is acute endometritis

Answer 8

bacterial infection of the endometrium

Question 9

clinical presentation for acute endometritis

Answer 9

fever
abnormal uterine bleeding
pelvic pain

Question 10

what can cause bacterial infection in acute endometritis

Answer 10

retained products of conception

after delivery or miscarriage

Question 11

what is chronic endometritis

Answer 11

chronic inflammation of endometrium

Question 12

what causes chronic endometritis

Answer 12

retained products of conception
chronic pelvic inflammatory disease ( chlamydia )
IUD
TB

Question 13

clinical features of chronic endometritis

Answer 13

abnormal uterine bleeding, pain and infertility

Question 14

what cells characterize chronic endometritis? which one is diagnositc

Answer 14

lymphocytes and plasma cells (B cells- diagnostic)

Question 15

what is endometrial polyp

Answer 15

hyperplastic protrusion of endometrium

Question 16

clinical presentation of endometrial polyp

Answer 16

abnormal uterine bleeding

Question 17

what drug can give an endometrial polyp. MOA of drug

Answer 17

Tamoxifen

• anti-estrogen effects on breast
• weak pro-estrogenic effects on endometrium

Question 18

What is endometriosis

Answer 18

endometrial glands and stroma outside of uterine endometrial lining

Question 19

endometriosis is commonly due to what

Answer 19

retrograde menstruation with implantation at an ectopic site

Question 20

clinical presentation of endometriosis

Answer 20

dysmenorrhea
pelvic pain
may cause infertility

Question 21

dysmenorrhea

Answer 21

pain during menstration

Question 22

what are changes in cycles for endometriosis

Answer 22

normal cyces

Question 23

what is the most common site of involvement for endometriosis? what does it form?

Answer 23

ovary

“chocolate cyst”

Question 24

other sites of involvement for endometriosis and their clinical features

Answer 24

uterine ligament (pelvic pain)
pouch of douglas ( pain with defecation)
bladder wall ( pain with urination) 
bowel serosa ( abdominal pain and adhesions)
fallopian tube mucosa ( scarring increases risk for ectopic pregnancy)

Question 25

typically implants in endometriosis classically look like what

Answer 25

yellow-brown 'gun-powder- nodules

Question 26

in endometriosis, involvement of uterine myometrium is called

Answer 26

adenomyosis

Question 27

what are the risks at site of endometriosis

Answer 27

carcinoma

Question 28

What is endometrial hyperplasia

Answer 28

hyperplasia of endometrial glands relative to stroma

Question 29

What causes endometrial hyperplasia

Answer 29

unopposed estrogen - obesity - PCOS - estrogen replacement

Question 30

clinical presentation of endometrial hyperplasia

Answer 30

postmenopausal uterine bleeding

Question 31

what type of histo is an important predictor for progression to carcinoma in endometrial hyperplasia

Answer 31

presence of cellular atypia

Question 32

what is the most common invasive carcinoma of female genital tract

Answer 32

endometrial carcinoma

Question 33

what is endometrial carcinoma

Answer 33

malignant proliferation of endometrial glands

Question 34

clinical features of endometrial carcinoma

Answer 34

postmenopausal bleeding

Question 35

what are two pathways endometrial carcinoma arises

Answer 35

hyperplasia or sporadic

Question 36

in hyperplasia pathway, endometrial carcinoma arises from what

Answer 36

endometrial hyperplasia

Question 37

in sporadic pathway, endometrial carcinoma arises from what

Answer 37

atrophic endometrium with not evident precursor lesion

Question 38

what are risk factors for hyperplasia endometrial carcinoma

Answer 38

``` estrogen exposure early menarche/late menopause nulliparity infertility anovulatory cycles obesity ```

Question 39

At what age does hyperplasia endometrial carcinoma present

Answer 39

60s

Question 40

histo for hyperplasia endometrial carcinoma

Answer 40

endometrioid ( normal endometrium-like)

Question 41

at what age does sporadic endometrial carcinoma present

Answer 41

70s

Question 42

histo for sporadic endometrial carcinoma

Answer 42

serous papillary structure psammoma body formatoin

Question 43

What is the most common tumor in females

Answer 43

leiomyoma (fibroids)

Question 44

what is leiomyoma (fibroids)

Answer 44

benign neoplastic proliferation of smooth muscle arising from myometrium

Question 45

what is cause of leiomyoma (fibroids)

Answer 45

estrogen exposure - premenopausal women - enlarge during pregnancy , shrink after menopause

Question 46

what is gross exam for leiomyoma

Answer 46

multiple-well-defined, white, whorled masses

Question 47

clinical symptoms for leiomyoma

Answer 47

usually asymptomatic - abnormal uterine bleeding - infertility - pelvic mass

Question 48

what is leiomyosarcoma

Answer 48

malignant proliferation of smooth muscle arising from the myometrium

Question 49

do leiomyosarcoma arise from leiomyomas

Answer 49

no

Question 50

who usually gets leiomyosarcomas

Answer 50

postmenopausal women

Question 51

gross exam for leiomyosarcomas

Answer 51

single lesion with areas of necrosis and hemorrhage

Question 52

histo features of leiomyosarcomas

Answer 52

necrosis mitotic activity cellular atypia