Twenty Seven Flashcards
(9 cards)
What is the endometrium? What is the myometrium? Describe the 3 phases of the endometrium and what drives each.
i. BASIC PRINCIPLE S
A. Endometrium is the mucosal lining of the uterine cavity.
B. Myometrium is the smooth muscle wall underlying the endometrium (Fig, 13.5).
C. Endometrium is hormonally sensitive.
1 . Growth of the endometrium is estrogen driven (proliferative phase).
2. Preparation of the endometrium for implantation is progesterone driven
(secretory phase),
3 . Shedding occurs with loss of progesterone support (menstrual phase).
What is asherman syndrome? What is the pathophys? Etiology? What is anovulatory cycle? What is the pathophys? What are the results in the uterus?
- ASHF.RMAN SYNDROM E
A. Secondary amenorrhe a due to loss of the basalis and scarring
B. Result of overaggressive dilation and curettage (D&C)
m . A N O V U L A T O RY CYCLE
A, Lack of ovulation
B. Results in an estrogen-driven proliferative phase without a subsequent progesteronedriven secretory phase
1 . Proliferative glands break down and shed resulting in uterine bleeding.
. Represents a commo n cause of dysfunctional uterine bleeding, especially during menarche and menopaus e
What is acute endometritis? What is the pathophys? How does it present? What is chronic endometritis? How is it characterized? What is necessary for diagnosis? What are some etiologies? How does it present?
IV ACUT E ENDOMETRITI S
A. Bacteria! infection of the endometrium
B. Usually due to retained products of conception (e.g., after delivery or miscarriage); retained products act as a nidus for infection.
C. Presents as fever, abnormal uterine bleeding, and pelvic pain
V. CHRONI C ENDOMETRITI S
A. Chronic inflammatio n of the endometrium
B, Characterized by lymphocytes and plasma cells
1 . Plasma cells are necessary for the diagnosis of chronic endometritis given that lymphocytes are normally found in the endometrium.
C. Causes include retained products of conception, chronic pelvic inflammatory disease (e.g., Chlamydia), IUD , and TB.
D, Presents as abnormal uterine bleeding, pain, and infertility
What is an endometrial polyp? How does it present? What is the etiology?
VI, ENDOMETRIAL POLYP
A. Hyperplastic protrusio n of endometrium (Pig. 13.6)
B. Presents as abnormal uterine bleeding
C. Can arise as a side effect of tamoxifen, which has ant i-estrogenic effects on the breast but weak pro-estrogenic effects on the endometrium
What is endometriosis? What is the most likely pathophys? How does it present? What is the most common site and what does it result in there? What are some other sites and what are the results there? What is the gross pathology at these sites? What is adenomyosis? What is the risk for CA? Where is it highest?
VU. ENDOMETRIOSI S
A. Endometrial glands and stroma outside of the uterine endometrial lining
1 . Most likely due to retrograde menstruatio n with implantatio n at an ectopic site
B. Presents as dysmenorrhea (pain during menstruation) and pelvic pain; may cause infertility
1 . Endometriosis cycles just like normal endometrium.
C. Most c o m m o n site of involvement is the ovary, which classically results in formatio n
o fa ‘chocolate’ cyst (Fig. 13.7A).
1 . Othe r sites of involvement include the uterine ligaments (pelvic pain), pouc h of Douglas (pain with defecation), bladder wall (pain with urination) , bowel serosa (abdominal pain and adhesions), and fallopian tub e mucosa (scarring increases risk for ectopic tubal pregnancy); implants classically appear as yellow-brown
‘gun-powder’ nodules (Fig, 13.7B),
2. Involvement of the uterine myometrium is called adenomyosis.
D. There is an increased risk of carcinoma at the site of endometriosis , especially in the ovary.
What is endometrial hyperplasia? What is the pathophys? Some etiologies? How does it present? How is it classified histologically? What do these classifications mean clinically?
VIII.ENDOMETRIA L HYPERPLASI A
A. Hyperplasia ot’endometrial glands relative to stroma (Fig. 13.8)
li. Occurs as a consequence of unopposed estrogen (e.g., obesity, polycystic ovary syndrome, and estrogen replacement)
C. Classically presents as postmenopausal uterine bleeding
D. Classified histologically based on architectural growth pattern (simple or complex) and the presence or absence of cellular atypia
I. Most important predictor for progression to carcinoma (major complication) is the presence of cellular atypia; simple hyperplasia with atypia often progresses to
cancer (30%); whereas, complex hyperplasia without atypia rarely does (<5%),
What is endometrial CA? How common is it? How does it present? What two pathways does it arise from? Which is most common? What are the risk factors for this pathway? Average age of presentation? What is the histology like? What is the other pathway like? Age of presentation? What is the histology like? What mutation is common? Behavior of tumor?
IX. E N D O M E T R I A L C A R C I N O M A
A, Malignant proliferation of endometrial glands (Fig. 13.9A)
1 . Most commo n invasive carcinoma of the female genital tract
[}. Presents as postmenopausal bleeding
C. Arises via two distinct pathways: hyperplasia and sporadic
D. In the hyperplasia pathway (75% of cases), carcinoma arises from endometrial hyperplasia.
1 . Risk factors are related to estrogen exposure and include early menarche/late menopause, nulliparity, infertility with anovulatory cycles, and obesity.
- Average age of presentation is 60 years.
3 . Histology is endometrioid (i.e., normal endometrium-like . Fig. 13.9B).
E. In the sporadic pathway (25% of cases), carcinoma arises in an atrophic endometrium with no evident precurso r lesion.
L Average age at presentation is 70 years.
2. Histology is usually serous and is characterized by papillary structures (Pig.
13.9C) with psammoma body formation; p5 3 mutation is common, and the tumo r exhibits aggressive behavior.
What is a leiomyoma? What is another name for it? How common is it? What is it related to? What implications does this have? What does gross exam show? What is the presentation like?
X. LEIOMYOM A (FIBROIDS )
A. Benign neoplastic proliferation of smooth muscle arising from myometrium; most commo n tumo r in females
B. Related to estrogen exposure
1 . C o m m o n in premenopausal women
2. Often multiple
3 . Enlarge during pregnancy; shrink after menopaus e
C. Gross exam shows multiple, well-defined, white, whorled masses thai may distort the uterus and impinge on pelvic structures (Fig. 13.10).
D. Usually asymptomatic; when present, symptoms include abnormal uterine bleeding,
infertility, and a pelvic mass.
What is a leiomyosarcoma? What is the pathophys? Epidemiology? Gross histology? Microscopic histology?
XI. L E I O M Y O S A R C O M A
A. Malignant proliferation of smooth muscle arising from the myometrium
B. Arises de novo; leiomyosarcomas do not arise Irom leiomyomas.
C. Usually seen in postmenopausal women
D. Gross exam often shows a single lesion with areas of necrosis and hemorrhage;histological features include necrosis, mitotic activity, and cellular atypia.
