FGT 3: Endometrium 1
endometrial polyp. how can it cause bleeding?
Hyperplastic protrusion of endometrium; can prolapse, tear off --> abnormal uterine bleeding
endometrial hyperplasia
Increased proliferation of endometrial glands relative to the stroma
Mid-secretory phase histo
Luminal secretions and stromal edema
Tumor suppressor gene mutated in endometrial hyperplasia (and endometrial carcinoma)
PTEN
chronic endometretis causes? (4)
Pelvic inflammatory disease, IUDs (foreign body), retained products of conception (e.g. placenta), TB
Late secretory phase histo
Prominent spiral arteries (supply the endometrium) and predecidual stromal change
What phase begins after ovulation? UNDERSTANDING
Secretory phase
Early secretory phase histo
Subnuclear vacuoles
What is a common cause of hemorrhage in the myometrium?
adenomyosis
adenomyosis
adenomyosis Extension of endometrial glands and stroma into the myometrium
What is the most common cause of dysfunctional uterine bleeding? Seen in what patients?
anovulatory cycle menarche and menopause
Which layer of the endometrium is always preserved during the menstrual phase?
basal layer (doesn't get sloughed off)
endometriosis. due to?
benign, hormonally sensitive endometrial tissue *outside of the uterus* (undergoes normal menstrual cycle) due to regurgitation of sloughed off endometrium through Fallopian tubes, into peritoneum --> implant at other site
acute endometritis arises in what setting?
caused by *bacterial infections* arising after delivery/miscarriage (from *retained products of conception, e.g. placenta* - nidus of infection)
tx for pt with endometrial hyperplasia (with cytologic atypia) that would like to become pregnant in the future?
continuous progestin and close follow-up --hysterectomy once done having kids
Days of the menstrual phase of the endometrium
days 0-4
Days of secretory phase of endometrium
days 15-28
Days of the proliferative phase of endometrium
days 4-14
endometriosis presentation. complication?
dysmenorrhea (pain during menstruation), pelvic pain can cause *infertility* (b/c can happen on Fallopian tube--> tubal scarring --> infertility --> egg has trouble moving to uterus to implant)
What is a "*chocolate cyst*"?
endometriosis of the ovary -- due to accumulation of old blood in the cyst (b/c implants in the ovary, grows/sheds, grows/sheds, etc.)
Presentation of acute endometritis (3)
fever, pelvic pain, abnormal uterine bleeding
Gestational endometrium has ______ changes on histology. This is called the ____-_____ reaction.
hypersecretory; Arias-Stella
Histo of menstrual phase
in the endometrium: neutrophilic infiltrate, necrosis and hemorrhage --b/c acute inflammation following necrosis (to clean up necrotic debris)!!!
How does an inadequate luteal phase cause dysfunctional uterine bleeding?
inadequate corpus luteum --> inadequate production of progesterone to maintain the secretory endometrium
endometriosis can give rise to?
malignant transformation to endometrioid/clear cell ovarian carcinomas note: requires malignant transformation b/c the initial tissue is benign
Cystic atrophy is associated with what cause of dysfunctional uterine bleeding? What is cystic atrophy?
menopausal/postmenopausal changes glands are cystically dilated, endometrium is atrophied
3 phases of menstrual cycle? UNDERSTANDING
menstrual phase, proliferative phase, secretory phase
Term for bleeding between periods Term for excessive bleeding during period
metrorrhagia (bleeding between periods) menorrhagia (excessive bleeding during period)
What process initiates the secretory phase of the endometrium?
ovulation (usually at day 14)
importance of endometrial hyperplasia?
precursor for endometrial carcinoma -- especially endometrial hyperplasia with *cytologic atypia*
What is the main determinant as to whether a woman with endometrial hyperplasia will develop endometrial carcinoma?
presence (or absence) of cytologic atypia
Type of endometrium seen in a biopsy of an anovulatory cycle patient
proliferative endometrium; glands present with stromal breakdown -- due to unopposed estrogen
when does endometriosis present?
reproductive age -- due to hormonal-sensitivity
Endometrial polyps are associated with what drug?
tamoxifen (anti-estrogen for breast cancer) -- this is b/c it has pro-estrogen effects in the endometrium --> endometrial hyperplasia
What histological feature helps to Dx endometrial polyps? Why are these present?
thick walled vessels -- need thick vessels so that the polyp is not sloughed off during menstruation
Histo of proliferative phase
tubular, elongated glands, glandular and stromal mitoses; no luminal secretions
endometrial hyperplasia presentation
uterine bleeding in *post menopause*
Tx for endometrial hyperplasia with cytologic atypia? without?
with cytologic atypia: hysterectomy without cytologic atypia: cyclic progestin
Histological findings in endometriosis (3) - common sense
- benign endometrial glands - benign endometrial stroma - hemorrhage
2 most common locations of cutaneous involvement of endometriosis. What are the implants (of tissue) called?
- periumbilical region - C section scar -- implants are called *gun powder nodules* note: endometriosis can arise in virtually any part of body
asymptomatic pt w/ chronic endometritis should be tested for what organisms?
--b/c these cause Pelvin inflammatory disease
What are the 2 types of abnormal uterine bleeding? Due to?
1. organic -- due to lesion (e.g. carcinoma) 2. dysfunctional -- usually due to hormonal imbalance
chronic endometritis buzzword
*Plasmacytes* (plasma cells) in the endometrium --normally, no plasma cells in endometrium
Endometrial hyperplasia is caused by (3)
*unopposed estrogen stimulation* (obesity, polycystic ovarian disease, estrogen replacement therapy)
What is the cause of an anovulatory cycle?
*unopposed estrogen*; endometrium keeps proliferating until outgrows blood supply --> proliferative glands break down, slough off --> bleeding
What begins the proliferative phase? What's happening in the proliferative phase? UNDERSTANDING
GnRH from hypothilamus stimulates ant. pituitary --> FSH, LH release --> development of primary follicle --> primary follicle produces estrogen --> estrogen stimulates endometrial proliferation
What happens to the corpus luteum? What results? UNDERSTANDING
Corpus luteum degenerates to corpus albcians --> decreased estrogen, progesterone --> endometrium cannot support implantation --> endometrium sloughs off (menstrual phase)
What causes the LH surge? What does the LH surge do? What results? UNDERSTANDING
Estrogen stimulates GnRH from hypothilamus, stimulates FSH, LH from ant. pituitary --> inc. LH, FSH --> LH causes developing follicle to rupture (ovulation), releasing oocyte and forming corpus luteum
What does the corpus luteum produce? UNDERSTANDING
Estrogen and progesterone; progesterone maintains endometrium to support implantation
