Endometrial Hyperplasia and Carcinoma
What drives growth of endometrium? - ANS-Estrogen (proliferative phase)
What drives preparation of endometrium for implantation? - ANS-Progesterone
(secretory phase)
What is acute endometritis, and how does it present? - ANS-Bacterial infection of
endometrium 2/2 retained products of conception
Fever, abnormal uterine bleeding, & pelvic pain
What is chronic endometritis, and how does it present? - ANS-Chronic inflammation of
endometrium 2/2 retained products of conception, PID, IUD, & TB
Abnormal uterine bleeding, pelvic pain, & infertility
What are histologic features of chronic endometritis? - ANS-Plasma cells
What are endometrial polyps, and how do they present? - ANS-Hyperplastic protrusion
of endometrium
Abnormal uterine bleeding
What are causes of endometrial polyps? - ANS-Side effect of tamoxifen (anti-estrogen
in breast, pro-estrogen in endometrium)
What is endometriosis, and how does it present? - ANS-Endometrial glands & stroma
outside uterine endometrial lining
Dysmenorrhea & pelvic pain, may cause infertility
What are causes of endometriosis? - ANS-Retrograde menstruation theory = prevailing
theory
Metaplastic theory: endothelial metaplasia of mullerian duct
Lymphatic dissemination theory
What are the common sites of endometriosis? - ANS-Ovary = most common —>
chocolate cyst (gunpowder lesions if involving soft tissue)
Uterine myometrium = adenomyosis
Uterine ligaments —> pelvic pain
Pouch of Douglas —> pain w/ defecation
Bladder wall —> pain w/ urination
What is adenomyosis? - ANS-Uterine thickening that occurs when endometrial tissue
moves into muscular walls of uterus (rather than just lining uterus) = endometriosis w/in
myometrium
What are complications of endometriosis? - ANS-Increased risk of carcinoma at site of
endometriosis, esp. ovary
What is endometrial hyperplasia, and how does it present? - ANS-Hyperplasia of
endometrial glands relative to stroma 2/2 unopposed estrogen
Postmenopausal uterine bleeding
What are histologic features of endometrial hyperplasia? - ANS-Based on architectural
growth & cellular atypia
What is the most important predictor for progression of hyperplasia to carcinoma? -
ANS-Cellular atypia
What are complications of endometrial hyperplasia? - ANS-Increased risk of
endometrial carcinoma
What is endometrial carcinoma, and how does it present? - ANS-Malignant proliferation
of endometrial glands
Postmenopausal or abnormal uterine bleeding —> endometrial stripe thickness > 5 mm
on transvaginal US
What are risk factors for endometrial carcinoma? - ANS-Unopposed estrogen
Tamoxifen
Late menopause
PCOS
Obesity
Granulosa cell tumor
Lynch syndrome
What are the pathways that lead to endometrial carcinoma? - ANS-Type I: unopposed
estrogen —> endometrial hyperplasia —> endometrial adenocarcinoma (in women age
50-60, heavier)
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