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22 Cards in this Set

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  • Back
What are the indications for an endometrial biopsy?
1) Abnormal uterine bleeding

2) Assess endometrial response to hormone therapy

3) Evacuation of products of conception

4) Evaluation of endometrium in infertile patients
When does one see histological changes associated with ovulation in endometrium?
Between 36 and 48 hours.

First sign: Abundant subnuclear vacuoles (that will eventually be secreted into the lumen)
What does proliferative endometrium look like?
1) Mitosis visible

2) STACKS of stratified nuclei
What does secretory endometrium look like?
SINGLE ROW of nuclei.

What are the progressive changes in secretory endometrium?
Day 17 of menstrual cycle: First changes post-ovulation

By Day 20-21, there are INTRALUMINAL secretions

By Day 23-24 there start to be PREDECIDUAL changes around the spiral arteries (in preparation for implantation)

By Day 26-27, there are confluent sheets of predecidua.
What are some causes of abnormal uterine bleeding?
Cancer...(more likely older patients)

Endometriosis, fibroids, polyps. (leiomyomas, endometriosis, polyps are more common in reproductive years and perimenopause)

Pregnancy complications (younger patients)

Anovulatory cycles (adolescents and perimenopausal).

Atrophy (menopause)
What are common finds in Dysfunctional Uterine Bleeding?
Stromal and glandular BREAKDOWN.

Indicates ovulatory dysfunction.

No underlying genetic disorder.

EXCLUDES Cancer and other pathologic processes.

NO PROGESTERONE, so ONLY proliferative tissue. UNCONTROLLED estrogen leads to continuous proliferation.

BLUE BALLS! Stroma starts to breakdown and then collapse into balled structure.
What is the cause of endometrial atrophy?
Lack of ESTROGEN stimulation. Cause of 25-50% of abnormal uterine bleeding in postmenopsusal.

LINING of glands is flat (no mitosis). Glands are cystically enlarged. Stroma is less cellular and fibrotic. Will also see blood and strips of bland epithelial cells.
Who will likely have polyps?

Where do polyps arise from?
Women in their 4th and 5th decades.

Arise from LOCAL HYPERPLASIA of endometrium
What will you see histologically from polyps?
Thickened, enlarged blood vessels.

Crowded, irregular glands.

Dense stroma.
Where do leiomyomas come from?
BENIGN smooth muscle tumors.

Can arise from ovaries, cervix, corpus, uterine ligaments.

ESTROGEN SENSITIVE! Increase in size during pregnancy, then regress after menopause.
What are the common symptoms of LEIOMYOMAS?
Intramural: Uterine enlargement!

Subserosal: Pelvic mass/abdominal pain.

Submucosal: Irregular bleeding, painful menses, spontaneous abortions, infertility.
Where are three sites where leiomyomas can arise within the uterus?
Subserosal / intramural / submucosal.
What is another term for leiomyoma?
What are morphologic and histologic features of BENIGN leiomyomas?

Solid, white/tan

Well circumscribed.

UNIFORM, oval, cigar-shaped nuclei. Spindled cells. Abundant cytoplasm.

Leiomyosarcomas transform from leiomyomas?

Leiomyosarcomas are common in African-Ameriacns and patients on tamoxifen.
What are histological features of a leiomyosarcoma?
Malignant, poorly defined borders.

FLESHY, not rubbery. Necrosis and hemorrhage

ALOT OF MITOTIC ACTIVITY. In leiomyomas, there is rare mitotic activity.
Who gets endometriosis? What tissues are involved?
Women in their reproductive years.

Endometrial tissue growth (both glandular and stromal) OUTSIDE uterine cavity.
Where is endometrial tissue most likely found in endometriosis?
Ovaries and along pelvic peritoneum. Fallopian tubes too.
What are risk factors for endometriosis?

Increased exposure to menstruation. Longer duraction of flow, etc.

OCP's DECREASE risk, as are woman with multiple pregnancies.
What are the three theories of endometriosis?
TRANSPLANTATION: Menstrual products retrograde flow into peritoneal cavity.

METAPLASIA of peritoneum

INDUCTION of undifferentiated mesenchyme in ectopic sites to form endometriotic tissue.
What are symptoms of endometriosis?
Abnormal uterine bleeding

Painful intercourse


Ascites can be present, pelvic mass