Obgyn Path Endometrium & Myometrium

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normal proliferative phase

Hint 1

endometrium under the influence of estrogen. glands have straight tubular appearance, dense and mitotically active stroma

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normal secretory phase

Hint 2

endometrium post ovulation, under the influence of progesterone. increasingly complex glands w/ edematous stroma, vascular changes, & pseudodecidual rxn

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normal menstrual phase

Hint 3

glands degenerate, stroma invaded by neutrophils

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post implantation endometrium

Hint 4

hobnailing of endometrium following implantation (hCG) w/ hypersecretory glands (Aria-Steele)

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post menopausal endometrium (mostly myometrium)

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inactive endometrium w/ atrophic glandular epithelium resulting from estrogen withdrawal

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endometritis

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acute: s/p ascending cervical infection, PMN infiltrate
chronic: s/p IUD, PID, retained POC, plasma cell & lymphocyte infiltrate

symptoms: abnormal bleeding, pelvic pain, pyometra w/ endocervical canal blockage (increased squamous endometrial carcinoma risk)

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adenomyosis

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hormonally responsive endometrial glands and stroma present in myometrium
enlarged uterus w/ reddish myometrium w/ cyst foci (not to be confused w/ adenocarcinoma)

symptoms: pelvic pain, abnormal bleeding, dysmenorrhea, dyspareunia, regression w/ menopause

tx: hysterectomy, or tx symptoms

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endometriosis

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endometrial glands/stroma outside the uterus, 5-10% young women
endometrial reflux through fallopian tube during menopause (most widely accepted theory)
reddish hemorrhagic lesions become cystic --> chocolate cysts --> cyclic bleeding
additional symptoms: dysmenorrhea, pelvic pain, dyspaneuria, 1-2% develop adenocarcinoma

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endometrial polyp

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benign proliferative lesions, typically in perimenopausal women. result from focal hypersensitivity of endometrial glands to estrogen. may show cystic of hyperplastic changes. may be associated w/ bleeding, 0.5% develop to adenocarcinomas

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endometrial hyperplasia

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pre neoplastic process occuring as a result of unopposed estrogen stimulation (PCOS, granulosa cell tumor, obesity, exogenous estrogen therapy)
simple - mild glandular complexity w/out atypia (1% progress to adenocarcinoma)
complex hyperplasia - marked glandular complexity w/out atypia (3%)
atypical hyperplasia - marked glandular complexity w/ atypia (25%)
symptoms: abnormal uterine bleeding
tx: reduce estrogen stimulation, hysterectomy

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endometrial adenocarcinoma

Hint 11

typically post-menopausal, endometroid differentiation following effects of increased or unopposed estrogen. increased risk w/ breast or ovarian cancer.
papillary growth invading the myometrium
endometrioid (60%) - glandular structures, nuclear atypia
secretory - well differentiated
serous - well differentiated, non-estrogen dependent, poor prognosis
clear cell - non-estrogen dependent, poor prognosis
post menopausal bleeding
metastasizes to paraortic lymph nodes

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Endometrial Intraepithelial Neoplasia

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alternative method to dx proliferative endometrial lesions. loss of PTEN (tumor suppressor) function. pre neoplastic lesion

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endometrial adenocarcinoma
Serous (top R) clear cell (bottom R)

Hint 13

typically post-menopausal, endometroid differentiation following effects of increased or unopposed estrogen. increased risk w/ breast or ovarian cancer.
papillary growth invading the myometrium
endometrioid (60%) - glandular structures, nuclear atypia
secretory - well differentiated
serous - well differentiated, non-estrogen dependent, poor prognosis
clear cell - non-estrogen dependent, poor prognosis
post menopausal bleeding
metastasizes to paraortic lymph nodes

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endometrial stromal sarcoma

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polypoid growth, derived from stromal cellls, invades myometrium & uterine vessels. resembles proliferative phase stroma, recurrence common

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leiomyomas

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benign tumor of myometrial origin, 75% of women, regression w/ menopause. uniform spindle cells in interlacing bundles, low mitotic rate, lack nuclear atypia & extensive necrosis
symptoms: bleeding, discomfort, compression of adjacent structures
tx: myomectomy, hysterectomy, ablation

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leiomyoma

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benign tumor of myometrial origin, 75% of women, regression w/ menopause. uniform spindle cells in interlacing bundles, low mitotic rate, lack nuclear atypia & extensive necrosis
symptoms: bleeding, discomfort, compression of adjacent structures
tx: myomectomy, hysterectomy, ablation

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leiomyosarcoma

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malignant neoplasm arising from myometrium. large areas of necrosis, high mitotic rate, nuclear atypia, 5 yr survival < 20%