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51 Cards in this Set
- Front
- Back
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What are the 4 indications for an endometrial biopsy?
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1. Determine cause of abnormal uterine bleeding
2. Evaluate endometrium in infertile patients (no longer done) 3. Evacuation of products of conception 4. Assess the response of endometrium to hormonal therapy |
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What are the 2 questions being answer in an endomerial biopsy looking at infertility?
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1. Is there morphologic evidence of ovulation?
2. Histologic Date |
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What are the histologic features of proliferative endometrium?
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1. Round, regular glands
2. Stratified nuclei |
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What are the histologic features of secretory endometrium (day 17)?
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1. Uniform subnuclear vacuoles
2. Single row of nuclei |
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What are the histologic features of secretory endometrium (day 20-21)?
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1. Intraluminal secretions
2. Marked stromal edema (naked nuclei) |
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What are the histologic features of secretory endometrium (day 23-24)?
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1. Prominent spiral arteries
2. Predicidual change around spiral arteries |
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What are the histologic features of secretory endometrium (day 26-27)?
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1. Confluent sheets of predecidua (cells with prominent pink cytoplasm)
2. Lymphocytes (little dark nuclei) |
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What is menorrhagia?
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Excessive bleeding in both amount and duration of flow occurring at regular intervals
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What is metrorrhagia?
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Bleeding, usually not heavy, occuring at irregular intervals
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What is menometrorrhagia?
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excessive bleeding with prolonged period of flow occurring at frequent and irregular intervals
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What is dysmenorrhea?
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Painful menses
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What is postmenopausal bleeding?
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Abnormal bleeding that occurs at least one year after menopause
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What is dysfunctional uterine bleeding (DUB)?
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Ovulatory dysfunction with alteration of the normal cyclical hormonal stimulation of the endometrium
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Is there an underlying organic disorder in DUB?
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NO
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DUB, by definition, excludes what 2 items?
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1. Postmenopausal bleeding
2. Presence of specific pathological processes |
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What is the common histological finding in DUB?
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Stromal and glandular breakdown
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What is a hallmark histological feature of DUB?
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Stromal blue balls
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Why is bleeding seen in DUB?
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Because endometrium outstripped the blood supply
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What causes 25-50% of abnormal uterine bleeding in postmenopausal women?
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Endometrial atrophy
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Endometrial atrophy is due to what?
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Due to lack of estrogen stimulation
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What type of the change in glands is common in endometrial atrophy?
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Cystic change of galnds (may result in thickened endometrial stripe)
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What are the histologic features of endometrial atrophy?
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1. Stroma is less cellular and fibrotic
2. Glands are cystically enlarged 3. Scant strips or bland epithelial cells and blood |
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Endometrial polyps originate from where?
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Localized hyperplasia of the basal endometrium - focal lesion
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Endometrial polyps present with what?
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Abnormal bleeding
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Is there a malignant potential in endometrial polyps?
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NO
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Is the whole endometrium involved in an endometrial polyp?
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NO, localized
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What connects a polyp to the myometrium/endometrium?
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Stalk
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What is a leimyoma?
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Benign smooth muscle tumor
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What is another term for a leimyoma?
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Fibroid
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The etiology of leiomyomas has to do with what?
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Hormones
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There is accelerated growth of fibroids with what?
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Tamoxifen
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An intramural leimyoma is found where?
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In the wall of the uterus
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Why might a patient with a leimyoma think they're pregnant?
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Due to uterine enlargement
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What are 3 complications of a large, pedunculated subserosal leiomyoma?
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1. Torsion
2. Infarction 3. Separation from uterus - parasitic leimyoma |
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Why might a patient with a leiomyoma bleed more readily?
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Due to the thinning of endometrium over leiomyoma
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What is the difference between an endometrial polyp and a submucosal leiomyoma?
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Leiomyoma arises from myometrium and "pushed up"
Polyp arising from endometrium |
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What are 4 characteristics of a typical cut surface of a leiomyoma?
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1. White
2. Whorles 3. Well Circumscribed 4. Protrudes |
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What are 2 characteristics histologically of a leiomyoma?
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1. Uniform, bland spindled cells
2. Fascicular arrangement |
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What is a leoimyosarcoma?
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Malignant counterpart of leiomyoma
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Do leimyomas progress to leomyosarcomas?
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NO
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What gross features are suspicious for malignancy?
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1. Loss of whorled pattern
2. Homogeneous 3. Margin not well defined, irregular |
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What type of cells are seen in a leiomyosaroma?
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Bizarre giants
Marked nuclear atypia |
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What is endometriosis?
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Endometrial tissue outside the uterine cavity
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what are the most frequent sites of endometriosis?
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1. Pelvic peritoneum
2. Ovaries |
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What are 2 factors that reduce the risk of endometriosis?
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1. Multi-pregnancies
2. Oral contraceptive use |
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What are the 3 theories for the pathogenesis of the endometriosis?
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1. Transplantation of endometrial fragments to ectopic sites
2. Metaplasia of peritoneum 3. Induction of undifferentiated mesenchyme in ectopic sites to form endometriotic tissue |
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How can a woman get blood in their pelvis?
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Retrograde flow during menses
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How does retrograde blow fit into the transplantation theory?
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Explains most common sites of endometriosis
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The gross appearance of endometriosis is variable reflecting what?
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The functional state (how far healed)
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Endometriotic cysts of ovary look like what?
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"Choclate Cyst)
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What is adenomyosis?
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Presence of endometrial tissue within the uterine wall (myometrium)
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