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Know the phases of Menstration
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What are the Major causes of abnormal bleeding in?
Adosescence?
Perimenopausal?
Post menopausal?
- Anovulatory phase
-Anovulatory phase, Irrecular chedding, organic lesions (carcinoma or hyperplasia or polyps_
- Organic lesions, Endometrial atrophy
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DUB
This is a premenopausal term
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When is anovulatory phase common? What is the cause?
What could it cause?
- •Most common at menarche & perimenopausal
- - might be due to prolonged estrogen stimulation, but as of now no obvious cuase
-may produce hyperplasia and cystic atrophy when complete ovarian atrophy
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Inadequte corpus luteum. What is it do to?
Low progesterone--> early menses
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What is endometritis?
What causes it?
What will it presend as clinically?
What will you see?
- Chronic Endometritis is inflamation of the endometrium.
- -Caused by: PID, IUD, Retained products of conception.
- -Symptons include: Bleeding, Pain and Infertility.
- -See PLASMA CELLS
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 What is going on here? What will you see?
- This is Chronic Endometritis.
- See Plasma cells
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What is this? What might this patient get as a result?
This is IUD with Actinomycies infection. See Sulfur granules. Could cause Chronic Endometritis.
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What is Adenomyosis?
is it functional tissue?
–Endometrial glands and stroma within the myometrium
- Usually not but can be functional
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This is a pic of a patients Myometrium. What does this patient have?
Adenomyosis.
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What is Endometriosis?
Is it functional tissue?
What does the patient present with clinically?
What do you see?
–Displaced endometrial glands & stroma, outside of the uterine corpus
- Usually IS Functional - - Pelvic pain, Dysmenorrhea and infertility
- -See GUN POWER BURNS and CHOCOLATE CYSTS
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What does this patient have? What do you see?
Endometriosis
See Gunpowder burns
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- Endometriosis
- See Chocolate Cysts
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Endometrial Polyps
What can they cause?
What is its reaction to estrogen?
What do you see histologically?
- Common cause of uterine bleeding
- Anti estrogenic (tamoxifen)
–Disordered endometrial tissue with central thick walled vessels in stroma
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What is seen here?
See a thick walled vessel. Associated with Endometrial polyp
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What can endometrial Hyperplasia cause? In who?
What causes it?
Treat it?
It is a common cause of DUB in peri and postmenopausal women.
Condition of prolonged, unopposed estrogen stimulation
- Progesterone agents with follow up or hysterectomy
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This is Endometrial Hyperplasia
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Endometrial Intraepithelial Neoplasia (EIN)
What is it?
What mutation?
What do you see?
It is Atypical hyperplasia that is not reproducable
PTEN(tumor supressor) associated
Gland to stroma ration is increased
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What is the most common malignancy of the female genital tract, bypassing cervical?
What ages?
Risk factors?
Endometrial Adenocarcinoma
Postmenopausal(55+) women with PID/DUB
Obesity, DM, hypertension, interfility, Nulliparity, late menopause
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Endometrial Adenocarcinoma
What are the clinical finding?
Diagnosis?
see Uterine enlargement and Pelvic discomfort
EmBx
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See increase in Gland to stroma ratio as you move from left to right
= EIN
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What are the Types of Endometrial Adenocarcinoma? Which is most common?
Type 1: Endometriold (Most common 80%)
Type 2: Serous Carcinoma (clear cells carcinoma)
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Endometrial Adenocarcinoma Type one:
Age? Histology?
Prog?
Perimenopausal Women
Squamus metaplasia my be present
Good Prognosis
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Endometrial Adenocarcinoma Type 2:
Age?
Fact?
Prognosis?
Post menopausal women
Not associated with prolonged unopposed estrogen stimulation
Automatically a grade 3, More aggressive
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Endometrial Adenocarcinoma types?
Morphology?
Genetics?
Behavior?
Precursors?
- Type 1:
- -Endometriod
- -PTEN & p53
- -Indolent (non aggressive)
- -EIN
- Type 2:
- -Serous,clear cell
- -p53
- -agressive
- -EIC
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- Endometrial Adenocarcinoma type 1
- Endometrioid
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This is a p53 stain
- Endometrial Adenocarcinoma type 2
- Serrpus type
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What are the Endometrial Tumors with stromal elements?
Carcinosarcoma
Adenosarcoma
Pure stromal tumors
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What is Carinosarcoma?
What are the two types?
Age? Prog?
- It is a tumor of unterine corpus of MIXED
- epithelial and mesenchymal cell origen.
- 1. Homologous
- 2.Heterologous
Seen in elderly patients, poor prognosis
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What is this? what is another name for it?
This is a carniosarcoma
or Malignant mixed mullerian tumor
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Endometrial Stromal Lesions
What are the two types?
- Adenosarcoma
- -Low grad
- - present as a polyp
- Stromal tumors
- Benign verse malignant
- Relapses 80% or the time
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Myometrium: Smooth Muscle Neoplasms
What are the types?
Which is the most common type?
–Benign (Leiomyoma (“Fibroid”))-- Most common type
–STUMP (Smooth Muscle Tumor of Uncertain Malignant Potential)
–Malignant (Leiomyosarcoma)
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Leiomyoma presents as?
Where is it usually located?
Histological?
- –Well circumscribed white-tan nodules
- –Variable sizes, usually multiple
- - usually in the uterine corpus
- –Pushing, non-infiltrating borders
-
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Leiomyosarcoma
Clinical presentation?
How does it arise?
Gross distription?
- Histological discription?
- •Peri- and postmenopausal females
- –Vaginal bleeding, enlarging pelvic mass
usually arises de novo
–Large, soft, hemorrhagic tumors with areas of necrosis
- –Infiltrating borders
- –Increased mitotic activity & cellular atypia
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This is a Leiomyosarcoma
See Mitotic figues (increased replication)
Large, soft looking tumor with an area of necrosis.
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