Endometrium

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Endometrium

• Dr. Raid Jastania

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Dysfunctional Uterine Bleeding

• Menorrhagia, intermenstrual bleeding
• Causes
• DUB
• Organic (structural) causes

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Dysfunctional Uterine Bleeding

• Menorrhagia, intermenstrual bleeding
• Causes
• DUB
• Organic (structural) causes
• Cervix CIN, carcinoma
• Endometrium polyp, hyperplasia, carcinoma,
  endometriosis
• Pregnancy related endometritis, retained
  products, tumors
• Myometrium Adenomyosis, Leiomyoma, Leiomyosarcoma

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Dysfunctional Uterine Bleeding

• DUB
• 1. Anovulatory cycle
• 2. Inadequate Luteal phase
• 3. Contraceptive-induced bleeding

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Dysfunctional Uterine Bleeding

• DUB
• 1. Anovulatory cycle
• Very young, or elderly
• Hormonal hypothalamic-pituitary, thyroid,
  adrenal, ovary
• Malnutrition, obesity, severe emotional stress
• Findings Proliferative phase endometrium,
  disordered, no secretory phase

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Dysfunctional Uterine Bleeding

• DUB
• 2. Inadequate Luteal phase
• Lack of progesterone
• Findings delay in secretory phase

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Dysfunctional Uterine Bleeding

• DUB
• 3. Contracepitve-induced bleeding
• With the old oral contraceptives
• Discordant appearance of gland and stroma

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Endometritis

• Acute infection, follow delivery or abortion
• Retained products of conception
• Chronic
• Chronic gonorrhea
• T.B
• Retained products of conception
• IUD
• Spontaneous chronic infection
• Findings
• acute infection neutrophils, necrosis
• Chronic infection Lymphocytes, plasma cells

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Endometriosis

• Endometrial foci outside the uterus
• Results in dysmenorrhea, infertility
• Common in pelvis, ovary, tube, ligaments, or any
  other sites
• Theory
• Regurgitation theory
• Metaplastic theory
• Vascular and lymphatic dissemination theory

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Endometriosis

• Findings
• Red-blue-brown nodules, solid/cystic chocolate
  cyst
• Foci of endometrium
• Endometrial glands
• Endometrial stroma
• Bleeding, hemosidrin
• Complications adhesions, infertility, pain,
  dysuria, dyspareunia

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Adenomyosis

• Endometrial foci within the myometrium
• Usually of the basal layer endometrium
• Usually non-functioning
• Findings
• Thick uterine wall with small cystic areas
• Endometrial tissue in the myometrium
• Symptoms pain, menorrhagia, dysmenorrhea

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Endometrial Hyperplasia

• Excess estrogen
• Anovulatory cycle
• Estrogen intake
• Tumors (or conditions) secreting estrogen
  polycystic ovary, granulosa cell tumor, thecoma
• Classification
• Simple hyperplasia (with or without atypia)
• Complex hyperplasia (with or without atypia)
• Complex hyperplasia with atypia 20-25 progress
  to endometrial carcinoma

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Tumors of the endometrium

• Endometrial polyps
• Endometrial carcinoma

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Tumors of the endometrium

• Endometrial polyps
• ?neoplastic
• Benign
• Findings
• Polypoid sessile 0.5-3 cm
• Normal endometrium, cystic change
• Symptoms menorrhagia
• Rarely associated with hyperplasia or carcinoma

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Tumors of the endometrium

• Endometrial carcinoma
• US the most common cancer of the female genital
  tract
• 55-65 years
• Risk factors
• Obesity
• DM, hypertension
• Infertility
• Previous hyperplasia

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Tumors of the endometrium

• Symptoms Menorrhagia, mass, pain
• Types
• Endometrioid adenocarcinoma
• Serous carcinoma
• Clear cell carcinoma

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Tumors of the endometrium

• Endometrial carcinoma
• Types
• Estrogen dependent
• Endometrioid adenocarcinoma
• 55-65 year
• Follow hyperplasia
• Mutation of PTEN gene
• Estrogen independent
• Serous carcinoma and Clear cell carcinoma
• Elderly 70 years
• P53 mutation
• High grade by definition, poor prognosis

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Tumors of the endometrium

• Endometrial carcinoma
• Survival 5-year survival
• Stage I (limited to uterine cavity) 90
• Stage II (extend to cervix) 50
• Stage III (outside the uterus) 20

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Tumors of the Myometrium

• Leiomyoma
• Leiomyosarcoma

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Tumors of the Myometrium

• Leiomyoma
• Most common benign tumor in female
• 30-50 of women at reproductive age
• BlackgtWhite
• ?Estrogen related
• Shrink postmenopausal
• Clinically asymptomatic, mass lesion,
  menorrhagia

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Tumors of the Myometrium

• Leiomyoma
• Findings
• Sharply circumscribed , firm, white gray, whorled
  cut surface
• Intramural, submucosal, subsersal
• Smooth muscle bundles
• Secondary changes cystic change, hemorrhage,
  degeneration

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Tumors of the Myometrium

• Leiomyosarcoma
• Malignant
• De novo (rarely arise in leiomyoma)
• Large mass, infiltrating the wall, or polypoid,
  sometime similar to leiomyoma
• Smooth muscle bundles Mitosis, atypia, necrosis
• Overall 5-year survival 40

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• A massively obese (5'3", 275 pounds),
  55-year-old, sexually active woman, nulligravida
  (no pregnancies), presented to her gynecologist
  because of vaginal spotting for 1 year. Her
  medical history included non-insulin-dependent
  diabetes mellitus and medically controlled
  hypertension, both diagnosed at age 43. Her
  gynecologic history included menarche, age 11
  coitarche, age 20 lifetime sexual partners, 2 6
  menses/year until age 51 when she became
  menopausal and her menstrual periods stopped.

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• An endometrial biopsy yielded abundant tissue.

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• Following the biopsy, the patient was lost to
  follow-up for 8 years. She is now brought to the
  ER after fainting at home. Her hemoglobin is 5
  g/dL. Endometrial biopsy is repeated, followed by
  a simple hysterectomy with bilateral
  salpingo-oophorectomy.

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