Endometrium Dr. Raid Jastania. Dysfunctional Uterine Bleeding Menorrhagia, intermenstrual bleeding...

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Endometrium Dr. Raid Jastania
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Transcript of Endometrium Dr. Raid Jastania. Dysfunctional Uterine Bleeding Menorrhagia, intermenstrual bleeding...

Page 1: Endometrium Dr. Raid Jastania. Dysfunctional Uterine Bleeding Menorrhagia, intermenstrual bleeding Causes: –DUB –Organic (structural) causes.

Endometrium

Dr. Raid Jastania

Page 2: Endometrium Dr. Raid Jastania. 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

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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

Page 37: Endometrium Dr. Raid Jastania. Dysfunctional Uterine Bleeding Menorrhagia, intermenstrual bleeding Causes: –DUB –Organic (structural) causes.

Tumors of the Myometrium

• Leiomyoma– Most common benign tumor in female– 30-50% of women at reproductive age– Black>White– ?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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