Uterus and Endometrium

Functional Endometrial Disorders (Dysfunctional Uterine Bleeding)
1. Causes per age
  1. Prepuberty
    1. percocious puberty
  2. Adolescence
    1. anovulatory cycle, coagulation disorders
  3. Reproductive Age
    1. complications of pregnancy, anatomic lesions, anovulatory cycle, ovulatory dysfunctional bleeding
  4. Perimenopausal
    1. anatomic lesions, anovulatory cycle
  5. postmenopausal
    1. endometrial atrophy, anatomic lesions
2. Anovulatory cycle
  1. causes
    1. endocrine: thyroid disease, adrenal disease, pituitary tumors
    2. ovarian lesions: ovarian tumor or PCOS
    3. metabolic: obesity, malnutrition
  2. excessive estrogens unopposed by progesterone
  3. lack progesterone made features
3. Inadequate Luteal Phase
  1. increased bleeding or amenorrhea
  2. low P
Inflammatory Disorders
1. Acute Endometritis
  1. infections after dilivery or miscarriage
2. Chronic Endometritis
  1. PID, retained gestational tissue, postpartum, post abortion, IUD, TB
  2. plasma cells in stroma
Endometriosis and Adenomyosis
1. ectopic endometrial tissue
  1. ovaries, uterine ligaments, pouch of Douglas, cul de sac, pelvic peritoneum, large and small bowel, and more
  2. infertility, dysmenorrhea, pelvic pain
  3. regurgitation theory
    1. others: benign metastases, metaplastic, extrauterine stem
  4. release of proinflammatory factors
    1. increased estrogen production
  5. link to ovarian cancer
    1. PTEN, ARID1A
2. adenomyosis
  1. endometrial tissue within uterine wall
  2. irregular menses, dysmenorrhea, dyspareunia, pelvic pain
3. Endometrial Polyps
  1. project into endometrial cavity
  2. stromal cells with chromosomal rearrangements
    1. neoplastic, glands along for ride
Endometrial Hyperplasia
1. cause of abnormally bleeding, precursor of endometrial carcinoma
2. hyperplasia from prolonged estrogenic stimuation
3. obesity, menopause, PCOS, granulosa cell tumors, excessive ovarian cortical, prolonged estrogen administration
4. inactivation of PTEN
  1. encodes lipid phosphatase
Malignant tumors of endometrium
1. carcinoma of endometrium
  1. Type I
    1. common type
    2. endometrial carcinoma
    3. endometrial hyperplasia
      1. obesity, diabetes, HTN, infertility, estrogen stim
    4. mutations of PI3K/AKT
    5. indolent, spread in lymphatics
    6. endometrioid
  2. Type II
    1. atrophy
    2. serous, clear cell, mixed mullerian tumor
    3. precursor: serous endometrial intraepithlial carcinoma
    4. TP53, aneuploidy
    5. aggressive tumor
2. Malignant Mixed Mullerian Tumors
  1. carcinosarcomas
  2. tumors can look like mesenchymal elements, heterologous malignant cell types
  3. PTEN, TP53, PIK3CA
Tumors of Endometrial Stroma
1. Adenosarcomas
  1. large endometrial polypoid growths
  2. malignant potential
2. stromal tumors
  1. resemble normal stromal cells
  2. benign or stromal sarcomas
    1. chromosomal aberrations in sarcomas
      1. translocation of JAZF1
Tumors of Myometrium
1. Leiomyomas
  1. fibroids, benign
  2. normal karyotypes
  3. abnormal bleeding, urinary frequency, impaired fertility
2. Leiomyosarcomas
  1. malignant
  2. irregular size, hyperchromatic nuclei

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Uterus and Endometrium

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	Created by Jeff Amos about 10 years ago