Unit 2 - Endometrial Pathology

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52 Terms

1
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A thickened endometrium may be a sign of:

  • Early intrauterine pregnancy

  • Gestational trophoblastic disease

  • Endometrial hyperplasia

  • Secretory endometrium

  • Estrogen replacement therapy

  • Polyps

  • Tamoxifen/HRT

  • Endometrial cancer

2
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What is this image showing?

Thickened Endometrium

3
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What is this image showing?

Thickened Endometrium

4
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Endometrial hyperplasia is caused by:

Unopposed estrogen stimulation

5
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What is unopposed estrogen?

Estrogen dominance, there isn’t enough progesterone produced to keep up with the amount of estrogen.

6
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A premenopausal patient with endometrial hyperplasia, would have an endometrial thickness of _______.

+14mm

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An asymptomatic postmenopausal patient with endometrial hyperplasia, could expect to have an endometrial thickness of _______.

8mm {upper normal limit}

8
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A patient with endometrial hyperplasia on sequential estrogen & progesterone, could expect to have an endometrial thickness of _______.

15mm

9
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What is the most common cause of pre & postmenopausal abnormal bleeding?

Endometrial Hyperplasia

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Endometrial Hyperplasia is a possible precursor of ___________ _______.

Endometrial Cancer

11
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What is this image showing?

Endometrial Hyperplasia

12
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What is this image showing?

Endometrial Hyperplasia

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What are endometrial polyps?

Overgrowth of endometrial tissue

14
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What symptom is common with endometrial polyps?

Vaginal bleeding

15
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What is this image showing?

Endometrial polyps

16
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What are these images showing?

Endometrial polyps

17
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What is endometritis?

Inflammation / infection of the endometrium

18
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Endometritis most commonly occurs in association with…

  • PID

  • Postpartum

  • Following instrumentation of the uterus

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What is the ultrasound appearance of Endometritis?

  • Thickened endometrium

  • Irregular endometrium

  • Endometrial fluid

  • “Gas”

  • Retained tissue

20
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Most endometrial carcinomas are _____________ occurring in _____________ patients.

Adenocarcinoma, Perimenopausal

21
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Endometrial carcinoma has a strong association with…

Estrogen replacement therapy

22
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What is the earliest sign of endometrial carcinoma?

Thickened endometrium

23
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What are the advanced signs of endometrial carcinoma?

  • Uterine enlargement with lobular contour

  • Mixed echogenicity

  • Endometrial fluid collections

  • Abdominal pain

  • Bleeding (postmenopausal)

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If there is uterine enlargement, the carcinoma has invaded the ____________.

Myometrium

25
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What evidence may support the diagnosis of endometrial carcinoma?

  • Endometrial thickening

    • TV to measure thickness

  • Myometrial invasion

    • Clear evidence for CA

  • Synechiae/Asherman Syndrome

    • Bands of endo tissue

26
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What is this image showing?

Endometrial Carcinoma

27
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What is this image showing?

Endometrial Carcinoma

28
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What is synechiae?

Fibrous adhesions across the endometrial cavity

  • Walls become adhered to each other

  • Various degrees of adhesions

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What is another name for synechiae?

Asherman Syndrome

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What may be a result from synechiae?

  • Infertility

  • Amenorrhea

  • Oligomenorrhea

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Patients with synechiae may have a history of _____ &/or ______.

D&C, abortion

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What is the ultrasound appearance of synechiae?

Bright echoes within the endometrial cavity

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What is this image showing?

Synechiae / Asherman Syndrome

34
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What is considered Stage l of endometrial cancer?

  • Confined to endometrium of body

    • B, C = myometrial extension

35
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What is considered Stage ll of endometrial cancer?

Endometrium into cervix

36
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What is considered Stage lll of endometrial cancer?

  • Spread to pelvic area lymph nodes

    • Extended through the serosal layer

37
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What is considered Stage lV of endometrial cancer?

  • Mets to other organs

  • Extension into bladder/bowel

  • Distal lymph nodes

38
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Differential Considerations for the Uterus: thickened endometrium

  • Early intrauterine pregnancy

  • Endometrial hyperplasia

  • Retained products of conception or incomplete abortion

  • Trophoblastic disease

  • Endometritis

  • Adhesions

  • Polyps

  • Inflammatory disease

  • Endometrial carcinoma

39
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Differential Considerations for the Uterus: endometrial fluid

  • Endometritis

  • Retained products of conception

  • {PID} Pelvic inflammatory disease

  • Cervical obstruction

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What is this image showing?

A thickened endometrium

41
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What flow has been seen in patients with endometrial carcinoma?

Low resistance {RI <.4}

42
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What flow has been seen in postmenopausal patients with normal or benign endometrium?

High resistance {RI >.5}

43
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Tumor vascularity is a _______ sensitive indicator than RI alone

More

44
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What is the normal measurement for a small endometrial fluid collection?

< 2 ml

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It is normal to find small endometrial fluid collections during the….

Normal menstrual cycle

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With postmenopausal patients, when is it normal to see endometrial fluid collections?

  • Sequential hormones

  • Endometrial atrophy

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Is the fluid collection included in the endometrial measurement?

No, do not measure the fluid collection

48
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What is this image showing?

Small endometrial fluid collection

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Large endometrial fluid collections can be ________, and should be investigated to find a cause.

Suspicious

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A large endometrial fluid collection may be a sign of:

  • PID

  • Pyometra

  • Hematometra

  • CA’s

  • Cervical stenosis

  • Congenital anomalies

51
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What is this image showing?

Large endometrial fluid collection

52
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What is this image showing?

Cervical stenosis

  • In a postmenopausal patient