Endometrial Conditions/IUD Complications – Flashcards
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What is Endometrial Hyperplasia, and when does it usually occur?
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Endometrial hyperplasia is the overgrowth of ENDOMETRIAL GLANDS & STROMA. It usually occurs around Menopause.
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List two forms of Endometrial Hyperplasia, and which type can be malignant?
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Endometrial Hyperplasia with cytological atypia and without cytological atypia. Endometrial Hyperplasia with cytological atypia may progress into invasive endometrial malignancy.
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What is major symptom of Endometrial Hyperplasia?
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All endometrial hyperplasias, regardless of their malignant potential, may cause significant blood loss through heavy and irregular vaginal bleeding.
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What causes or conditions are risk factors for Endometrial Hyperplasia, and what do they all have in common?
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-Women near menopause -anovulation -being overweight -diabetes -polycystic ovarian syndrome -unopposed estrogen hormone therapy *All of these factors, similar to edometrial cancer, are caused by medications or conditions that continuously produce estrogen.
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What specific medication causes Endometrial Hyperplasia, and what are the symptoms?
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Tamoxifen is a mixed estrogen agonist-antagonist used extensively in the treatment of postmenopausal women with estrogen receptor-postive breast cancers. Symptoms: -Abnormal bleeding -Enlarged uterus -Pelvic mass (estrogen-producing ovarian tumor)
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What is the ultrasound appearance of endometrial hyperplasia?
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-Enlarged thickened endometrial stripe -Postmenopausal w/ no HRT >5mm -Postmenopausal with HRT >8mm -Inhomogenous (malignancy risk) -Tiny internal cysts
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Who needs an endometrial biopsy?
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Patients presenting with: -Posmenopausal bleeding -Postmenopausal endometrial cells on Pap smear -Perimenopausal intramenstrual bleeding -Abnormal bleeding w/ history of anovulation -Thickened endometrial stripe via sonography -Infertility
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What percentage of cancers affecting the uterine body are endometrial carcinomas?
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90%!!!!!!!!
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Describe endometrial cancer, and what causes it?
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Endometrial cancer is an invasive cancer of the endometrial lining of the uterus that most commonly arises from a background of endometrial hyperplasia. It is a consequence of unopposed endogenous or exogenous estrogen on a hormonally responsive endometrium.
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What is the most common gynecological malignancy? Who most commonly gets endometrial cancer?
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ENDOMETRIAL CANCER Perimenopausal and postmenopausal women are predominantly affected.
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What is the HALLMARK symptom of endometrial cancer?
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Perimenopausal or postmenopausal bleeding.
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What tests are warranted when someone presents with perimenopausal or postmenopausal bleeding?
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The doctor will perhaps order a transvaginal ultrasound in order to measure the endometrial stripe and possibly perform endometrial biopsies.
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What percentage of endometrial cancer has abnormal results on PAP SMEAR?
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50%
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What is the standard treatment for endometrial cancer?
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Hysterectomy, further treatment depends on the pathological and surgicall findings.
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What is the ultrasound appearance of Endometrial Cancer?
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-Prominent, abnormally enlarged, inhomogenous endometrium. -Indistinct and distorted endometrial-myometrial border(measuring is hard) -Increased uterine size -Bulbous lobulated contour - Focal areas of thickness -Increased vascularity
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What is Asherman's Syndrome?
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Also known as Intrauterine adhesions. Asherman's Syndrome is partial or complete obliteration of the endometrial cavity by adherance of the uterine walls from scarring. Scarring causes fibrous adhesions or synechiae, which can obliterate the endometrial cavity.
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What are some causes of Asherman's Syndrome?
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Patients may have a history of instrumentation or illness that has scarred the endometrial canal. Can be a cause of secondary infertility following therapeutic abortions.
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What should arouse suspicion of Asherman's syndrome?
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Amenorrhea following D&C or endometritis.
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What exam is used to visualize the endometrium better for people that have Asherman's Syndrome?
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A Hysterossalpingogram can be used to visualize these intrauterine adhesions.
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What are signs and symptoms of Asherman's Syndrome? What would a patient with Asherman's be at risk for if they conceive?
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Menstrual or reproductive abnormalities (amenorrhea, hypoomenorrhea, dysmenorrhea infertility, and recurrent abortion) If a person with Asherman's conceives there is a high incidence of complications including premature labor, placenta accreta, placenta previa, and postpartum hemorrhage.
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What is the ultrasound appearance of Asherman's syndrome?
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-Echogenic endometrium due to the presence of mutliple adhesive bands. -Endometrium can be normal or thickened. -Adhesionscan appear hypechoic when contrasted against the background of a secretory endometrium. -Adhesions can cause a discontinuity of the normal endometrial stripe.
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What are endometrial polys?
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Endometrial Polyps are hyperplastic overgrowths of glands and stroma that are localized to form a projection from the basal layer of the endometrium, this is why they do not slough off during menstruation.
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What are polyps usually attached by, and how much do they usually measure?
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Polyps are usually connected by a stalk, pedunculated. (If no stalk is present is called sessile.) They can range in size from 0.5cm-3.0 cm in size. (Can be single or multiple)
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In what age group are polyps least common, and most common?
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Incidence of endometrial polyps are rare in anyone younger than 20 years old. They are more common in increasing age, peaking in the fifth decade of life. The incidence declines after menopause.
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What kind of cancer rarely develops in a endometrial polyps?
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Adenocarcinoma
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What are some signs and symptoms of endometrial polyps?
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-Endo polyps can be asymptomatic if small. -Symptoms can include: excessive bleeding during menstrual period, or bleeding between periods, or even spotting after intercourse. -Bleeding symptoms may be from the polyps dangling from their stalks, irritating the surrounding tissue, it can cause the tissue to rub off, exposing tiny blood vessels.
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What is the ultrasound appearance of Endometrial Polyps?
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-Most are hyperechoic (compared to proliferative endometrium) discrete focal masses within the endometrial canal. -The best time to view a polyp is during the proliferative phase bc they will appear hyperechoic compared to the normal endo & will cause localized thickening. -During secretory phase the polyp can blend in with the background. -Color DOPPLER will demonstrate a VASCULAR STALK -Similar in appearance to submucosal fibriods.
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Which exam can be used to differentiate a polyp from a uterine fibroid?
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Hysterosonography
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What things can be associated with Endometrial Fluid?
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It can be normal in trace amounts, but it may be associated with other pathological processes
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What is the term used to describe retained secretions within the endometrial cavity secondary to obstruction.
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Hydrometra
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When fluid is in the endometrial canal how do you measure the endometrium?
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DO NOT INCLUDE THE FLUID! Measure each layer of endometrium separately, and then add together.
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What are some differentials for Endometrial Fluid?
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-Pregnancy/Ectopic pregnancy -Obstructive process (congenital, malignant, or iatrogenic) -Menstrual blood, pus or serous fluid -Semen
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What is the oldest form of birth control, and in what year did its popularity peak in the US?
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IUD intrauterine devices or intrauterine contraceptive devices. Their popularity peaked in 1960
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When and how are the IUDs placed?
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IUDs are inserted through the cervix during menstruation and are placed in the endometrial canal. In order to be effective, IUDs need to be placed in the fundus of the uterus.
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How do IUDs work?
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They work by creating a sterile inflammatory reaction in the endometrium, which prevents implantation.
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What are some complications related to IUDs?
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-Malposition (Can travel to peritoneal cavity) anywhere that is not the endometrial canal or fundus. -Perforation, myometrial penetration, bc of improper insertion. -Infection -Ectopic pregnancy -PID -Intrauterine pregnancy, in order to prevent torch infections it is taken out in the 1st trimester. -Expelled IUD if string is not located
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What are some indications for an ultrasound exam for an IUD?
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-An ultrasound demonstrates malposition, perforation, and incomplete removal. Also, it would demonstrate if there is a coexisting intrauterine pregnancy or ectopic pregnancy.
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What are synechiae?
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Permanent endometrial adhesions to the endometrial walls.
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What are the stages of endometrial cancer?
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Stage 1-Confined to uterus Stage 2- Spreads to involve uterus Stage 3- Spreads beyond uterus but confined to true pelvis Stage 4-METS or bowel/bladder involvement
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What is endometritis? What causes it?
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Inflammation/infection of the endometrium. Occurs with PID, after delivery, after prolonged labor,chorioamnionitis, after D&C, with retained products of conception. Most common in post partum patients (following c-section)
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What are the symptoms of endometritis?
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-Post partum fever, fever in general -pain -irregular discharge -bleeding -elevated WBC count -odorous discharge
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What will you see on ultrasound of endometritis?
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-Prominent or irreg endometrium -Endo may contain fluid, debris, or gas (dirty shadow is a diagnostic sign) -May see retain products of conception (hyperechoic & vascularity) -Abscess
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What are some causes of endometrial calcifications?
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-Endometrial trauma -Retained products of conception -From degenerated fibroids
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How can you tell the difference between a endometrial polyp or a submucosal fibroid?
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Polyp arises from the endometrium. Fibroid has an endometrial layer seen overlying the submucosal fibroid.
